Overall, many international experts are pulling back from the “gender-affirming” model and returning to a more cautious, psychotherapy-first approach. Meanwhile, many clinics in the United States continue to fast-track minors toward medical transition—often with only cursory psychological evaluation.

In the United States, around 3.3 percent of adolescents identify as transgender, and a futher 2.2 percent question whether they might be. Rather than exploring why young people are 329 percent more likely than adults to identify as transgender, and why there are almost as many transgender teens as there are adult men and women who identify as gay and lesbian, the medical community has rushed to impose “gender-affirming care.” The medical interventions falling under this term include puberty blockers, cross-sex hormones, and the surgical removal of breasts from girls.

“Despite increasing pressure to promote these drastic medical interventions for our nation’s youth,” says the U.S. Department of Health and Human Services (HHS), “the science and evidence do not support their use, and the risks cannot be ignored.”

The HHS recently released a major report titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” which provides an in-depth look at the science and outcomes behind puberty blockers, cross-sex hormones, and surgeries in minors, and represents one of the most comprehensive government analyses of pediatric gender transition treatments to date.

One of the report’s most significant findings is that the scientific support for gender-transition treatments in minors is exceedingly weak. After reviewing the available research, HHS concluded that “the overall quality of evidence . . . is very low.”​ The findings reveal little reliable proof that “gender-affirming care” actually improves children’s long-term well-being.

The report warns that even the positive results reported in some studies likely differ substantially from true outcomes. It notes,

In many areas of medicine, treatments are first established as safe and effective in adults before being extended to pediatric populations. In this case, however, the opposite occurred: clinician-researchers developed the pediatric medical transition protocol in response to disappointing psychosocial outcomes in adults who underwent medical transition. This means the field of pediatric medicine lacks the rigorous, long-term data that would normally justify such drastic medical interventions on children.

Serious Medical Risks and Unknowns

The HHS review also documents serious risks associated with puberty blockers, hormone therapies, and gender-related surgeries in youth. These interventions aren’t minor or easily reversible and can have permanent, life-altering effects. The report says, “The risks of pediatric medical transition include infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret.”

A child put on blockers and cross-sex hormones may lose future fertility, experience sexual dysfunction, and develop weaker bones, among other harms. These are sobering risks to impose on vulnerable young people—especially when long-term outcomes (fertility, fractures, cognitive development, and so on) remain largely unstudied​.

This embrace of early gender transitions for minors in the United States is increasingly at odds with trends in Europe.

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