Pediatric Gender Affirming Care is Not Evidence-based
- La Petite Sirène
- Jun 10
- 19 min read
Pediatric Gender Affirming Care is Not Evidence-based
10 mai 2025 - Current Sexual Health Reports - Volume 17 - Article n°12
Abstract
Purpose of Review
This paper reviews outcomes for risks and benefits of puberty blockers and gender-affirming hormones for pediatric gender dysphoria or gender-related distress.
Recent Findings
Studies conducted over the past 15–20 years have generally reported the effects of these interventions on bone health, metabolic outcomes, and mental health outcomes.
Summary
With respect to mental health outcomes, individual clinical research studies have inconsistently demonstrated benefit. Systematic evidence reviews, which provide high-level, reliable evidence according to evidence-based medicine (EBM) principles, have found the evidence in this field is comprised of studies with significant quality issues; the body of evidence is considered weak/uncertain. Clinical guidelines should be updated to reflect the reality of the limited evidence.
Introduction
Several influential clinical guidelines/policies [1,2,3] recommend puberty blockers (PBs) and gender-affirming hormones (GAH) be used as standard treatment practice for pediatric patients with gender dysphoria (GD) or gender-related distress. This approach, considered an essential aspect of pediatric “gender-affirming care,” involves initiation of PBs as early as Tanner Stage II to halt the development of the natal sex characteristics, followed by initiation of GAH (estrogen/anti-androgen, for natal male patients, or testosterone, for natal females) to induce secondary sex characteristics consistent with the patient’s gender identity. This treatment approach was conceptualized by Dutch researchers in the 1990’s and rapidly incorporated internationally and formalized into guidelines in the early 2000’s [4]. However, the approach has also been the subject of longstanding controversy [5,6,7]. Controversy has increased over time in light of the exponential rise in gender clinic referrals and demographic changes in the patient population, from majority prepubertal natal males to majority adolescent natal females with high rates of autism and mental health comorbidities [8,9,10,11].
Critics of PB/GAH use for pediatric GD have pointed out adolescents’ limited capacity to provide informed consent to irreversible interventions [12, 13], especially in context of significant risks of treatment, which include compromised bone density, fertility, and sexual function [14, 15]. Proponents, on the other hand, contend that hormonal interventions are beneficial–even medically necessary. This view is espoused by many North American professional medical organizations [16,17,18,19,20,21,22], who generally reference three influential guidelines/policies: the World Professional Association for Transgender Healthcare (WPATH) guideline describes PBs/GAH as “medically necessary gender-affirming medical treatment” [1:S47]; the Endocrine Society (ES) guideline states that “Gender-affirming treatment…may include…hormone therapy” [2:3876] and makes strong recommendations for PB/GAH initiation in eligible patients [2:3881,3883], and the American Academy of Pediatrics (AAP) policy statement defines PBs/GAH as major components of the gender-affirmative care model [3:6].
A key question at the center of the controversy regarding pediatric gender-affirming care is whether it is safe and effective. Therefore, analysis of the evidence base for PB/GAH use requires understanding of the potential risks and benefits. Thus, the relevant questions are: what are the goals of PB/GAH in the context of pediatric gender-affirming care? To this end, is treatment effective? What are the risks? Are these treatments safe?
Risks Associated with Pediatric Gender-Affirming Care
There are multiple potential risks associated with pediatric PB/GAH use, including:
1.
Decreased bone mineralization. PBs suppress sex hormones, which are required for increased bone mineralization during puberty [23].
2.
Negative impact on neuropsychological functioning. During normal puberty, there is intense formation of neuronal connection as well as neuronal pruning in response to sex hormones [24].
3.
Metabolic and cardiovascular risks. In adults, feminizing GAH (estrogen) is associated with increased fat mass, increased insulin resistance, and increased risk of cardiovascular disease; masculinizing GAH (testosterone) is associated with polycythemia, atherogenic changes to lipid profile, and increased blood pressure [25, 26].
4.
