How to Provide the Best Care for Young People with Gender Dysphoria

Abstract

In a recent report pediatrician Hilary Cass (UK) makes recommendations on high standard care for children and young adolescents experiencing gender dysphoria; care, that meets their needs, is safe, holistic and effective. This report fuels the polarized debate on the moment that throughout the Western world, there has been a very significant increase of children with gender dysphoria. This group is characterized by a predominance of natal girls with late onset gender dysphoria who have frequently additional mental health problems. These children are often treated in gender clinics according to the Dutch Protocol which implies administration of puberty blockers, administration of cross-sex hormones, followed by surgical procedures, including genital reassignment.

In this manuscript we describe concerns about the scientific basis of the Dutch Protocol. The argument that gender-affirming care improves the well-being of transgender and reduces suicide risks is not supported by sufficient empirical support. Two systematic reviews have shown that the evidence for the benefits of hormone interventions on the mental health of minors is very weak while the use of pubertal suppression seems to be a one way ticket towards transition: more  than 95% of those who started puberty suppression continue with gender-affirming treatment. Although the effectiveness of puberty blockers is not endorsed by evidence there are significant risks, such as infertility, lifelong drug dependence, reduced bone density, reduced sexual function. The authors of this manuscript plaid for a first-line intervention  that is supportive, non-judgmental and based on exploratory psychotherapy by an independent psychotherapist outside a gender clinic.