HHS published a federal report calling doctors predators. Seven of its ten authors aren't doctors. One of them wrote the vocabulary the government now uses.
On August 13, the Department of Health and Human Services released a 64-page document titled Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of "Gender Medicine."
Sit with that title for a second. This is not a blog post. This is not a Substack. This is the United States federal health agency, the one that is supposed to be staffed by people who know what a p-value is, publishing a document that calls American physicians wolves. Predators. Animals that eat children.
You would expect a document making that accusation to be written by doctors.
It mostly wasn't.
Of the ten listed authors, three are medical doctors, and only two of those work in fields with any bearing on the subject. The remaining seven come from Christian Right advocacy organizations, anti-feminist policy shops funded by conservative billionaires, and the opinion pages of National Review and The Daily Wire.
The first name on the list is Aaron Baer, president of the Center for Christian Virtue. His background, per his own LinkedIn, is a 2009 public relations degree from Ohio University. His first job out of school was marketing and PR at ZooLoo.com, a web dashboard startup that no longer exists.
I want to be fair here. Somebody has to do PR for the web dashboard startups. It is honest work. It is simply not the credential you would expect on a federal document accusing pediatric endocrinologists of medical fraud, and it is a strange qualification for deciding what happens to 130,000 transgender kids on Medicaid.
Baer's organization has been designated an anti-LGBTQ+ hate group by the Southern Poverty Law Center. It first appeared on that list in 2015 under its former name, Citizens for Community Values, and was designated again in 2023 following SPLC's report on anti-LGBTQ+ pseudoscience and the groups manufacturing it.
So the lead author of the federal government's report on gender medicine runs an organization that the federal government's report would have to describe, if it were being consistent, as a primary manufacturer of the pseudoscience it is built on.
The word laundry
Here is the part that should actually alarm you, and it has nothing to do with anybody's résumé.
Another author is Dr. Aaron Kheriaty, a psychiatrist who was fired from UC Irvine for refusing the COVID-19 vaccine and sued unsuccessfully to get his job back. He is a fellow at the Ethics and Public Policy Center, a Christian Right organization backed by conservative legal architect Leonard Leo.
EPPC is where the term "sex-rejecting procedures" was invented.
That phrase appears throughout the HHS report. It also appears in the Centers for Medicare and Medicaid Services final rule published in the Federal Register on the very same day, August 13, which strips federal Medicaid and CHIP dollars from puberty blockers, hormone therapy, and surgical care for minors starting October 13.
Track the sequence, because it is not subtle once you see it.
A privately funded advocacy organization coins a term designed to reframe medical care as psychological pathology. A fellow of that organization is appointed to co-author a federal report. The term appears throughout the federal report. The term appears in the Federal Register. The term is now, functionally, United States law.
That is not bias. Bias is when someone leans. This is a vocabulary supply chain, and it runs from a Leonard Leo-funded think tank straight into the Code of Federal Regulations with roughly the friction of a greased chute.
Kheriaty's other affiliations are worth listing purely for the aesthetic. He is a senior scholar at the Brownstone Institute, known for spreading COVID conspiracy theories and vaccine misinformation. He is a senior fellow at the Zephyr Institute. He served in March as a witness for the president's Religious Liberty Commission, and three months later the Justice Department settled a censorship lawsuit he had brought against Biden officials, a suit the Supreme Court had already indicated he lacked standing to file.
He has also edited a book on how to identify demonic possession.
I am not making a joke about that. I am reporting it, and then I am stepping back and letting it sit there, because there is nothing I could add to "co-author of the federal report on your child's endocrinology also edited a manual on spotting demons" that would improve it.
The data comes from a group that already decided
Every fraud accusation needs numbers. The report's insurance figures come substantially from Stop the Harm, an affiliate of the billionaire-funded group Do No Harm.
Stop the Harm publishes its methodology, which is more than most advocacy shops manage. On that methodology page, it states that gender-affirming care is "not based in well-established science."
Read that again slowly. The organization supplying the data declared the conclusion on the page explaining how it gathers the data.
This is not a bias problem. This is a design problem. If I hand you a dataset assembled by people who wrote down in advance what the dataset would show, you do not have evidence. You have a very expensive opinion with footnotes.
The rest of the report's substantiation runs through a similarly small and airless room: a lawsuit from Texas Attorney General Ken Paxton, who has spent years fending off corruption allegations and is currently running for Senate; cases filed by this administration's own DOJ; reporting from The Daily Wire and The Daily Caller; and the writings of a whistleblower aligned with the religious right.
Then Vice President JD Vance referred the report's findings to the Department of Justice.
So the report cites DOJ actions as evidence, and the report then generates new DOJ actions, which will presumably be cited as evidence in the next report. It is a perpetual motion machine, and like all perpetual motion machines it only works if nobody looks at where the energy is actually coming from.
The profit motive that costs thirty-one million dollars
The central thesis is that doctors are doing this for money. The word "profited" is in the subtitle. The report has an entire chapter titled "Captive Patients," which frames trans kids and their parents as livestock rather than people with opinions about their own bodies.
CMS did the math on its own rule. Ending federal Medicaid and CHIP funding for this care is projected to save approximately $175 million over ten years, extrapolated from about $31 million in pediatric spending in 2023.
Thirty-one million dollars. Across the entire United States. In a health system that spends over four trillion annually.
