Scientific evidence on the use of hormones for trans minors is scarce, according to new reviews of studies
The lack of research is a recognized problem in clinical guidelines, which are used in daily practice
Two systematic reviews of all published scientific literature on the use of puberty blockers and hormones for trans adolescents, or adolescents with disorders related to gender identity, have recently been published. They highlight that available evidence on these treatments is still scarce and results don’t allow for “drawing conclusions about the impact on gender dysphoria, mental and psychosocial health or cognitive development” of patients in the medium and long-term.
“Gender medicine is built on shaky foundations,” warned one of the authors, Hilary Cass, in an interview with The British Medical Journal. She added that “unfortunately, there’s no evidence that gender-affirming treatment — in its broadest sense — reduces the risk of suicide.”
In total, the two works have analyzed more than 100 studies published between 2006 and 2022 — most between 2020 and 2022 — in several countries, including the United States, the United Kingdom, Canada, Belgium, Israel, and Germany. They’ve been published in an international pediatric journal, Archives of Disease in Childhood. The two reviews, along with other more specific ones, are part of a series commissioned by the University of York and aim to analyze the situation of specialized services in this discipline, in the face of the growing number of children and young people experiencing what the study calls “gender dysphoria.” The WHO — which removed pathologizing categories affecting trans and gender diverse people from the ICD-10 several years ago — refers to this situation as “gender incongruence,” or the anguish caused by a mismatch between sex assigned at birth and gender identity.
The conclusions come after three-and-a-half years of work. They were highly-anticipated in the U.K. due to the relevance that Dr. Cass has acquired in recent years in this area of medicine. A previous report by her — published in February 2022 — led the National Health Service (NHS) to close Tavistock, the only center that, for more than 30 years, had treated minors who questioned their gender identity, through the Gender Identity Development Service (GIDS).
Cass believes that the health system and society have “let young people down” and insists that gender-questioning children and young people who seek help from public health services should be able to access a comprehensive, broad-based assessment carried out by a multi-professional team, which includes pediatricians, child psychiatrists and allied health experts. This work model — which has received global attention — is the one that has been followed in Spain for years, via the specialized gender identity units within the National Health System.
Dr. Marcelino Gómez Balaguer — an endocrinologist and coordinator of the Sexual Identity and Differentiation Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) — feels that the scientific reviews conducted by Cass “don’t say anything new.”
“All endocrinologists and professionals who are dedicated to identity know [about these shortcomings] already,” he emphasizes. “And unfortunately, this is after 40 years of gender-affirming healthcare not only in Spain, but throughout Europe. We still don’t have enough evidence [that said treatments reduce the risk of suicide],” he laments.
This specialist — who, for years, coordinated the gender unit at the Doctor Peset University Hospital in Valencia — recalls that “all the clinical guidelines” published in Spain and other countries insistently remind us of the need to promote research that provides “this much-needed evidence.” “Unfortunately,” he points out, “it’s something that hasn’t been done for several reasons, including the lack of interest and resources from the [public health] administrations and the [medical] industry.”
“We’re clear about two things,” Dr. Gómez Balaguer affirms. “The first is that we have some patients who need help. And the second is that — in the absence of this evidence — we do have extensive experience and protocols that have proven to be very useful until now.” He thinks that the reviews’ conclusions show that it’s necessary to “do more and allocate more resources than the opposite, which is what some voices seem to want.”
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