Stats for Gender

Only six of the 30 people interviewed for a UK Government-commissioned study of conversion therapy identified as transgender or non-binary, limiting the conclusions that could be drawn about gender-identity change efforts.

For a qualitative study commissioned by the UK Government and published in 2021, researchers interviewed 30 people about their experiences of conversion therapy. Six interviewees (20%) identified as transgender or non-binary, while 24 did not.

Of the 30 participants, 24 (80%) reported experiencing sexual-orientation change efforts only, three reported gender-identity change efforts only, and three reported both.

Among the six transgender or non-binary interviewees, four reported being pressured by family members or religious leaders to engage in conversion efforts. All four cases involved religious contexts. The remaining two said psychiatrists had treated their gender identities as symptoms of mental health conditions. The report noted that these psychiatric treatments did not appear to have been specifically designed to change their gender identities.

All participants were self-selected. The report stated that it was not possible to determine how representative the findings were of the wider population of people who had undergone conversion therapy. It also acknowledged that the limited number of transgender participants restricted the generalisations that could be made.

The report concluded that relatively little evidence was available concerning gender-identity change efforts.

^{Jowett, A., Brady, G., Goodman, S., Pillinger, C., & Bradley, L. (2021). Conversion therapy: An evidence assessment and qualitative study. Government Equalities Office. UK Government report}

Conversion Therapy

Only four of the 46 studies reviewed by the UK Government focused exclusively on conversion therapy for gender identity, and none focused exclusively on the practice in the UK

The very small number of studies on gender-identity change efforts means that the evidence base is extremely limited.

A 2021 UK Government assessment reviewed 46 studies concerning conversion therapy. Of these, 41 focused exclusively on sexual orientation (89%), four focused exclusively on gender identity (9%), and one examined experiences relating to either sexual orientation or gender identity (2%).

Of the four gender-identity studies, three were conducted in the United States and one was a systematic review of international evidence. The assessment found no study focusing exclusively on conversion therapy for gender identity in the UK.

The accompanying Government-commissioned review found that conversion therapy appeared to occur most commonly in religious settings and that exposure was consistently associated with holding certain conservative religious beliefs. It also cautioned that most of the research originated in North America and might not reflect how conversion therapy operates elsewhere. Given the importance of religious context, the direct applicability of predominantly US evidence to UK policy should not simply be assumed.

The systematic review was itself limited by the scarcity of available research. The Government assessment also found little UK evidence concerning the nature, frequency, duration or characteristics of practices described as conversion therapy for gender identity, or people’s subsequent experiences.

The evidence available to inform UK policy specifically on gender-identity change efforts is therefore extremely limited and heavily reliant on US research.

^{Government Equalities Office. (2021). An assessment of the evidence on conversion therapy for sexual orientation and gender identity. UK Government. https://www.gov.uk/government/publications/an-assessment-of-the-evidence-on-conversion-therapy-for-sexual-orientation-and-gender-identity/}

_{^{Jowett, A., Brady, G., Goodman, S., Pillinger, C., & Bradley, L. (2021). Conversion therapy: An evidence assessment and qualitative study. Government Equalities Office. UK Government report}}

Conversion Therapy

Evidence suggests rapid-onset gender dysphoria may represent a distinct subtype of gender dysphoria.

Rapid-onset gender dysphoria (ROGD) was first described by Lisa Littman in 2018, who reported a pattern of adolescents and young adults with a sudden onset of gender dysphoria based on 256 parent reports. She proposed ROGD as a hypothesis requiring further investigation.

Subsequently, Diaz and Bailey (2025) reported findings from a survey of 1,655 parent-reported cases, in which 75% of adolescents were born female and reportedly developed gender dysphoria during adolescence rather than childhood. The authors concluded that further research was needed to better understand the phenomenon.

In a 2026 paper, clinical psychologist Dr Kenneth Zucker reviewed the evidence on age of onset in gender dysphoria. He concluded that the available evidence supports a distinct clinical presentation—rapid-onset gender dysphoria—which appears during adolescence, particularly among born females, without a history of gender dysphoria in childhood. Zucker argued that this subtype should be formally recognised in future editions of the DSM because distinguishing between early-onset, late-onset, and rapid-onset gender dysphoria may have important implications for understanding causes, sexual orientation patterns, and desistance rates.