Infertility. For natal males initiated on PBs at Tanner Stage II who proceed to estrogen, infertility is an expected sequelae (gamete maturation does not occur and cryopreservation of sperm is therefore not possible) [23]. For natal males of any age, estrogen can cause testicular atrophy and decreased spermatogenesis, which may be irreversible even if estrogen were to be stopped. PB/GAHs may also affect fertility in natal females [27].
5.
Impaired sexual function. Former WPATH president, Dr. Marci Bowers, has reported that she is not aware of any natal male patients who received PBs at Tanner Stage II who are able to achieve orgasm either before or after gender-affirming vaginoplasty: “it’s really about zero” [28]. There is concern that hormonal interventions result in physiologic anorgasmia for these patients [15, 29].
6.
Surgical complications. The use of PBs in natal males arrests penile/scrotal growth, which can make the most common gender-affirming vaginoplasty procedure, penile inversion, impossible due to dearth of available tissue. Other riskier surgical methods, such as use of intestinal tissue, may be required [30].
7.
Detransition and/or regret. There is a risk that patients treated in adolescence will come to regret the irreversible physical changes (e.g., physical characteristics like voice change or hair growth) or the irreversible physiologic effects (e.g., infertility) caused by hormonal interventions, or that they will detransition (revert back to identification with natal sex, an experience that may or may not involve regret) [31, 32].
Most clinical research studies investigating risks of treatment (Table 1) have focused on bone health and metabolic/cardiovascular risks, and a few have investigated sexual function, fertility preservation, and detransition and/or regret. To our knowledge, a single study has investigated interventions’ impact on feasibility of surgical procedures.
Clinical Rationales for Pediatric Gender-Affirming Care & the Intended Benefits
In addition to awareness of the potential risks associated with pediatric PB/GAH, clinicians need to understand the metrics whereby the potential benefits of pediatric gender-affirming care should be measured.
Decades of on-label use of PBs for central precocious puberty (CPP) has established that these medications are effective at halting pubertal progression, and that normal puberty resumes when the PB is removed [78]. For a small number of children puberty starts abnormally early–even in infancy or toddlerhood [79, 80]. For some patients with CPP who are at risk of negative outcomes like short stature (due to premature epiphyseal closure) and elevated body mass index, the balance of benefits outweighs the harms of not providing treatment [81,82,83]. It is well-known from decades of GAH use for physical feminization or masculinization in adult transgender patients that use of these medications (as well as androgen blockers in natal males) causes reduction of endogenous sex hormone levels/increase in the exogenous sex hormone levels, leading to subsequent feminizing or masculinizing physical effects [26].
That PBs/GAH suppress or increase certain hormone levels, and that GAH causes physical feminization or masculinization, is not controversial. However, pediatric gender medicine guidelines/policies do not justify provision of these interventions because they are pharmacologically effective at producing secondary sex characteristics. Instead, their justification is based on improving patients’ lives and mitigating distress [84]. Thus, analysis of effectiveness must focus on whether or not these treatments mitigate distress and improve the lives of patients.
Historically, there are several specific clinical indications that have been used to justify pubertal blockade at Tanner Stage II followed by GAH:
1)
Favorable impact on mental health outcomes, including gender dysphoria and suicidality. Most clinicians are likely familiar with the conceptualization of pediatric gender-affirming care as a treatment intended to relieve gender-related distress or dysphoria. Additionally, these interventions are also commonly described as being “lifesaving” [85,86,87,88] implying that they prevent suicide.
2)
To make it easier for patients to “pass successfully” [23] as transgender adults, thereby preventing distress stemming from identity-incongruent appearance. An early Dutch paper explained that “the physical treatment outcome following interventions in adulthood is far less satisfactory than when treatment is started at an age at which secondary sex characteristics have not yet been [fully] developed.” Researchers hoped to “avoid…the impact of an unfavorable physical appearance.” The paper clarified that this rationale generally applied to natal males seeking feminization as opposed to natal females seeking to masculinize: testosterone-induced physical developments like “beard growth and voice breaking [in natal male puberty] give so many [natal males] a never disappearing masculine appearance” [23].
