Since announcing Robert F. Kennedy Jr. as his pick for Health and Human Services secretary last year, President Trump and Kennedy have touted their dedication to "Gold Standard Scientific Research" and making federal health agencies "beacons of Transparency."

But a recent report released by the agency has left some experts with substantial doubts about its researchers' methods, its claims about its findings and its authors' political intentions. The report, titled "Where the Clinic Meets the Movement: Does Gender Ideology Arm Left-Wing Authoritarian Psychology?" was not peer reviewed and its underlying data and funding have also not been made available. All are common best practices for research. (One author says its data will be released "soon.")

The report is the latest in a string of efforts by HHS to undermine established clinical standards of care for transgender patients. Many experts interviewed for this story said it frames transgender identity as illegitimate or even dangerous.

In recent years, right-wing figures and media outlets have advanced the narrative that transgender people and those who support them are violent or dangerous to society. The phrase "gender ideology extremism" has appeared in White House directives. These arguments have proliferated despite a substantial body of evidence showing transgender people are far more likely to be targets of violence, and an absence of evidence showing they commit violent crime at higher rates.

One of the authors of the latest HHS report is Colin Wright, an evolutionary biologist with the Manhattan Institute, a right-wing policy think tank that's been at the forefront of campaigns against diversity, equity and inclusion initiatives and "wokeness."

While it's not uncommon for HHS to work with outside experts on reports, said Adrian Shanker, a former deputy assistant secretary for health policy at the department in the Biden administration, in his experience, "The department had longstanding contracts with generalist science writing firms. They were not political in any way."

"That's vastly different from how this administration seems to already have the answers for the reports they're publishing before they start. And they're partnering with politically-aligned researchers and think tanks to develop reports that meet a political conclusion rather than a scientific one," said Shanker.

HHS did not respond to NPR's interview request for this story. In emails with NPR, report co-author Wright provided lengthy responses to NPR's questions, but insisted his answers could not be used unless they were reprinted in their totality. Wright subsequently posted NPR's questions and his answers on his X account. Other authors of the report did not accept NPR's interview requests.

Wright said the paper will eventually be submitted to a scientific journal, adding, "the fact that our report has not yet undergone peer review at a journal does not make it pseudoscience."

What's missing

The term "gender ideology" is a rhetorical device often used by the religious right to suggest that acceptance of any alternatives to a fixed idea of traditional gender norms, corresponding with someone's sex at birth, is part of a larger plot to corrupt society. The existence and acceptance of transgender people is often also seen as an indicator of a sinister agenda.

In the HHS report, the term is used interchangeably with "gender-affirming care," which is the accepted medical and mental health standard of care for treating transgender patients.

"Generally speaking, I do not believe the term 'gender ideology' is a political term, even though many on the left reject it. It accurately captures the reality that debates surrounding issues of transgenderism are not simply debates about facts, but belief systems," Wright told NPR in a statement later posted on social media.

The HHS report's core conclusion is that support for gender-affirming care is tied to what it describes as "Left-Wing Authoritarianism" and "a willingness to justify political violence." According to the report, "gender ideology may function as an ideological accelerant, telling left-wing authoritarian psychology who the enemy is, why the situation is urgent, and—in those already disposed toward force—that violence is legitimate."

"'May' is doing important work in that sentence," Wright said in response to NPR's questions.

In another post on X, Wright said "Gender 'medicine' is the only area of healthcare" that supplies people with targets for hostility, and called support for gender-affirming care "an extremist political movement disguised as a medical guideline."

The "ideological accelerant" conclusion isn't backed up in the actual data the study presents, wrote Alexander Tsai, a psychiatry professor at Harvard Medical School in response to the paper. Other academics who study political violence have also noted significant design flaws in the research and a lack of some key points of context.

"If I were to be a peer reviewer for this paper, I would recommend that it be rejected. I just don't believe that it's written in good faith and the measures are not well validated," said Liliana Mason, a political psychologist at Johns Hopkins University who has spent more than a decade researching what drives support for political violence.