^{Diaz, S., & Bailey, J. M. (2025). Rapid-Onset Gender Dysphoria: Parent Reports on 1,655 Possible Cases. Journal of Open Inquiry in the Behavioral Sciences, 3(4). https://doi.org/10.58408/issn.2992-9253.2023.01.01.00000012}

^{Littman, L. (2018). Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLOS ONE, 13(8), e0202330.}

^{Zucker, K. J. (2026). Is “rapid-onset” gender dysphoria in adolescence a new clinical phenomenon? European Journal of Developmental Psychology. https://doi.org/10.1080/17405629.2026.2680292}

Rapid-onset Gender Dysphoria (ROGD)

Three decades of research based on the Dutch Protocol have not produced reliable evidence to support the use of puberty blockers and hormones in adolescents.

In a 2026 critique, McDeavitt and Cohn reviewed three decades of research underpinning the Dutch Protocol and concluded that it has not produced reliable evidence to support the use of puberty blockers and cross-sex hormones in adolescents.

Their critique addressed a 2026 narrative review in which researchers from the Amsterdam Center of Expertise on Gender Dysphoria argued that three decades of their own research supported the use of puberty blockers and cross-sex hormones in adolescents. The review did not represent an independent evaluation of the evidence, as it was authored by the same research group that had generated much of the underlying literature.

The Amsterdam team concluded that puberty blockers and cross-sex hormones are associated with reduced gender dysphoria, high appearance and treatment satisfaction, improved mental health, good self-esteem and general functioning, low discontinuation rates of cross-sex hormones, and limited or no long-term adverse effects on growth following treatment with puberty blockers, hormones and surgery. They also reported that treatment from early puberty limits genital growth, meaning alternatives to penile inversion vaginoplasty may be required; that mastectomy at ages 16–17 produced similar satisfaction and low decisional regret compared with surgery at ages 18–20; and that adolescents were found able to make informed decisions about treatment. The Dutch authors concluded that the available evidence supports the provision of these interventions, while acknowledging that further research is needed in several areas.

McDeavitt and Cohn argued that these conclusions are not justified because the underlying studies have important methodological limitations. They identified inadequate long-term follow-up to assess outcomes such as cardiovascular disease, fertility and treatment regret; lack of appropriate comparison groups; reliance on surrogate outcome measures rather than clinically meaningful outcomes; substantial loss to follow-up (for example, in one study only 39% of participants could be contacted after seven years); inadequate adjustment for confounding variables; and the absence of any randomised controlled trials. They argued that these limitations prevent reliable conclusions about the long-term benefits and risks of treatment.

McDeavitt and Cohn concluded that, despite three decades of research, the evidence underpinning the Dutch Protocol remains insufficient to support the use of puberty blockers and cross-sex hormones in adolescents.

^{de Vries, A. L. C., Steensma, T. D., Kreukels, B. P. C., van de Grift, T. C., van Mello, N. M., & Hannema, S. E. (2026). The Dutch approach for transgender adolescents; past, present and future perspectives. European Journal of Developmental Psychology. https://doi.org/10.1080/17405629.2026.2615311}

^{McDeavitt, K., & Cohn, J. (2026). Three decades of ‘Dutch Protocol’ research has not produced reliable evidence. European Journal of Developmental Psychology. https://doi.org/10.1080/17405629.2026.2680285}

A 2026 commentary raised methodological concerns about a study linking anti-trans laws to increased suicide attempts.

A 2024 study by Lee et al. concluded that state-level anti-transgender laws increased suicide attempts among transgender and non-binary youth in the United States. However, a 2026 commentary published in Nature Human Behaviour raised several methodological concerns about the analysis.

The commentary questioned the selection of control states, noted that much of the apparent effect was driven by data from a single state, challenged the validity of the parallel trends assumption, and found that the results were not robust to alternative analytic approaches. The authors argued that these limitations weakened the study’s ability to support causal conclusions about the effects of state laws on suicide attempts.