3)
To reduce the need for future invasive surgical procedures. Per the AAP policy statement, “[PB use] reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam’s apple, male pattern baldness, voice change, breast growth, etc.) are prevented” [3].
4)
To use PB to “[buy] time,” thereby using this intervention as a “diagnostic tool.” Researchers have theorized that halting puberty “would allow patients to engage in exploration without pressures of potentially unwanted pubertal development” [23]. Those who chose to proceed to GAH could then do so, and the others would progress with their puberty.
The majority of studies investigating treatment effectiveness (Table 2) have generally focused on the first clinical indication (favorable impact on mental health). Some studies have reported on the progression to GAH after PB initiation, which speaks to the fourth clinical indication (PBs providing “time to think”). One paper published data regarding reduction in need for surgical procedures. No studies have (to our knowledge) investigated the effect of pediatric PB/GAH use on achieving a “passing” cross-sex appearance, thereby preventing distress in adulthood.
Overview of Evidence-Based Medicine (EBM) & the Hierarchy of Evidence
Evidence based medicine (EBM) is a rigorous, explicit, systematic approach to clinical practice. It emphasizes the use of the best available evidence to make clinical decisions, and “de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making” [115]. A formal framework for analyzing an evidence base allows clinicians to understand reliability (or certainty) of the evidence in a particular area. The “evidence pyramid” (Fig. 1), familiar to many clinicians, depicts the evidence hierarchy. Expert opinion (bottom of pyramid) constitutes the least reliable evidence. Individual research studies provide greater reliability than expert opinion. Their reliability depends upon study design and research methodology (randomized controlled studies, by virtue of random assignment, provide more reliable evidence than uncontrolled studies).
Systematic evidence reviews and meta-analyses are at the top of the pyramid (most reliable evidence). Systematic reviews utilize a transparent process, in which the “PICO”(defining the patient population, intervention, comparator/alternative to the intervention, and the outcomes of interest) is usually pre-registered. Inclusion/exclusion criteria are then used to identify all relevant studies. This approach aims to assess the entire body of research rather than isolated studies. Included studies are assessed for risk of bias using validated tools, data from studies are pooled for meta-analyses (when possible); and relevant information is summarized/synthesized. Finally, bodies of evidence for various outcomes are rated for certainty. According to the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework, for example, evidence gleaned from randomized controlled trials begin with the assumption that it is high quality, but may be rated down based on studies’ methodological limitations resulting in risk of bias, indirectness of the evidence regarding the outcomes of study, imprecision of estimates, inconsistency of results, and publication bias. Evidence from observational studies is typically rated low quality, but may be rated up based on large effect sizes, evidence of a dose–response relationship or the use of methodologies that control confounding [117]. According to GRADE, very low certainty evidence means that the true effect is likely to be different than the estimate of the effect, low certainty evidence means the true effect may be different than the estimate of the effect, moderate certainty evidence means the true effect is likely to be similar to the estimate of the effect (but could be substantially different), and high certainty evidence means that the true effect is very likely to be similar to the estimate of the effect [118].
“Umbrella reviews” utilize similar processes, but instead of individual studies, they review systematic reviews. Systematic reviews and umbrella reviews use standardized methodologies like GRADE or other frameworks (described in the Cochrane handbook) [119] and standardized reporting practices (described in the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement) [120] to ensure that reviews are “reproducible, transparent, and include[s] all relevant details” [121].
Safety/Effectiveness of PBs/GAH: Individual Research Studies (Bottom of Pyramid)
Using the evidence pyramid (Fig. 1), we summarize the evidence base for the use of PBs/GAH. We will begin at the bottom of the pyramid, with individual studies, and move upwards to the apex (systematic reviews and meta-analyses).
