Current Concerns About Gender-Affirming Therapy in Adolescents

Abstract

Purpose of Review Results of long-term studies of adult transgender populations failed to demonstrate convincing improvements in mental health, and some studies suggest that there are treatment-associated harms. The purpose of this review is to clarify concerns about the rapid proliferation of hormonal and surgical care for the record numbers of youth declaring transgender identities and seeking gender reassignment procedures. Recent Findings Systematic reviews of evidence conducted by public health authorities in Finland, Sweden, and England concluded that the risk/benefit ratio of youth gender transition ranges from unknown to unfavorable. As a result, there has been a shift from “gender-affirmative care,” which prioritizes access to medical interventions, to a more conservative approach that addresses psychiatric comorbidities and psychotherapeutically explores the developmental etiology of the trans identity. Debate about the safety and efficacy of “gender-affirming care” in the USA is only recently emerging. Summary The question, “Do the benefits of youth gender transitions outweigh the risks of harm?” remains unanswered because of a paucity of follow-up data. The conclusions of the systematic reviews of evidence for adolescents are consistent with long-term adult studies, which failed to show credible improvements in mental health and suggested a pattern of treatment-associated harms. Three recent papers examined the studies that underpin the practice of youth gender transition and found the research to be deeply flawed. Evidence does not support the notion that “affirmative care” of today’s adolescents is net beneficial. Questions about how to best care for the rapidly growing numbers of gender-dysphoric youth generated an intensity of divisiveness within and outside of medicine rarely seen with other clinical uncertainties. Because the future well-being of young patients and their families is at stake, the field must stop relying on social justice arguments and return to the time-honored principles of evidence-based medicine.

Gender services for children and adolescents across the EU-15+ countries: an online survey

“…An over-representation of those with neurodevelopmental conditions, and high rates of co-occurring mental health difficulties have also been reported 8–10. Addressing the needs of this growing population is a concern for clinicians and policymakers 11 12…”

Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future

“…Additionally, they believe the quality of the evidence supporting puberty blockers has been misrepresented (Lepore et al, 2022 ; McNamara et al, 2022 , 2023 ), and maintain that respect for the child’s autonomy should generally override concerns about decision-making competence (Ashley, 2022 , 2023 ; Priest, 2019 ). On the other hand, there is growing recognition that the evidence supporting puberty blockers is very low quality and at high risk of bias, long-term harms and benefits are uncertain (Block, 2023a ; Cass, 2022 ; COHERE, 2020 ; Ludvigsson et al, 2023 ; NICE, 2020 ; Socialstyrelsen, 2022 ), and the goals of treatment are unclear (Levine & Abbruzzese, 2023 ). Moreover, potential consequences, which extend beyond physical and psychological outcomes to encompass family and intimate relationships, may be difficult for children to understand and appreciate (Levine, 2018 , 2019 ).…”