Importantly, the study examined self-reported suicide attempts rather than suicide deaths. Suicide attempts and suicide mortality are distinct outcomes. Population-based studies of suicide mortality have found that pre-existing psychiatric comorbidities are major predictors of suicide risk. For example, a Finnish nationwide register study found that 20 of 2,083 adolescents and young adults referred to gender identity services (0.96%) died by suicide during long-term follow-up. Suicide mortality was initially higher than in matched controls from the general population, but after taking previous psychiatric treatment into account, the difference was no longer statistically significant. These findings suggest that psychiatric history, rather than gender referral status itself, largely explains the elevated suicide risk.

^{Lee, W. Y., Hobbs, J. N., Hobaica, S., DeChants, J. P., Price, M. N., & Nath, R. (2024). State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA. Nature Human Behaviour, 8, 2096-2106. https://doi.org/10.1038/s41562-024-01979-5}

^{Cohn, J., Sim, P., & Kerr, K. F. (2026). Methodological considerations for evaluating policy impacts on transgender and non-binary youth suicidality. Nature Human Behaviour. Advance online publication. https://doi.org/10.1038/s41562-026-02467-8}

Suicide

A Belgian gender clinic reported three requests for euthanasia from post-transition patients within a two-year period.

A 2015 paper from a Belgian gender clinic reported that three individuals requested euthanasia after completing gender-affirming surgery. The authors described one case in detail and noted that two additional requests had occurred during the same two-year period. They argued that these cases highlighted the importance of careful psychological assessment and ongoing support.

Separately, the widely publicized case of Nathan Verhelst involved euthanasia following severe psychological and physical suffering after complications from phalloplasty. This case was not part of the clinical report.

^{Heylens, G., Elaut, E., Verschelden, G., & De Cuypere, G. (2015). Transgender persons applying for euthanasia in Belgium: A case report and implications for assessment and treatment. Journal of Psychiatry, 18(6). https://doi.org/10.4172/2378-5756.1000347}

^{Het Laatste Nieuws. (2013, October 1). Nathan krijgt euthanasie na mislukte geslachtsoperatie. https://www.hln.be/binnenland/nathan-krijgt-euthanasie-na-mislukte-geslachtsoperatie~a71c8913/}

^{Holehouse, M. (2013, September 30). Belgian killed by euthanasia after a botched sex change operation. The Telegraph. https://www.telegraph.co.uk/news/worldnews/europe/belgium/10346616/Belgian-killed-by-euthanasia-after-a-botched-sex-change-operation.html}

20 of 2,083 adolescents and young adults referred to Finnish gender services died by suicide (about 1%), with pre-existing psychiatric comorbidities largely explaining the elevated risk.

A Finnish nationwide register study followed 2,083 adolescents and young adults who had been referred to gender identity services. During long-term follow-up, twenty individuals (0.96%) died by suicide.

Suicide mortality was initially higher among those referred to gender services than among matched controls from the general population (0.51 versus 0.12 deaths per 1,000 person-years). However, after taking previous psychiatric treatment into account, the difference was no longer statistically significant. The findings suggest that pre-existing psychiatric comorbidities, rather than gender referral status itself, are the primary predictors of suicide mortality. The study found that a history of psychiatric treatment largely explained the elevated suicide risk.

^{Ruuska, S. M., Tuisku, K., Holttinen, T., & Kaltiala, R. (2024). All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996-2019: A register study. BMJ Mental Health, 27(1), Article e300940. https://doi.org/10.1136/bmjment-2023-300940}

Suicide

Five of 235 adolescents (2.1%) referred to the Belgian Pediatric Gender Clinic died by suicide during follow-up, a remarkably high cumulative mortality that shows that access to medical interventions does not eliminate the risk of suicide.

Five of 235 adolescents referred to the Belgian Pediatric Gender Clinic between 2007 and 2016 died by suicide during follow-up. Published case descriptions indicate that several of these individuals had already begun medical treatment at the time of death, but the study does not establish any causal relationship between treatment status and suicide.

For comparison, annual suicide mortality among adolescents in Western countries is typically between 0.5 and 1.2 deaths per 10,000 adolescents per year. Because the Belgian study followed patients over several years and did not include a matched control group, the figures are not directly comparable. Nevertheless, five suicides among 235 patients represents a substantially higher cumulative risk than that observed in the general adolescent population.