There are multiple clinical research studies that have investigated safety (Table 1) and effectiveness (Table 2) of PB/GAH in pediatric gender-affirming care. Studies listed in these Tables were identified from inclusion in systematic reviews (listed in Table 3) and from scans of reference lists for recent reviews/commentaries [122,123,124,125]. Publications from the ongoing multi-site “Trans Youth Care” study were included as well [40, 56, 57, 59, 108, 114]. The reference list of a recent paper on fertility preservation [69] identified other articles on this topic [35, 39, 44, 46]. Additionally, we included the small number of studies that have (to our knowledge) investigated sexual function and differential surgical outcomes in pediatric gender medicine [30, 49, 74]. We also included other recent clinical research studies on risks of PB/GAH that have (to our knowledge) been published within the past 1-2 years [67, 68, 71, 72]. Tables 1 & 2 summarize the relevant statistically significant findings from each study.
With respect to safety of PB/GAH in this population, 11 longitudinal studies found a decrease in bone mineralization with PB use [23, 34, 37, 42, 43, 48, 54, 55, 65, 68, 71]; two longer-term studies found bone mineralization returned to pre-treatment baseline after 3–11 years of subsequent GAH treatment in natal females but not in natal males [48, 65]. Multiple longitudinal studies investigating metabolic outcomes after PB and/or GAH use have reported increases in body mass index (BMI) [38, 41, 50, 54, 55, 64, 71] and atherogenic changes to lipid profiles [40, 50, 53, 56]. Of note, in two of these GAH studies, the lipid profile became more atherogenic in natal females but less atherogenic in natal males [53, 56].
Table 1 also shows that a small number of PB and/or GAH clinical studies have investigated neuropsychological functioning [33, 60, 61] as well as treatment discontinuation or regret [63, 66, 73, 75]. Results were varied. Research on the effect of PB/GAH on sexual function is sparse; with data from only one small patient cohort [49, 74]. No studies have investigated sexual function outcomes in natal males initiated on GAH specifically after Tanner II blockade. One retrospective analysis found greatly increased odds of natal males receiving intestinal vaginoplasty as young adults if they initiated PBs in Tanner Stage II or III [30].
Of the effectiveness studies (Table 2), there were 26 studies reporting on mental health outcomes, 21 of which were longitudinal with follow-up ranging from five months in Cantu et al. [100] to six years in the early sequential Dutch studies [89, 90] (most studies had follow up periods of around one year). Two of the early Dutch studies reported multiple mental health outcomes on a single patient cohort [89, 90]. Thus, these two studies should be conceptualized as a single longitudinal study. Another two studies from the “Trans Youth Care” research project [108, 114] should be conceptualized similarly, as they, too, reported on a single cohort. Grouping the Dutch studies and the Trans Youth Care studies, roughly half (10/19) of these studies reported improvement in at least one mental health outcome [64, 94,95,96,97, 99, 111, 113] plus [89, 90] and [108, 114]; the largest study, however, reported worsening mental health as measured by increased psychotropic medications [103], and there were two patient suicides in one study [108]. Seven studies reported no change in mental health outcomes [54, 91, 100, 102, 105, 106, 112] and one cohort study reported that improvement was similar between a group treated with PBs and a group treated with psychotherapy alone [92]. Three studies reported extremely high rates of continuation (> 90%) to GAH in patients who initiated PBs [54, 93, 101].
Safety/Effectiveness of PBs/GAH: Systematic Reviews and Meta-Analyses (Top of Pyramid)
We now move up the evidence pyramid (Fig. 1) to present the findings of systematic reviews and meta-analyses. Multiple systematic reviews have looked at the evidence for PB/GAH use in this population. One such review, commissioned by health authorities in Finland in 2019, is not available in English. The others are listed in Table 3. Of these, two reviews [129, 130] were less rigorous (they did not assess the quality of the body of evidence). Lack of rigor was noted by the umbrella review, which rated their methodologies as critically low [131].
