Based on a review of more than 60 studies related to the mental health of adolescents, the American College of Pediatricians (ACPeds) has concluded that social transition, puberty blockers, and cross-sex hormones “have no demonstrable, long-term benefit on psychosocial well-being of adolescents with gender dysphoria.”

ACPeds President Dr. Michael Artigues said the organization’s review of the referenced research points to “what many who practice medicine intuitively understand, that young patients experiencing gender dysphoria deserve help in accepting and loving themselves as they are, not interventions that destroy their healthy bodies and put them on track of medicalization for life.” 

The principal authors of the research review, led by ACPeds Vice President Jane Anderson, expressed their grave concern “that parents, along with health care and educational professionals who support the transgender ‘transition’ of children and adolescents are, in fact, contributing to increased depression by appearing to validate to the children that ‘something is wrong with their body and biological sex.’”

The pediatricians concluded that “there is no long-term evidence that current ‘gender affirming’ medication and surgical protocols benefit their mental well-being. High rates of suicide attempts and/or completions in those who have received ‘gender affirming’ interventions indicate that at minimum, long-term controlled trials should be conducted if these interventions are to be continued.”

In lieu of social affirmation, medical intervention, or surgical mutilation of children and adolescents identifying as transgender or gender nonconforming, the pediatricians recommended “intensive psychotherapy for the individual and family to determine and hopefully treat the underlying etiology of their gender incongruence.” 

The pediatricians also said “more attention and support should be afforded to individuals seeking help in detransitioning after having made a decision during their formative adolescent years with lifelong consequences.”

“We urge medical professionals and parents to affirm the truth about childhood gender dysphoria in the presence of harmful thoughts and address the underlying mental illness, adverse events, and family dysfunction,” Anderson emphasized.

Burgeoning mental illness

Youth who identify as a gender other than their biological sex have high rates of mental health issues “regardless of any affirmation of their gender identities,” the group said.

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“This is particularly serious given the exponential increase in the number of adolescents identifying as ‘transgender’ in the past decade,” they continued. 

Citing U.S. Centers for Disease Control and Prevention (CDC) data, the doctors said that in 2015, 11% of adolescents identified as “bisexual, gay, or otherwise questioning,” while in 2021 that number rose to 25%.

Research contradicts value of ‘social affirmation’

The idea that social affirmation, such as using an individual’s desired pronoun, could aid the long-term “psychosocial well-being” of an adolescent identifying as transgender is contradicted by research, the organization said.

“One of the earliest studies matched 73 ‘transgender’ children between 3–12 years with 73 gender-matched community controls that included 49 siblings of the ‘transgender’ children,” the pediatricians reported.

In that study, parental reports indicated similar rates of depression in each group, but “slight increases” of anxiety in children who identified as transgender. The organization noted that “this study did not provide evidence that social ‘transitioning’ improved psychological well-being.” 

Cautions against puberty blockers and cross-sex hormones

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Hormone therapy intended to prevent children from going through puberty has failed to produce any “significant benefits” for gender incongruent youth, the doctors said.

One study of 20,619 transgender adults cited by the organization compared individuals who used puberty blockers as adolescents with those who had not. Both had extremely high suicide ideation and attempt rates all above 40%.

The group also pointed to studies from various countries indicating that cross-sex hormones “result in little mental health benefit” while adding that “these chemical interventions were associated with greater use of psychiatric services than patients who were not treated with hormones.”

The statement said that the NHS, the health care system in England, conducted “a systematic review” of cross-sex hormone treatment for gender dysphoria and its impact on mental health.

The NHS concluded that “[a]ny potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.”

Seeking positive outcomes

Citing several studies, the pediatric group found that many adolescents who have undergone either hormonal or surgical transitions “later embraced their biological sex as their gender.”

The University of Toronto conducted a study of 7.5-year-old boys referred for gender dysphoria who were followed for an average of 20 years. Most, 87.8%, had their gender dysphoria stop. The far minority, 12.2%, had it persist.

“Gender-dysphoric youth need to have mental illness, adverse childhood events, and family dysfunction dealt with and need the reassurance to embrace their biological sex as their gender identity and to avoid the harmful consequences of ‘transgender-affirming’ interventions,” the pediatricians concluded.