“…They point to the potential distress associated with the development of secondary sex characteristics that are incongruent with gender identity and the high rates of self-harm and suicidal ideation reported among children with gender dysphoria (de Snoo-Trimp et al, 2022 ; de Vries et al, 2021 ; Giordano, 2008 ; Kreukels & Cohen-Kettenis, 2011 ; Rafferty et al, 2018 ). 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 ).…”