Across the rigorous systematic reviews, multiple issues with the evidence base have been identified. These reviews found that individual studies in this field, such as those in Tables 1 & 2, contained the following methodological issues: lack of long-term follow-up (especially relevant to development of metabolic and cardiovascular risk factors or regret, which may evolve over years), infrequent inclusion of comparison groups, use of indirect or surrogate outcome measures, very high loss to follow-up, absence of methodologies that control for confounders in order to isolate the effects of the intervention on the measured outcomes–and/or the absence of reporting concomitant treatment such as mental health treatments and lack of acknowledgement that these represent potential confounders, and variable findings with small effect sizes (when positive effects were observed). Additionally, there are no randomized studies of these interventions. Most reviews did not perform subgroup, sensitivity or meta-analysis in the setting of heterogeneity of patient population (i.e., grouping-sexes, Tanner Stages, etc.) and intervention (PBs, testosterone, estrogen) and the paucity of research. The two most recent reviews [140, 141] were able to perform limited meta-analysis by combining outcomes of similar studies.
The systematic reviews that have used GRADE to assess evidence certainty have generally found very low certainty evidence for benefits of treatment. This means that the true effect of PBs/GAH (i.e., impact on mental health outcomes, whether related to GD, depression, suicidality/suicide risk, etc.) is likely to be substantially different from reported findings. With respect to safety, the impacts of interventions on outcomes, like bone density and metabolic parameters, were also considered very low certainty, although one systematic review found low certainty evidence for decreased bone mineralization with PB use [133]. With respect to safety of GAH, a recent systematic review reported moderate and high certainty evidence that there is some risk of cardiovascular events (stroke, myocardial infarction, venous thromboembolism) with GAH use in young people [141].
The remainder of the rigorous reviews utilized alternate (but standardized) approaches to evidence assessment. Consistent with the findings from systematic reviews that used GRADE, these reviews found that the evidence for PB/GAH use in this population was quite weak (see “Findings” column in Table 3: “great uncertainty,” evidence is “lacking,” “impossible to draw conclusions,” “dearth and poor quality of evidence,” etc.).
Discussion
This review focuses on what is known regarding the safety and effectiveness of the hormonal interventions (PBs/GAH) used in pediatric gender-affirming care. From an evidence-based perspective, it summarizes results of individual non-randomized, observational clinical research studies (which are situated towards the base of the evidence pyramid, constituting less reliable evidence). We also present findings of systematic reviews and meta-analyses (the apex of the evidence pyramid, constituting highly reliable evidence).
Individual clinical research studies of treatment benefits have reported variable effects on mental health outcomes (another review of mental health outcomes has also pointed out the unclear clinical significance of positive results [124]). Numerous systematic reviews and meta-analyses have consistently found weak/very low certainty evidence for benefits of these interventions. Thus, based on the current state of the evidence, it is unknown what type of impact–favorable, neutral, or unfavorable–gender-affirming care in the form of PBs/GAH may have on mental health outcomes, including gender dysphoria or suicidality/suicide risk.
The evidence with respect to risks such as decreased bone mineralization or development of metabolic issues is also low or very low certainty. However, this does not negate the fact that infertility is an expected sequelae of treatment for some patients, as is the possibility of lifelong sexual dysfunction. Despite being poorly-studied in the extant literature, these risks merit serious attention and must be considered when considering treatment options. As has been pointed out in other reviews/commentaries, the impact of PB use in adolescence on neuropsychological functioning remains unclear [24], as does the risk of early onset of osteopenia/osteoporosis after PB use in adolescence [76]. Further, the rates of detransition and regret remain unknown [123]. A recent systematic review of GAH in young people reported moderate to high certainty evidence of risk of some cardiovascular events [141]. Increased risk for cardiovascular events has also been observed in adults taking GAH [142] and may manifest many years after treatment initiation. Given that these interventions have only recently become widely-used in pediatric gender distress, and given the lack of long-term data on this population, it is unknown how the elevated risk observed in patients who initiated interventions as adults will compare to those who initiated interventions as minors.
