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  Find the full HSS Systematic Review here.

Introduction

In our second post, we dive deeper into the risks associated with medical treatments for pediatric gender dysphoria, as outlined in the Department of Health and Human Services’ 2025 review. While proponents of “gender-affirming care” argue these interventions are essential, the systematic review (Chapter 7, pages 106-124) highlights significant physiological and psychological risks that deserve careful consideration.

Key Findings on Risks

The review details how puberty blockers, cross-sex hormones, and surgeries impact young bodies. Puberty blockers, used to halt natural pubertal development, can lead to impaired bone mineral density, increasing the risk of fractures later in life (page 110). They may also affect neurocognitive development and sexual function, with potential long-term consequences that are not fully understood (pages 111-112). Cross-sex hormones, such as testosterone for girls or estrogen for boys, introduce risks like cardiovascular disease, metabolic disorders, and infertility (pages 118-119). Surgeries, though less common, carry risks of complications and regret, particularly when performed after early pubertal suppression (page 120).

The review emphasizes that these risks are not hypothetical—they are grounded in established physiological knowledge. For instance, blocking puberty disrupts normal developmental processes critical for bone, brain, and reproductive health (pages 108-112). Yet, the evidence for these interventions’ benefits remains weak, with systematic reviews unable to confirm improvements in mental health or quality of life (page 13).

Why This Matters

Children and adolescents are particularly vulnerable to these risks because their bodies are still developing. The irreversible nature of many of these effects—like sterility or surgical changes—raises ethical concerns about applying them to minors who may not fully grasp the long-term implications. The review’s findings align with international trends, such as restrictions in Finland and Sweden, where psychotherapy is now prioritized (pages 142-143).

Three Arguments Against Transitioning Children

1. Irreversible Physical Harms: Puberty blockers and hormones can cause permanent effects like infertility, reduced bone density, and sexual dysfunction, which are particularly concerning for developing children (page 14).

2. Uncertain Long-Term Outcomes: The review found no reliable evidence that medical interventions improve long-term mental health or quality of life, making the risk-benefit ratio unfavorable (page 13).

3. Ethical Concerns with Consent: Adolescents may lack the maturity to consent to treatments with lifelong consequences, especially given the uncertain benefits and significant risks (page 155).

References

• Department of Health and Human Services. (2025). Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, page 14.

• Ibid., page 13.

• Ibid., page 155.