^{Van Cauwenberg, G., Dhondt, K., & Motmans, J. (2021). Ten years of experience in counseling gender diverse youth in Flanders, Belgium: A clinical overview. International Journal of Impotence Research, 33(7), 671-678. https://doi.org/10.1038/s41443-021-00441-8}

^{World Health Organization. (2021). Suicide worldwide in 2019: Global health estimates. World Health Organization. https://iris.who.int/handle/10665/341728}

Suicide

Puberty blockers disrupt the normal timing of puberty relative to same-age peers, with associated psychosocial effects

A 2024 systematic review noted that puberty blockers disrupt the normal timing of pubertal development relative to same-age peers. Puberty is an important developmental phase associated with identity formation, body image, emotional development, and peer integration.

Broader adolescent research has associated variations in pubertal timing with psychosocial outcomes including mood difficulties, social challenges, and depressive symptoms.

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1-21. DOI: 10.1024/1422-4917/a000972
PDF: Full paper PDF}

The combination of puberty blockers followed by cross-sex hormones leads to permanent loss of fertility

A 2024 systematic review notes that puberty suppression alone does not necessarily eliminate future fertility, as endogenous puberty may resume after treatment stops. However, when puberty blockers are followed by cross-sex hormones, fertility potential may be significantly impaired or permanently lost, particularly if fertility preservation has not occurred beforehand. This review therefore highlights that fertility risks emerge through the sequential treatment pathway from puberty suppression to cross-sex hormones.

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1-21. DOI: 10.1024/1422-4917/a000972
PDF: Full paper PDF}

A 2024 systematic review found that 39% of female participants were overweight before starting puberty blockers. During treatment, BMI increased further, particularly among females, alongside disruptions to expected growth patterns.

A 2024 systematic review reported that 39% of biologically female participants were classified as overweight prior to beginning puberty blockers. During treatment, increases in BMI-SDS were observed, particularly among biologically female participants, alongside alterations in expected growth trajectories.

The review noted that the available evidence remains limited by small sample sizes, heterogeneity between studies, and the observational nature of the data.

Jazz Jennings, star of the reality TV series I Am Jazz, began puberty blockers at age 11. Jennings gained substantial weight (nearly 100 pounds / ~45 kg) after starting blockers and cross-sex hormones, reaching morbid obesity (over 200 lbs / 90+ kg) at one point, which further complicated surgical preparation and recovery. (TLC, 2022).

^{TLC. (2022, January 25). Jazz is heartbroken by her weight gain | I Am Jazz [Video]. YouTube. https://www.youtube.com/watch?v=MSv3vq6L-fA}

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1-21. DOI: 10.1024/1422-4917/a000972
PDF: Full paper PDF}

Puberty blockers impair genital development and may complicate later surgical outcomes

Suppressing puberty alters normal genital and bodily development, which may affect later surgical options and outcomes. Reviews of the evidence have raised concerns that reduced genital tissue development following puberty suppression can limit surgical options – for example, by making standard penile inversion vaginoplasty impossible – and increase the complexity of later genital surgeries.

Prominent examples include:

In the seminal Dutch cohort (de Vries et al., 2014), an 18-year-old patient died from necrotizing fasciitis and sepsis following intestinal (sigmoid) vaginoplasty. Due to early puberty suppression, there was insufficient penile tissue for the standard surgical technique, necessitating the use of a higher-risk bowel segment procedure.
Jazz Jennings, star of the reality TV series I Am Jazz, began puberty blockers at age 11. This resulted in insufficient penile tissue development, requiring a more complex vaginoplasty using additional tissue sources, including peritoneal tissue and skin grafts. Jennings later experienced severe post-operative complications, including wound separation and splitting of the neovagina, necessitating multiple revision surgeries (TLC, 2018). Jennings also gained substantial weight – nearly 100 pounds (~45 kg) – after starting puberty blockers and cross-sex hormones, at one point reaching morbid obesity (over 200 lbs / 90 kg), which further complicated surgical preparation and recovery (TLC, 2022).

Observational studies have also reported changes in growth, bone development, and BMI during and after treatment with puberty blockers, although the available evidence remains limited and methodologically weak. Long-term outcomes remain insufficiently studied (Taylor et al., 2024).