If use of PBs/GAH is undertaken with the goal of favorable impact on mental health (e.g. gender dysphoria, suicidality) or adjacent parameters (e.g. quality of life, psychosocial functioning), clinicians should be aware that the evidence to support the use of PB/GAH for these indications is remarkably weak. Based on the existing evidence, it is unknown what type of effect/s PBs/GAH may have on the health and well-being of minors with gender-related distress. Therefore, it is inaccurate to describe the current practice of pediatric gender-affirming care as “evidence-based” [143].
Limitations
This article is not a systematic review, and due to our lack of a systematic literature search strategy, some studies may have been missed. We focus here on PBs/GAH, but readers should be aware that pediatric gender-affirming care also includes surgeries, which are considered part of the standard of care according to several guidelines/policies, and are performed on minors [144,145,146]. The evidence for outcomes of pediatric gender-affirming surgeries has also been found to be limited. A recent systematic review of mastectomy for young people with gender dysphoria [147] found low or very low certainty evidence pertaining to mental health outcomes, and high certainty evidence that there is at least some increased risk of harm (including necrosis and excessive scarring). An umbrella review also found the evidence pertaining to gender-affirming surgeries in adolescents was of low or very low certainty [131] as did a systematic review [138].
Conclusion
There are real and significant risks associated with pubertal-stage provision of hormonal interventions in gender-distressed minors (e.g., infertility, sexual dysfunction), and the existing research data is woefully insufficient to inform on the question of whether PBs/GAH mitigate distress and lead to favorable mental health outcomes (including with respect to gender dysphoria or suicidality/suicide risk).
In order for a clinical guideline to make a truly evidence-based recommendation about a certain treatment, there must first be a rigorous systematic evidence review. Second, the strength of the guideline’s recommendation must be commensurate with the certainty of evidence found in the systematic review/s. Rare exceptions to this rule do exist, but if recommendations are discordant with the certainty of evidence, there must be a clear rationale (because low certainty evidence means there is considerable uncertainty regarding balance of current and long-term risks and benefits) [5]. Thus, the guidelines/policies that make strong recommendations for standard-of-care use of PBs/GAH [1, 2], or that strongly imply such recommendations [3], are out-of-step with foundational EBM principles. Relatedly, these guidelines/policies were found to “lack methodological rigor” and were not recommended for practice by a recent systematic guideline appraisal [148, 149].
Sound guidelines must make explicit the trade-off between benefits and risks associated with all treatments, and must be extremely cautious in making strong recommendations based on weak evidence, as doing so may falsely imply the existence of a strong/reliable evidence base. Clinical guidelines/policies in pediatric gender medicine should be updated to reflect the reality of the limited evidence. Further, as this area of medicine is rapidly expanding, regular updating of such guidelines may be warranted.
Key References
Chen D, Berona J, Chan YM, Ehrensaft D, Garofalo R, Hidalgo MA, et al.
Psychosocial Functioning in Transgender Youth after 2 Years of Hormones. N Engl J Med. 2023 Jan 19;388(3):240–50.
Cette grande étude longitudinale multicentrique financée par le NIH a examiné les résultats en santé mentale des adolescents après l’utilisation de GAH. Elle illustre les problèmes liés à la dépendance aux études individuelles pour évaluer les améliorations en santé mentale. Chen et al. n’ont rapporté que les résultats de 4 des plus de 19 échelles listées dans leur protocole (préenregistré). En ce qui concerne les moyennes de groupe, la seule amélioration rapportée concernait la « congruence de l’apparence » ; les autres domaines (dépression, anxiété, satisfaction de vie/affect positif) ne se sont améliorés (légèrement) que chez les filles. Les auteurs ont présenté leurs résultats — omettant de nombreuses échelles listées dans le protocole, y compris celles portant sur l’image corporelle, l’automutilation et la suicidabilité — comme étant positifs. En outre, ils ont mis l’accent sur la légère amélioration de la congruence de l’apparence, au lieu de se concentrer sur un fait cliniquement plus significatif : 2 des 315 patients sont décédés par suicide. À noter : dans leur protocole, les auteurs avaient initialement formulé l’hypothèse que l’intervention améliorerait la suicidabilité.