The report's researchers, including graduate students at Rutgers University, said they used a paid online survey platform to ask around 1,200 adults about their support for gender-affirming medical care, government censorship and aspects of capitalism. Survey takers were then asked whether they believe violence is justified against figures like Charlie Kirk, the pro-Trump political organizer who was assassinated in 2025, President Donald Trump and Brian Thompson, the health insurance CEO who was killed by Luigi Mangione in 2024.

Mason found several problems with the study, including a survey sample that overrepresents Democrats compared to the political demographics in the United States. The study also omits key context her research has found which shows that approval for political violence shows up on both sides of the spectrum for people with the strongest partisan identities.

"What they're saying is 'these people on the left are dangerous people. They are politically violent.' [They're saying this] without putting into context how common these attitudes are across the political spectrum," said Mason.

Wright acknowledged to NPR that that context is "relevant background," but said "The purpose of our study was not to argue that violence is uniquely left-wing or that right-wing authoritarianism and right-wing violence are unimportant."

The HHS study's use of a "Left-Wing Authoritarianism" scale also puzzled Mason.

She said that there's been a long academic discussion focused on the flaws of a widely used "Right-Wing Authoritarianism" scale that emerged after World War II. Many researchers have since realized the scale mostly measures attitudes associated with being conservative. Mason said experts in her field do not deny the existence of authoritarian personalities on the left, but ended up developing other, less partisan scales including one based on people's values for raising children.

"It's going backwards," said Mason of the Left-Wing Authoritarianism scale. "This is just the same problem that we had with Right-Wing Authoritarianism as a measure…first of all, it's not really measuring authoritarian personality. And second of all, it's really just measuring how closely associated you are with the Democratic Party."

Wright told NPR he disagrees that using another scale would have improved the research. He said doing so would have made it a different study.

In a post on X, he said countless studies using the Right-Wing Authoritarianism scale "go back decades and have amassed thousands of citations. But we publish a study using a well-validated Left-Wing Authoritarianism scale, and link it to some problematic outcomes, and the left goes insane and call it 'nakedly political.'"

"Gold standard" science?

This "gender ideology" report is the third recent attempt by HHS to reject gender-affirming standards of care for transgender patients.

In August, the Trump administration announced it would end Medicaid and CHIP funding for gender-affirming care for youth based on an HHS review of treatment for pediatric gender dysphoria which claimed that the existing evidence supporting gender-affirming care models is "very low-quality" and urged a more narrow reliance on psychotherapy instead.

For years, doctors and pediatricians have worked to debunk the "low-quality" claim by pointing out that the vast majority of active clinical care recommendations are based on a range of nuanced considerations and would also be classified as based on "low-quality" evidence. Additionally, supportive talk therapy is already a prominent part of gender-affirming treatment models. One recent study found that less than 0.1% of American minors with private insurance receive puberty blocking medication or gender-affirming hormones.

The review by HHS, originally released in 2025 without peer review or named contributors, turned out to be mostly authored by well-known advocates against gender-affirming care and included no contributions from major medical groups.

Weeks before releasing the "gender ideology" report in August, HHS released another report called "Wolves in White Coats" accusing doctors and hospitals of pressuring youth into gender-affirming surgeries while using fraudulent billing practices. Presented alongside a 12-minute "short-form documentary" featuring the stories of young people who have detransitioned, the report cited flawed data from an anti-LGBTQ advocacy group which has also promoted anti-DEI and anti-white discrimination messaging. Citing the report, Vice President Vance has asked the Justice Department to investigate dozens of hospitals.

The reports on transgender health care have alarmed career staff at HHS, who tell NPR they were not aware of the research before it was released publicly. "We're supposed to be the department that people look to for actual facts — these are lies," a health official at HHS told NPR. The person requested anonymity because they are not authorized to speak on the subject. "This is not a real issue; they're depicting it as being bigger and more important than it actually is and skewing the facts."

"These are real people's lives that they're messing with," said the official.

In the early days of President Trump's second term, the Office of Assistant Secretary for Health altered the nameplate under the portrait of the former assistant secretary for health during the Biden administration, Admiral Rachel Levine, a transgender woman. Her name was changed from her current legal name to her birth name, a practice known as "deadnaming" in transgender communities.

