Two participants hold signs in support of the Trans Day of Visibility rally on the National Mall.
Activists rally for the rights of transgender people at the National Mall in Washington DC last month.Credit: Kayla Bartkowski/Getty
As the US National Institutes of Health (NIH) continues to defund nearly every research project on transgender health, the White House has directed the agency to focus on studying “regret” after a person transitions to align their body with their gender identity. Several NIH employees, who were granted anonymity because they are not authorized to speak to the press, confirmed the directive to Nature.
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Two weeks ago, Matthew Memoli, who was acting NIH director at the time, sent an e-mail to the directors of several NIH institutes. It said that the Department of Health and Human Services (HHS), which is the NIH’s parent agency, “has been directed to fund research on a few specific areas” related to what it calls “chemical and surgical mutilation” of children and adults — a reference to gender-affirming care and surgery. “This is very important to the President and the Secretary” of the HHS, Robert F. Kennedy Jr, the e-mail added.
Based on its priorities, the White House sometimes directs the NIH — the world’s largest public funder of biomedical science — to study certain broad topics, such as cancer or women’s health, but the latest directive’s specificity, inflammatory language and focus on a hyper-polarizing topic are unprecedented, the NIH employees say. Although the White House can sometimes “push us on various different things, we normally get to chart out the approach”, a staff member says.
Many scientists, reeling from the abrupt cancellation of more than US$180 million in NIH funding for research on transgender health, slammed the proposed studies as ideologically driven.
“It’s really pigeonholing trans people into this medical lens where the only thing important to know about them is that they seek medical transition” and regret it, says Harry Barbee, who studies the health of people from gender and sexual minorities (LGBT+) at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and identifies as non-binary and queer. “When ideology is prioritized over scientific merit, that threatens the entire scientific enterprise.”
The NIH and the White House did not respond to Nature’s queries about the new research priorities or scientists’ concerns with their apparent ideological bent. The HHS said that the “NIH is prioritizing research that serves the best interests of public health, not ideological agendas, and will continue to support studies that provide clear, objective data — particularly regarding the long-term effects of gender transitions.”
Shifting focus
Estimates suggest that 1.6 million people in the United States identify as transgender, and about one-quarter of them obtain gender-affirming surgeries. Research suggests1 that access to these procedures can reduce anxiety, depression and suicidal ideation in transgender people.
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US President Donald Trump signed an executive order on his first day in office on 20 January that directed the US government to stop acknowledging that gender can differ from sex at birth. The cancellation of many trans-health research grants quickly followed, and now the agency seems to be shifting the type of research it funds. The e-mail from Memoli, obtained by Nature, specifies two areas of research that the Trump administration wishes to fund about “social transition”, which is when a person changes how they express their gender to others — for example, by changing their name or appearance.
These include “regret and detransition following social transition as well as chemical and surgical mutilation of children and adults” and “outcomes from children who have undergone social transition and/or chemical and surgical mutilation”, the e-mail says.
More research on the experience of trans people — including understanding reasons for dissatisfaction after transition — is direly needed, Barbee says. But they worry that the sole focus on negative consequences is misplaced: fewer than 1% of transgender people who undergo gender-affirming surgery regret it, according to an analysis published by Barbee and their colleagues2. By comparison, 14.4% of the broader population reports regret after any kind of surgery3.
So far, about 187 NIH grants funding trans-health research have been terminated, according to an online effort to track the Trump team’s researchcuts by Brittany Charlton, an epidemiologist at the Harvard T. H. Chan School of Public Health in Boston, Massachusetts, who studies LGBT+ health, and her colleagues. In 2023, the NIH funded about 180 projects in this field, according to another NIH employee.
If these proposed studies move forwards, it will create a “a distorted research ecosystem where only politically favourable findings are permitted to exist” and an “evidence vacuum for clinicians who are trying to do right by their patients”, Barbee says.
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