If this is the great medical profit conspiracy of our time, the conspirators need to fire whoever is running it. American healthcare offers a genuinely spectacular menu of ways to extract money from sick people, and "underserved population with disproportionate rates of homelessness and economic hardship" is not on the list. As one New York physician who treats trans patients put it to Important Context: if you wanted to scam the healthcare system, there are a lot of easier ways.
The report also leans on the reliable claim that this care is uniquely suspicious because it requires lifelong treatment. It does not mention that lifelong treatment describes high blood pressure, thyroid disorders, diabetes, heart disease, asthma, epilepsy, glaucoma, ADHD, Crohn's disease, HIV, hemophilia, organ transplant maintenance, and hormone replacement for cisgender women going through menopause.
Nobody has yet written a federal report about the wolves in white coats pushing levothyroxine on captive hypothyroid patients. Give it time. The template exists now.
The honest part
Here is what the other side has, and it is not nothing, and pretending otherwise would make me exactly what I am accusing them of being.
Billing codes are a real regulatory area. If a hospital coded a mastectomy as a breast reduction to secure reimbursement, that is a legitimate compliance question no matter what you think about the underlying care. Coding audits exist. They are boring, technical, and occasionally they catch real fraud. The report's specific claim that patients aged 13 to 17 received diagnostic codes for precocious puberty, a condition that by definition cannot apply at those ages, is the kind of allegation that deserves an actual answer rather than a wave of the hand.
Detransitioners are real people. The report includes firsthand accounts, including from a young woman who had a double mastectomy at 14 and describes being met with evasion when she sought help reversing course. Her experience is hers. It is not invalidated by the fact that it is being deployed instrumentally, and any clinician worth trusting has to be able to hold both things at once.
The international evidence picture genuinely has shifted. CMS cited the UK's Cass Review and systematic reviews from Sweden and Finland, and a February 2026 position statement from the American Society of Plastic Surgeons recommending against gender-related surgery in minors. Reasonable clinicians disagree about what those reviews establish. The disagreement is real, and it is not confined to the American right.
And the SPLC hate group designation is contested. Baer has called SPLC corrupt, pointing to instances where the organization apologized or rescinded listings, and to the 2019 firing of its founder over racism and sexism allegations in the workplace. That history is real. It is fair for readers to weigh it.
None of that rescues the document. You can believe every word of the Cass Review and still recognize that a report is not a review. A report written by the president of a designated hate group, two staffers from an anti-feminist advocacy shop, a psychiatrist who works for the think tank that invented the terminology, and a handful of movement columnists, resting on data from a group that pre-published its conclusions, is not an evidence synthesis. It is a press release with a federal seal on it.
If the evidence is as strong as they say, they did not need any of this. They could have commissioned a systematic review. They chose columnists instead.
That choice tells you what the document is for.
What it's actually for
This is the second HHS report attacking this care. The first landed in spring 2025 with the authors' names withheld entirely, and was revised that November to add them. That version ran over 400 pages and drew heavy criticism for its handling of data and its promotion of conversion therapy.
Anonymous authorship then. Movement authorship now, with the names on the cover and the demon-manual editor listed proudly among them. That is not an accident of process. That is an organization that has stopped worrying about being caught, because being caught was never a risk it was managing.
The purpose is not to inform anybody. The report is aimed at hospital administrators and general counsels, and the message is simple: continue providing this care and the word attached to you in a federal document will be "fraud," which is a word with prison attached. It does not need to be proven. It only needs to be said, on letterhead, by people with subpoena power.
It is already working. Systems have cut deals. Providers have quietly suspended services. That was the deliverable.
And the collateral damage is the thing the New York doctor named at the end of the interview, which is the line I keep coming back to: you politicize healthcare, you damage trust in the institution, and eventually nobody is going to trust anything anymore. Which is kind of their whole point.
They are not trying to win the argument about pediatric medicine. They are trying to make the category "medical consensus" mean nothing, so that whatever the Ethics and Public Policy Center decides to call things next becomes the only vocabulary left standing.
They have a term for that. They coined it. It is in the Federal Register now.
Sources
- HHS, Wolves in White Coats (full report PDF): https://opa.hhs.gov/sites/default/files/2026-08/wolves-in-white-coats-report.pdf
- Walker Bragman and Billie Jean Sweeney, "New HHS Report on Gender-Affirming Care Rife With False Information," Important Context / Assigned Media, Aug 19, 2026: https://www.importantcontext.news/p/new-hhs-report-on-gender-affirming
- CMS final rule ending federal Medicaid and CHIP funding, press release Aug 11, 2026: https://www.cms.gov/newsroom/press-releases/cms-ends-federal-medicaid-chip-funding-sex-rejecting-procedures-children-youth
- AJMC analysis of the CMS final rule, including fiscal projections: https://www.ajmc.com/view/cms-final-rule-ends-federal-medicaid-chip-funding-for-youth-gender-affirming-care
- The Buckeye Flame, "Ohio's Center for Christian Virtue reclassified as anti-LGBTQ+ hate group": https://thebuckeyeflame.com/2025/07/07/ohios-center-for-christian-virtue-reclassified-as-anti-lgbtq-hate-group/
- Aaron Kheriaty, "Wolves in White Coats" (author confirmation): https://aaronkheriaty.substack.com/p/wolves-in-white-coats
- HFMA, "HHS report raises scrutiny of gender-affirming care billing and coding": https://www.hfma.org/revenue-cycle/gender-affirming-care-billing-hhs-report/
- Stop the Harm methodology page: https://stoptheharmdatabase.com/method/
