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A recent review by the Department of Health and Human Services explores the evidence and best practices for treating pediatric gender dysphoria, a condition where children and teens experience distress related to their sex or its social expectations. As more young people identify as transgender or nonbinary, the U.S. has widely adopted the “gender-affirming” care model, which includes social affirmation, puberty blockers, hormones, and surgeries. However, this approach is under scrutiny internationally due to its experimental nature and potential risks, prompting this review to clarify the evidence for policymakers, clinicians, and families.

Background: Rising Diagnoses, Diverging Approaches

The review highlights a sharp increase in gender dysphoria diagnoses among youth, with the U.S. favoring a “gender-affirming” model that prioritizes medical interventions. This approach, originally developed for adults with poor outcomes, was extended to minors before robust outcome data emerged. Internationally, there’s no consensus—some countries, like the UK, have restricted puberty blockers and hormones for minors, citing insufficient evidence of safety and efficacy, and now emphasize psychosocial support instead.

Evidence Review: Weak Benefits, Known Risks

An “umbrella review” of systematic reviews found that evidence supporting the benefits of medical treatments—like improved psychological outcomes or quality of life—is of very low quality, suggesting reported benefits may not hold up. Evidence on harms is limited, partly due to short follow-ups and poor tracking, but established risks include infertility, sexual dysfunction, bone density issues, cognitive effects, cardiovascular and metabolic disorders, psychiatric conditions, surgical complications, and regret. This gap between uncertain benefits and clearer risks calls for caution.

Clinical Realities: Guidelines and Practice Under Fire

Influential U.S. guidelines from WPATH and the Endocrine Society lack rigor, with WPATH accused of suppressing systematic reviews and loosening standards under political pressure. Many U.S. gender clinics bypass even these permissive guidelines, often limiting mental health assessments to brief sessions. Whistleblowers and detransitioners report serious risks and harms, but their concerns are frequently ignored, revealing a disconnect between practice and evidence-based care.

Ethics and Alternatives: Caution and Psychotherapy

Ethically, while patients can refuse treatments, they aren’t entitled to unproven ones, and clinicians should avoid interventions with disproportionate risks. The review finds no evidence that medical transition reduces suicide rates, which are low and tied more to comorbidities than gender dysphoria itself. Psychotherapy emerges as a noninvasive option, with systematic reviews showing no adverse effects, yet it’s understudied due to misconceptions. The review urges more research and a careful approach to pediatric care.