Summary

  • The Department of Health and Human Services published an unreviewed September report arguing that support for gender-affirming medical care signals “Left-Wing Authoritarianism” and tolerance for political violence, drawing three convergent lines of critique — methodological, disclosure-related, and procedural — from academic researchers, a former departmental official, and current career staff interviewed by NPR.
  • Political violence researchers Liliana Mason of Johns Hopkins University and Alexander Tsai of Harvard Medical School identified survey-sample composition, omitted cross-partisan context, and an unvalidated measurement scale as flaws that, in Mason’s assessment, render the document’s central conclusion unsupported.
  • The report lists co-author Colin Wright’s affiliation with the Manhattan Institute but omits his advisory role with the Society for Evidence Based Gender Medicine and a book chapter he authored for Genspect — organizations a Southern Poverty Law Center report characterizes as nodes in “an ever-shifting network of dozens of organizations” that use “the veneer of science to legitimize anti-LGBTQ aims.”
  • Former Biden-era HHS deputy assistant secretary Adrian Shanker described a different historical practice for outside research at the department, and an anonymous current HHS official told NPR career staff were not briefed before the release.

A Department of Health and Human Services report released in late September and titled “Where the Clinic Meets the Movement: Does Gender Ideology Arm Left-Wing Authoritarian Psychology?” argues that support for gender-affirming medical care for transgender patients functions 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.” Co-author Colin Wright acknowledged to NPR that “‘May’ is doing important work in that sentence.” The document was not peer reviewed, and its underlying data and funding have not been made publicly available, NPR reported. Three independent critiques — methodological, disclosure-related, and procedural — converge on the report, and the agency’s own stated standard of “Gold Standard Scientific Research” frames the gap between what HHS has pledged and what the document delivers.

Methodological objections

Political violence researchers who reviewed the document identified what they described as significant design flaws. Liliana Mason, a political psychologist at Johns Hopkins University who has spent more than a decade researching what drives support for political violence, told NPR: “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.”

Mason identified three concerns. The survey sample of approximately 1,200 adults, recruited through a paid online platform, “overrepresents Democrats relative to U.S. political demographics.” The study omits context from her own research showing that approval for political violence appears on both sides of the political spectrum among 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,” Mason said. Mason also questioned the validity of the Left-Wing Authoritarianism scale the study used: “It’s going backwards. 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.”

Alexander Tsai, a psychiatry professor at Harvard Medical School, wrote that the report’s “ideological accelerant” conclusion is “not supported by the data the study presents.” Other academics who study political violence also identified design flaws, NPR reported. Respondents were asked about their support for gender-affirming medical care, government censorship and aspects of capitalism, and then whether they believed violence is justified against figures including President Donald Trump, the pro-Trump political organizer Charlie Kirk, who was assassinated in 2025, and Brian Thompson, the health insurance CEO who was killed by Luigi Mangione in 2024.

Wright’s responses, as reported by NPR and in his subsequent posts on X, defended the work on each front: “The fact that our report has not yet undergone peer review at a journal does not make it pseudoscience,” and the paper will eventually be submitted to a scientific journal. On cross-partisan context, Wright said the broader picture is “relevant background” but added: “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.” On using a different scale, Wright said doing so would have made the work “a different study.” On the political reaction to the document, Wright wrote: “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.’”

The disclosure record

The report lists Wright’s affiliation with the Manhattan Institute, a right-leaning think tank. Not listed are his advisory role with the Society for Evidence Based Gender Medicine, as documented in his Manhattan Institute biography, and his work writing the opening chapter to a 2026 book commissioned by Genspect, which operates a think tank called the Killarney Group. Wright told NPR in a statement he posted online that he believes “it would be misleading to present any of those as current institutional affiliations.”

A Southern Poverty Law Center report alleges that SEGM, Genspect, and adjacent organizations are central nodes in “an ever-shifting network of dozens of organizations” that use “the veneer of science to legitimize anti-LGBTQ aims.” Emerson Hodges, a co-author of the SPLC report, said: “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.” Major medical associations have repeatedly confirmed that gender-affirming care is the best model for treating transgender patients, NPR reported.

The Society for Evidence Based Gender Medicine publicly rejected the SPLC’s allegations, stating that SEGM “categorically rejects the SPLC’s allegations that we are a ‘hate group’ peddling ‘pseudoscience’ and ‘manufacturing doubt,’” and affirming its commitment to “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.”

