Managing Gender Dysphoria in Minors—What Insights Does Evidence-Based Medicine Offer in 2024?

Beryl Koener; Alexandre Ledrait; Céline Masson

doi:10.53941/dbgs.2025.100003

Abstract

Context: A dramatic increase in young people experiencing gender distress has been observed globally over the past 10–15 years, resulting in a surge in demand for specialized care. This increase is particularly notable among female adolescents. Significant misinformation surrounds the clinical management of minors with gender dysphoria/incongruence. While guidelines from organizations such as the World Professional Association for Transgender Health (WPATH) have historically guided treatment of the minors, based on the Dutch Protocol, these are increasingly challenged due to their reliance on weak scientific evidence. Recent systematic reviews, including those informing the UK’s Cass Review, have critically evaluated existing evidence, highlighting inconsistencies and insufficient data on the benefits and risks associated with established treatment protocols. This has prompted a readjustment of the framework use of the protocol in several countries, fueled by concerns over both clinical outcomes and ethical implications. The emergence of the debated notion of “rapid-onset gender dysphoria” (ROGD) further complicate the clinical landscape and necessitate a critical review of current approaches. Method: The article reviews available evidence-based data on the care of children and adolescents diagnosed with gender dysphoria/incongruence, primarily focusing on systematic reviews, including those used to inform the recent Cass Review. The analysis includes international literature and hypotheses regarding the increase in children and adolescents seeking for sex/gender reassignment. Results: Systematic reviews reveal a lack of sufficient data regarding the benefits and risks linked to the use of the Dutch Protocol. Many guidelines promoting gender-affirming care are based on weak evidence. Studies highlight a high co-occurrence of mental health issues in young people seeking care for gender dysphoria. The systematic reviews also reveal significant methodological inconsistencies across different studies, mainly focusing on the lack of long-term follow-up. Conclusions: The evidence suggests the arguments supporting the use of early interventions such as puberty blockers and cross-sex hormones are not sufficiently supported by scientific evidence. Concerns regarding the long-term effects and ethical implications of current treatments are raised. Moreover, the article advocates for a more holistic approach to care, prioritizing evidence-based principles and addressing the mental health needs of these young people. It also highlights the recommandations of the Cass Review and the European Society of Children and Adolescent Psychiatry (ESCAP), calling for further research with larger, more representative samples and long-term follow-up to fully evaluate treatment protocols.

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