Cass H.
Independent review of gender identity services for children and young people: final report [Internet]. 2024.
Disponible sur : https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/https://cass.independent-review.uk/home/publications/final-report/
La Cass Review est une évaluation indépendante des services pédiatriques d’identité de genre, commandée par le National Health Service (NHS) britannique. Son rapport final a été publié en avril 2024. Cette évaluation a commandé sept revues systématiques, une enquête internationale auprès de cliniques de genre, des recherches qualitatives formelles pour documenter les expériences et points de vue des patients, et a conduit plus de 1 000 entretiens avec des cliniciens, patients, parents et associations. S’appuyant en partie sur les revues systématiques commandées concernant les interventions hormonales (références [136, 137] dans cet article), le rapport a conclu que les preuves étaient faibles, et que tous les patients devraient recevoir en premier lieu un accompagnement psychosocial solide, tandis que les PB et GAH ne devraient être utilisés que dans des protocoles de recherche ou avec une extrême prudence. Ces recommandations sont cohérentes avec les lignes directrices de la Suède et de la Finlande, également fondées sur des revues systématiques, mais divergent fortement des lignes directrices américaines (références 1, 2 et 3), qui continuent de recommander les interventions hormonales comme pratique standard pour les patients répondant à certains critères.
Gorin M, Smids J, Lantos J.
Toward Evidence-Based and Ethical Pediatric Gender Medicine. JAMA. 2025.
JAMA a récemment publié cette perspective coécrite par deux bioéthiciens. L’article souligne que les organisations médicales américaines, en émettant des lignes directrices non fondées sur des revues systématiques rigoureuses, n’ont pas respecté les principes de la médecine fondée sur les preuves. L’article conclut :
« Étant donné l’état des connaissances dans ce domaine, il est éthiquement problématique de considérer comme fondée sur des preuves l’utilisation de routine des interventions hormonales ou chirurgicales chez les jeunes atteints de dysphorie de genre. »
Brignardello-Peterson R, Wiercioch W.
Effects of gender affirming therapies in people with gender dysphoria: Evaluation of the best available evidence [Internet]. 2022.
Disponible sur : https://ahca.myflorida.com/letkidsbekids/docs/AHCA_GAPMS_June_2022_Attachment_C.pdf
Cette revue ombrelle rigoureuse des revues systématiques dans le domaine de la médecine de genre pédiatrique, réalisée par des méthodologistes experts, a évalué de nombreuses revues de la littérature. Elle conclut que les preuves concernant les effets des bloqueurs de puberté et des hormones affirmant le genre sont très incertaines.
Gorin M.
What Is the Aim of Pediatric ‘Gender-Affirming’ Care? Hastings Cent Rep. 2024;54(3):35–50.
Dans cet article, le bioéthicien Moti Gorin souligne que les chercheurs en médecine de genre pédiatrique et les principales organisations médicales qui soutiennent l’usage standardisé des PB/GAH ont :
« adopté explicitement la position selon laquelle les interventions médicales liées à la transition apportent des bénéfices pour la santé, à savoir une réduction de la morbidité psychiatrique et des issues associées telles que la réduction du suicide… c’est en invoquant ces supposés bénéfices que les cliniciens justifient leurs offres d’interventions endocriniennes et chirurgicales aux patients et à leurs familles. »
Ce point est crucial, et nous avons tenté de l’explorer en détail dans la présente revue. Lorsque des médicaments provoquant des effets physiques et physiologiques irréversibles — y compris l’infertilité et des troubles sexuels — sont proposés à des mineurs, et en particulier à des membres vulnérables d’un groupe minoritaire, les cliniciens doivent s’assurer de savoir :
Quelle est la justification exacte de l’intervention,
Quels bénéfices sont supposés en découler,
Ce que disent (et ne disent pas) les données scientifiques disponibles.
Comments