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A comprehensive analysis of available research has cast doubt on the effectiveness and safety of puberty blockers and hormone treatment for children and young people experiencing gender dysphoria, according to two systematic reviews published in the Archives of Disease in Childhood.
The reviews, commissioned by the University of York to inform an independent review into specialist services for gender dysphoria, found a lack of high-quality evidence supporting the use of these treatments. Out of the numerous studies examined, only a handful met the criteria for quality and rigor.
Lack of Quality Evidence
Of the 50 studies on puberty blockers, only one was deemed of high quality, with inconclusive findings regarding its impact on gender dysphoria, mental health, and cognitive development. Similarly, out of 53 studies on masculinising and feminising hormones, only one met the standards for quality, with inconsistent evidence on key outcomes such as body satisfaction, psychosocial and cognitive outcomes, and cardiometabolic effects.
Additionally, most of the 23 clinical guidelines analyzed were found to lack independence or evidence-based recommendations. The reliance on international guidelines lacking scientific rigor further complicates the issue, according to the authors.
Call for Holistic Assessment
Dr. Hilary Cass, author of the report, emphasized the need for a broad-based holistic assessment delivered by a multi-professional team, including paediatricians, child psychiatrists, and allied health experts. She stressed the importance of listening to the needs of children and young people seeking help and providing support to help them feel better about themselves.
Cass expressed concerns about the lack of evidence to suggest that puberty blockers improve psychological well-being or reduce suicide risk. She acknowledged that gender medicine is “built on shaky foundations” and called for a network of regional centers to deliver care collaboratively with embedded research and data collection.
Urgent Need for Improved Services
Dr. Camilla Kingdom, outgoing President of the Royal College of Paediatrics and Child Health, highlighted the vulnerability of children and young people with gender dysphoria and the urgent need for improved services to meet their health and well-being needs. She called for an overarching holistic approach to care and emphasized the importance of making up for lost time in providing adequate support to this population.
The findings of these reviews underscore the complexity of gender medicine and the need for evidence-based approaches to ensure the safety and well-being of children and young people experiencing gender dysphoria.
