Gender-affirming care for minors under fire

Paediatric gender dysphoria has rapidly emerged as one of the most divisive and urgent issues in medicine today. In the past decade, the number of children and adolescents identifying as transgender or nonbinary has soared.

In the US alone, diagnoses among youth aged 6 to 17 nearly tripled-from around 15,000 in 2017 to over 42,000 by 2021-signalling a seismic shift not only in culture but in clinical practice.

Children diagnosed with gender dysphoria-a condition defined by distress related to one's biological sex or associated gender roles-are increasingly being offered powerful medical interventions.

These include puberty blockers, cross-sex hormones, and, in some cases, irreversible surgeries such as mastectomy, vaginoplasty, or phalloplasty.

An umbrella review from the US Department of Health and Human Services (HHS) states that "thousands of American children and adolescents have received these interventions," despite a lack of solid scientific footing.

While advocates often claim the treatments are "medically necessary" and "lifesaving," the report concludes "the overall quality of evidence concerning the effects of any intervention on psychological outcomes, quality of life, regret, or long-term health, is very low."

It also cautions that evidence of harm is sparse-not necessarily because harms are rare, but due to limited long-term data, weak tracking, and publication bias.

This 409-page report delivers a scathing review of the assumptions, ethics, and clinical practices driving gender-affirming care in the US.

An inversion of medical ethics

At the heart of the HHS critique is a reversal of medical norms.

"In many areas of medicine, treatments are first established as safe and effective in adults before being extended to paediatric populations," the report explains. "In this case, however, the opposite occurred."

Despite inconclusive outcomes in adults, these interventions were rolled out for children-without rigorous data, and with little regard for long-term, often irreversible consequences.