At the time of the nameplate change, an HHS spokesperson told NPR: "Our priority is ensuring that the information presented internally and externally by HHS reflects gold standard science. We remain committed to reversing harmful policies enacted by Levine and ensuring that biological reality guides our approach to public health."

"This is an administration that started day one with three or four anti-trans executive orders and then really pushed those executive orders on to the agencies and told the agencies to figure out ways to implement them," said Andrew Ortiz, an attorney with the Transgender Law Center.

Ortiz said the messaging from HHS is layered atop a substantial increase over the last five years in the number of state bills aimed at blocking transgender people from access to gender-affirming health care and public services and spaces including bathrooms and sports. The volume of calls to his center's help desk have especially surged since Trump retook office in 2025, Ortiz said, with many looking for guidance on leaving the United States.

"It doesn't feel like a coincidence to me that HHS is clearly focused on weird, anti-trans stuff when we have more measles deaths in this country than we've had in decades, you can't eat lettuce or you have to be very careful about what you're putting in your body," Ortiz added, pointing out recent public health challenges.

"Hydra situation"

In 2023, HHS report author Colin Wright responded to a social media post by Elon Musk who said he would "be actively lobbying to criminalize making severe, irreversible changes to children below the age of consent," in reference to puberty-blocking medication. Musk has tied his own attitudes on transgender rights to his estrangement from one of his children, who is a transgender woman.

"I would love to work with you on this," Wright posted, going on to say he was a lifelong liberal and dedicated to nonpartisan work on the issue.

Before his work with the Manhattan Institute, Wright researched wasp and spider behavior. In 2020, he began advocating against DEI initiatives in academia, eventually suing Cornell University for what he described as anti-white discrimination. He describes himself as a speaker "known for his criticisms of gender ideology and defending the reality of biological sex."

In the HHS report, Wright's association with the right-wing Manhattan Institute is listed. Not listed are some other interrelated organizations Wright has affiliated with that oppose gender-affirming care, including the Society for Evidence Based Gender Medicine and Genspect's Killarney Group think tank.

Wright, who lists an advisor role for SEGM in his personal bio at the Manhattan Institute, and who wrote the opening chapter to a 2026 book commissioned by Genspect, told NPR in the statement he posted online that he believes "it would be misleading to present any of those as current institutional affiliations."

A detailed report by the Southern Poverty Law Center alleges the groups are central nodes in an ever-shifting network of dozens of organizations that use the veneer of science to legitimize anti-LGBTQ aims.

"The reason they have a multitude of groups and they've got this sort of hydra situation going on is because they need to look bigger than they actually are in order to be taken seriously," said Emerson Hodges, who co-authored the SPLC report. Major medical associations have repeatedly confirmed that gender-affirming care is the best model for treating transgender patients.

The Society for Evidence Based Gender Medicine has publicly refuted the SPLC's description, saying "To be clear, SEGM categorically rejects the SPLC's allegations that we are a 'hate group' peddling 'pseudoscience' and 'manufacturing doubt.' SEGM affirms the right of all individuals to live free from harassment and discrimination. We promote the principles of evidence-based medicine and the ethical principles of autonomy, beneficence, non-maleficence, and justice in healthcare." Genspect called the SPLC's hate group designation "a baseless accusation."

Other reports issued by HHS addressing transgender issues have also featured many authors with ties to the same network of groups, Hodges said, adding that he believes HHS appears to be the agency where these groups currently have the most influence.

"If [HHS] can make the argument that anyone who supports trans rights is more likely to be politically violent and politically aggressive, then it makes it easier to demonize their opponents and to try and criminalize trans people," Hodges said.

In a post on X, Wright said their report for HHS is "only the first" in a series he's working on in collaboration with this team of researchers. Lines from the report itself offer a possible preview of their future output: "Violence connected to gender ideology remains largely undocumented in the academic literature. This study provides a first systematic empirical look at the psychological infrastructure that makes such violence conceivable."

NPR's Selena Simmons-Duffin contributed reporting

Lisa Hagen

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