Departmental procedure

Adrian Shanker, who served as deputy assistant secretary for health policy at HHS under President Biden, described a different historical practice for outside expert work at the department: “The department had longstanding contracts with generalist science writing firms. They were not political in any way.” Shanker added: “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.”

Career HHS staff told NPR they were not aware of the research before it was released publicly. A health official at HHS, requesting anonymity because they were not authorized to speak, told NPR: “We’re supposed to be the department that people look to for actual facts — these are lies.” “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.”

HHS did not respond to NPR’s interview request for the story. In emails with NPR, Wright provided lengthy responses but insisted his answers could not be used unless reprinted in their entirety; 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.

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.”

The standard cited vs. the standard applied

The publication of the report arrived against a backdrop the department itself had set. President Trump and HHS Secretary Robert F. Kennedy Jr. have publicly committed the agency to “Gold Standard Scientific Research” and to making federal health agencies “beacons of Transparency,” NPR reported. The September document’s documented features — unreviewed status, underlying data and funding not made publicly available, omitted institutional affiliations of the lead author, and substantive objections from researchers in the relevant field — fall outside the standard the administration has named as its goal. The gap between the standard HHS cites and the features of the document it released is the accountability question the report itself does not address.

The pattern across HHS documents

The September report is the third recent HHS effort to challenge gender-affirming standards of care, NPR reported. In August, the Trump administration announced it would end Medicaid and CHIP funding for gender-affirming care for youth, citing an HHS review that described existing evidence for gender-affirming care as “very low-quality.” NPR reported that review, “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 contributors from major medical groups.” 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, and that 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.

Weeks earlier, HHS released a report titled “Wolves in White Coats” that “cited data from an anti-LGBTQ advocacy group and was presented alongside a 12-minute ‘short-form documentary’ featuring young people who have detransitioned.” Citing that report, Vice President Vance asked the Justice Department to investigate dozens of hospitals.

Andrew Ortiz, an attorney with the Transgender Law Center, tied the sequence to the administration’s broader posture: “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.” Ortiz also argued that the agency’s focus on what he called “weird, anti-trans stuff” coincides with concurrent public-health concerns, citing “more measles deaths in this country than we’ve had in decades” and food-safety advisories as evidence of misallocated departmental attention. Ortiz noted that the volume of calls to his center’s help line has surged since Trump retook office in 2025, with many looking for guidance on leaving the United States.

Frame-audit: paradigms in dispute

Three documented positions converge in the document and the dispute surrounding it. The HHS-Wright position treats support for gender-affirming care as a measurable correlate of an authoritarian psychology the report calls “Left-Wing Authoritarianism,” with “gender ideology” used, in Wright’s statement to NPR, to describe debates that “are not simply debates about facts, but belief systems.” Wright, an evolutionary biologist with the Manhattan Institute, was previously known for research on 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.”

The academic political violence research position, as represented by Mason and Tsai, treats methodological standards — peer review, validated measures, representative samples, cross-partisan context — as constitutive of claims about political violence. Within that position, Mason’s conclusion that the report would be “rejected” if peer reviewed is a description of a process failure. Major medical associations, which NPR reported have “repeatedly confirmed that gender-affirming care is the best model for treating transgender patients,” represent an evidence-based clinical paradigm centered on standards of care.

The civil rights advocacy position, as represented by Ortiz and the SPLC report, treats administrative documents as part of a pattern affecting a protected population, with attention to disclosure and process as constitutive of legitimacy. Within that position, Hodges’s statement — “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” — connects the report’s framing to its potential downstream uses. The SPLC report alleges these groups are central nodes in the “ever-shifting network” characterized above.

Consequences and sequel

Wright said on X that the HHS report is “only the first” in a series he is working on with his team of researchers. The report itself previews the series’ direction: “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.”

Whether the methodological, disclosure, and procedural critiques raised by Mason, Tsai, Shanker, and others affect subsequent outputs — and whether departmental review and affiliation-disclosure practices change in response — remains to be seen.

Analytical techniques used in this piece

This analysis applies the methods below. Each links to a short, plain-English explainer you can read and reuse.

Dialectical Analysis
Holds thesis against antithesis and works toward a higher synthesis.
Wicked Problems
Treats a problem as wicked — no stopping rule, no clean test of success, every attempt consequential.
Worldview Cartography
Maps the clashing worldviews underlying a dispute.