^{de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696-704. https://doi.org/10.1542/peds.2013-2958}

^{Taylor, J., Mitchell, A., Hall, R., Heathcote, C., Langton, T., Fraser, L., & Hewitt, C. E. (2024). Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: A systematic review. Archives of Disease in Childhood, 109(Suppl 2), s33-s40. https://doi.org/10.1136/archdischild-2023-326669}

^{TLC. (2018, September 8). Jazz experiences complications post surgery | I am Jazz [Video]. YouTube. https://www.youtube.com/watch?v=rU-uzjzNCVc}

^{TLC. (2022, January 25). Jazz is heartbroken by her weight gain | I Am Jazz [Video]. YouTube. https://www.youtube.com/watch?v=MSv3vq6L-fA}

^{University of California San Francisco, Gender Affirming Health Program. (2016, June 17). Vaginoplasty procedures, complications and aftercare. UCSF Transgender Care. https://transcare.ucsf.edu/guidelines/vaginoplasty}

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1-21. DOI: 10.1024/1422-4917/a000972
PDF: Full paper PDF}

Fertility preservation creates an iatrogenic tension between protecting future fertility and imposing immediate psychological burden

Fertility preservation is often recommended before cross-sex hormones because these treatments may impair future fertility. However, studies report that the procedures required for egg or sperm retrieval are frequently experienced by adolescents and young adults with gender dysphoria as psychologically distressing, physically invasive, or emotionally intolerable. As a result, many decline fertility preservation altogether. This creates an iatrogenic tension in which a medical intervention intended to protect future reproductive autonomy may itself become a source of distress and reduced decision-making capacity.

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1-21. DOI: 10.1024/1422-4917/a000972
PDF: Full paper PDF}

In Sweden, the number of girls aged 13-17 diagnosed with gender dysphoria rose by approximately 1,500% between 2008 and 2018 – a fifteen-fold increase

The Zepf et al. (2024) systematic review documents sharp increases in adolescent referrals for gender dysphoria across several European countries over the past decade. The increase has been particularly pronounced among adolescent females, who have shifted from being a historically rare presentation to the most commonly referred cohort over the past fifteen years.

Socialstyrelsen. (2020). The evolution of the diagnosis of gender dysphoria: Prevalence, co-occurring psychiatric diagnoses and mortality from suicide. National Board of Health and Welfare (Sweden). https://www.transgendertrend.com/wp-content/uploads/2020/11/English-NBHW-report-002.pdf

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1–21. DOI: 10.1024/1422-4917/a000972
PDF: Full paper PDF}

Demographics

In the United Kingdom, referrals of female individuals under 18 to gender clinics increased by more than 6,900% (a nearly 70-fold increase) between 2009 and 2016

Data from the Gender Identity Development Service (GIDS) at the Tavistock Clinic in London showed sharp increases in referrals for adolescents with gender dysphoria over the past decade. The Zepf et al. (2024) systematic review similarly documents substantial increases in adolescent referrals across several European countries. The increase has been particularly pronounced among adolescent females, who have shifted from being a historically rare presentation to the most commonly referred cohort over the past fifteen years.

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1–21. DOI: 10.1024/1422-4917/a000972
PDF: Full paper PDF}

Demographics

Systematic reviews carried out on the impact of the treatment of puberty blockers or cross-sex hormone for minors show that medical transition has no evidence base

The UK NICE evidence reviews (2020), examining both puberty blockers and cross-sex hormones for minors with gender dysphoria, found no reliable evidence of significant improvement in gender dysphoria, mental health, body image, or quality of life outcomes.

Zepf et al.’s Beyond NICE systematic review (2024), which evaluated newer studies published after the NICE reviews, similarly concluded that the evidence base remains methodologically weak and insufficient to support reliable conclusions regarding benefits or long-term outcomes.

The HHS evidence review (2025), Miroshnychenko et al.’s systematic review and meta-analysis (2025), the NICE reviews (2020), and Beyond Nice (2024) systematic review have consistently identified low-quality evidence, methodological weaknesses, limited long-term follow-up, and substantial uncertainty regarding the effects of puberty blockers and cross-sex hormones in minors with gender dysphoria.

