ARTICLE

 The past 10 years have seen an exponential rise in the occurrence of gender confusion or gender dysphoria (also called transgender or gender non-conforming)* among young people worldwide, especially among teenage girls. The distress of these young people is real, and the causes of this unprecedented trend are unclear, raising difficult questions about compassionate, ethical, and effective ways to respond. Experts disagree, with some recommending watchful waiting plus counseling and some asserting that cross-sex medical procedures are necessary in order to prevent suicide. The U.S. federal policy of the current administration, which endorses “early gender affirming care” for “children and adolescents” (HHS, 2022), is considered controversial by many. And the dramatic rise in use of cross-sex hormones and surgery for young people has been the focus of heated debate, causing uncertainty in patients, parents, physicians, and policy-makers as to what is best. Below is a summary of the latest research on five key questions about these issues, shared in the hope of helping gender-confused young people receive the best care. 

1. What does research show about the benefits and harms of cross-sex medical treatment for minors? 

Scientific evidence has not shown that cross-sex medical treatments are beneficial to children or adolescents. In fact, there is evidence of harmful impact. Consequently, a growing number of authoritative scientific agencies do not recommend such treatments. Instead, they recommend counseling and watchful waiting for gender-confused youth. 

Summary of Evidence 

Many scientific agencies—both U.S. and international—do not recommend medical “transition” for youth because the research claiming to show positive effects from cross-sex hormones or surgery is methodologically flawed and not scientifically reliable. The limitations of these studies include lack of control groups, small sample sizes, recruitment bias, nongeneralizable study populations, short follow-up times, and high numbers lost to follow-up. However, studies finding negative outcomes from medical transition tend to be of adequate scientific quality. In other words, reliable studies have shown harmful effects. “Watchful waiting,” is the option recommended by many scientific agencies. It means deferring transgender interventions for gender-confused children or youth for an extended time during which counseling can occur and a natural desistance or persistence process can play out.