What Has Medical Research Found on Gender Treatments for Trans Youth?
- La Petite Sirène
- Jun 26
- 3 min read
18 juin - Azeen Ghorayshi - New York Times
The Supreme Court cited the uncertainty in the scientific evidence when upholding Tennessee’s ban on the treatments.
In Wednesday’s Supreme Court ruling, the chief justice made many references to the medical research on gender treatments for minors, arguing that the scientific uncertainty in the field justified Tennessee’s ban.
“This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy and propriety of medical treatments in an evolving field,” Chief Justice John G. Roberts Jr. wrote in the majority opinion. He argued that these questions should be resolved by “the people, their elected representatives and the democratic process.”
Countries across the world have grappled in recent years with thorny questions over the care for adolescents, which can include puberty-blocking drugs, hormones and, in rarer cases, surgeries. While the published medical evidence in support of such care is limited, many clinicians who provide these treatments and some families of transgender children say they can be beneficial and even lifesaving.
Systematic reviews commissioned by international health bodies have consistently found that the evidence of the benefits of the treatments is weak, as is the evidence on the potential harms. Small studies have suggested that hormonal treatments can improve mental health outcomes and well-being in some adolescents, while preventing the physical changes of puberty that might make it more difficult to live as the opposite sex. But few have followed children in the long term.
The drugs have risks, including the loss of fertility and the possibility that adolescents may come to regret the treatments, some of which are irreversible. An estimated 5 to 10 percent of patients choose to stop or reverse their treatments, a process known as detransition.
As demand for the treatments has risen, countries have chosen different ways to respond. Health agencies in England, Sweden, Finland and Denmark have limited the treatments to extreme cases or allowed them only in clinical trials. Medical groups drafting guidelines in Germany recently acknowledged the uncertain evidence but cautiously endorsed the treatments, citing the clinical consensus and the lack of effective alternatives.
“The Finnish, Swedish and U.K. approaches have some shortcomings in my opinion in answering what to do instead,” said Dr. George Romer, a child and adolescent psychiatrist who led the development of the German guidelines. “To conclude that because of the evidence you cannot treat would be very unusual in any other field of medicine.”
In his majority opinion for the Court, Chief Justice Roberts cited the changes in Europe as evidence of the uncertainty in the field. “The voices in these debates raise sincere concerns,” he wrote. “The implications for all are profound.”
He noted that last spring, the National Health Service in England published an independent review into the country’s youth gender services — known as the Cass Review, after Dr. Hilary Cass, who led it. That report concluded that the evidence to support the treatments in adolescents was “remarkably weak” and noted that “results of studies are exaggerated or misrepresented by people on all sides of the debate.”
In December, Britain announced that it was banning the use of puberty blockers in all children except for those enrolled in a government-sponsored clinical trial. That study, which will run until January 2031, will analyze the physical, social and emotional well-being of children prescribed puberty blockers over the course of two years.
In the United States, the issue has primarily played out in statehouses and the courts. Twenty-five American states have banned gender transition treatments for minors, laws that are now be protected as a result of the Supreme Court’s ruling. But American medical groups have continued to endorse gender transition treatments, largely sidestepping the debates about the evidence while firmly condemning the bans.
“Gender-affirming care is medically necessary for treating gender dysphoria and is backed by decades of peer-reviewed research, clinical experience and scientific consensus,” said Dr. Susan J. Kressly, the president of the American Academy of Pediatrics. The World Professional Association of Transgender Health and its American affiliate noted that bans on care “will make it much more difficult to create an evidence base to support access to health care of this kind.”
The A.A.P. announced that it was conducting its own review of the evidence in 2023 while continuing to reaffirm its endorsement of the treatments. That review is still underway.
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