^{Miroshnychenko, A., Roldan, Y., Ibrahim, S., Kulatunga-Moruzi, C., Montante, S., Couban, R., Guyatt, G., & Brignardello-Petersen, R. (2025). Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis. Archives of Disease in Childhood, 110(6), 429-436. https://doi.org/10.1136/archdischild-2024-327909}

^{National Institute for Health and Care Excellence (NICE). (2020). Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria. NHS England and NHS Improvement.}

^{Available at: NICE Evidence Review PDF}

^{National Institute for Health and Care Excellence (NICE). (2020). Evidence review: Gender-affirming hormones for children and adolescents with gender dysphoria. NHS England and NHS Improvement.}

^{PDF: NICE Evidence Review – Gender-affirming hormones for children and adolescents with gender dysphoria}

^{U.S. Department of Health and Human Services, Office of Population Affairs. (2025). Treatment for pediatric gender dysphoria: Review of evidence and best practices. Washington, DC: U.S. Department of Health and Human Services.}

^{URL: HHS Gender Dysphoria Report
PDF: Full Report PDF
Executive Summary: Executive Summary PDF}

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1-21. DOI: 10.1024/1422-4917/a000972
PDF: Full paper PDF}

All systematic reviews carried out on the treatment of puberty blockers on minors found no robust evidence that puberty blockers improve key psychological outcomes

Across systematic reviews of puberty blockers for minors, key clinical outcomes including gender dysphoria, quality of life, and body image showed no consistent or statistically significant improvements. Reported psychosocial benefits were inconsistent and difficult to distinguish from baseline differences or comparison conditions. Overall, the evidence base was rated as “very low certainty,” indicating substantial uncertainty regarding the reliability of the reported effects.

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1-21. DOI: 10.1024/1422-4917/a000972‘}

_{^{National Institute for Health and Care Excellence (NICE). (2020). Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria.}}

^{NICE evidence review}

^{U.S. Department of Health and Human Services, Office of Population Affairs. (2025). Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices. Washington, DC.}

^{URL: HHS Gender Dysphoria Report}

^{PDF: Full Report PDF}

^{Executive Summary: Executive Summary PDF}

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1-21. DOI: 10.1024/1422-4917/a000972}

^{PDF: Full paper PDF}

Puberty blockers

The most up-to-date reviews of puberty blockers and cross-sex hormones for minors identify “significant conceptual and methodological flaws” in the evidence base.

Zepf et al.’s systematic review Beyond NICE (2024) found that the available evidence on puberty blockers and cross-sex hormones for minors with gender dysphoria remains limited. Existing studies are characterized by small sample sizes, weak methodology, missing data, high dropout rates, lack of appropriate controls, and limited long-term follow-up. The review also identified significant conceptual and methodological flaws across the literature, limiting confidence in reported findings and making reliable conclusions difficult.

Some studies report short-term reductions in gender dysphoria, depression, or suicidality following cross-sex hormones, but findings remain inconsistent and methodologically weak. Long term results remain unknown. In some cases, studies include no meaningful statistical analysis or suffer from substantial loss to follow-up, further limiting interpretation of outcomes and risks.

^{Zepf, F.D. et al. (2024). Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 1-21. DOI: 10.1024/1422-4917/a000972
PDF: Full paper PDF}

^{National Institute for Health and Care Excellence (NICE). (2020). Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria. NHS England and NHS Improvement.}

^{PDF: NICE Evidence Review PDF}

^{National Institute for Health and Care Excellence (NICE). (2020). Evidence review: Gender-affirming hormones for children and adolescents with gender dysphoria. NHS England and NHS Improvement.}

^{PDF: NICE Evidence Review – Gender-affirming hormones for children and adolescents with gender dysphoria}

High psychiatric burden suggests complex underlying mental health needs in gender-referred adolescents.

In a nationwide Finnish register study, adolescents referred to gender identity services showed markedly elevated rates of specialist psychiatric treatment both before and after referral, with a substantial proportion already engaged in mental healthcare prior to contact. After medical transition, they remained three- to six-fold more likely to require psychiatric care than matched controls. While the study does not assess psychological mechanisms or coping strategies, the high and persistent comorbidity indicates that gender-related healthcare seeking may occur in the context of broader and complex mental health difficulties in some individuals.