HHS report links gender-affirming care support to 'left-wing authoritarianism'

Co-author’s ties to organizations opposing gender-affirming care omitted from report

The Department of Health and Human Services released a report titled “Where the Clinic Meets the Movement: Does Gender Ideology Arm Left-Wing Authoritarian Psychology?” arguing that support for gender-affirming medical care for transgender patients is connected to “Left-Wing Authoritarianism” and “a willingness to justify political violence.” The report was not peer reviewed, and its underlying data and funding have not been made publicly available.

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,” NPR reported.

NPR reports 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 the 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, and the phrase “gender ideology extremism” has appeared in White House directives. These arguments have proliferated, NPR reported, despite a substantial body of evidence showing transgender people are far more likely to be targets of violence than perpetrators.

The HHS report’s core conclusion, according to its own text, is that “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.” Co-author Colin Wright acknowledged that “‘May’ is doing important work in that sentence.”

Wright, an evolutionary biologist with the Manhattan Institute, told NPR that “the fact that our report has not yet undergone peer review at a journal does not make it pseudoscience” and said the paper will eventually be submitted to a scientific journal. In subsequent posts on X, Wright called gender-affirming care “an extremist political movement disguised as a medical guideline” and 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.’”

Political violence researchers who reviewed the paper identified significant design flaws and missing 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, surveyed approximately 1,200 adults through a paid online platform. 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.

Mason identified several problems with the study, including a survey sample that overrepresents Democrats relative to U.S. political demographics. The study also omits context her research has identified 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.

Wright acknowledged to NPR that broader 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.”

Mason also questioned the study’s use of a “Left-Wing Authoritarianism” scale, noting that researchers in her field have spent years discussing flaws in the older “Right-Wing Authoritarianism” scale and developing alternatives. “It’s going backwards,” Mason said. “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 disagreed that using a different scale would have improved the research, saying doing so would have made it “a different study.”

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.

The report uses the term “gender ideology” interchangeably with “gender-affirming care.” “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 “gender ideology” report is the third recent HHS effort to challenge gender-affirming standards of care. 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.” 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, NPR reported. 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 called “Wolves in White Coats” accusing doctors and hospitals of pressuring youth into gender-affirming surgeries while using fraudulent billing practices. The report 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.

The HHS report lists Wright’s affiliation with the Manhattan Institute, a right-wing policy think tank. Not listed in the report are Wright’s advisory role with the Society for Evidence Based Gender Medicine, as listed 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.”

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 2023, Wright responded to a social media post by Elon Musk — who had 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 — with “I would love to work with you on this,” writing that he was a lifelong liberal and dedicated to nonpartisan work on the issue. Musk has tied his own attitudes on transgender rights to his estrangement from one of his children, who is a transgender woman.

A detailed report by the Southern Poverty Law Center alleges that these 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, a co-author of the SPLC report. Major medical associations have repeatedly confirmed that gender-affirming care is the best model for treating transgender patients, NPR reported.

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.

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.”

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.

Adrian Shanker, a former 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 said. “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.”

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.”

Career HHS staff told 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, requesting 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.” The official added: “These are real people’s lives that they’re messing with.”

Andrew Ortiz, an attorney with the Transgender Law Center, said the pattern extends beyond research. “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 said. 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. “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 to recent public health challenges.

Wright said on X that the HHS report is “only the first” in a series he is working on with his 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.”