Editing Gender dysphoria (section)

== Treatment ==
Treatment for a person diagnosed with GD may include psychological counseling, supporting the individual's [[gender expression]], or may involve physical transition resulting from medical interventions such as hormonal treatment, genital surgery, electrolysis, laser hair removal, chest surgery, breast surgery or other reconstructive surgeries.<ref name="NHS">{{cite web |year=2016 |title=NHS - Treatment - Gender dysphoria |url=https://www.nhs.uk/conditions/gender-dysphoria/treatment/ |access-date=January 10, 2019 |publisher=[[NHS]] |archive-date=November 2, 2013 |archive-url=https://web.archive.org/web/20131102135038/http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Treatment.aspx |url-status=live}}</ref> The goal of treatment may simply be to reduce problems resulting from the person's transgender status, for example, counseling the patient in order to reduce guilt associated with cross-dressing.<ref name="Leiblum-2006">{{Cite book |vauthors=Leiblum S |title=Principles and Practice of Sex Therapy, Fourth Edition |publisher=[[Guilford Press]] |year=2006 |isbn=978-1-59385-349-5 |pages=488–9}}</ref>

Guidelines have been established to aid clinicians. The [[World Professional Association for Transgender Health]] (WPATH) [[Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People|Standards of Care]] are used by some clinicians as treatment guidelines. Others use guidelines outlined in Gianna Israel and Donald Tarver's ''Transgender Care''.<ref>{{cite journal |vauthors=Heyes CJ, Latham JR |date=2018 |title=Trans surgeries and cosmetic surgeries: The politics of analogy |journal=[[Transgender Studies Quarterly]] |volume=5 |number=2 |pages=174–189|doi=10.1215/23289252-4348617 }}</ref> Guidelines for treatment generally follow a "[[harm reduction]]" model.<ref name="AAP">{{cite journal |vauthors=((Committee On Adolescence)) |title=Office-based care for lesbian, gay, bisexual, transgender, and questioning youth |journal=[[Pediatrics (journal)|Pediatrics]] |volume=132 |issue=1 |pages=198–203 |date=July 2013 |pmid=23796746 |doi=10.1542/peds.2013-1282 |quote=However, adolescents with multiple or anonymous partners, having unprotected intercourse, or having substance abuse issues should be tested at shorter intervals. |doi-access=free}}</ref><ref name="GLMA">{{cite web |year=2013 |title=www.glma.org Compendium of Health Profession Association LGBT Policy & Position Statements |publisher=GLMA |url=http://www.glma.org/_data/n_0001/resources/live/GLMA%20Compendium%20of%20Health%20Profession%20Association%20LGBT%20Policy%20and%20Position%20Statements.pdf |access-date=August 27, 2013 |archive-date=November 9, 2020 |archive-url=https://web.archive.org/web/20201109071446/http://www.glma.org/_data/n_0001/resources/live/GLMA%20Compendium%20of%20Health%20Profession%20Association%20LGBT%20Policy%20and%20Position%20Statements.pdf |url-status=live}}</ref><ref name="APA">{{cite web |year=2011 |title=APA Policy Statements on Lesbian, Gay, Bisexual, & Transgender Concerns |url=http://www.apa.org/about/policy/booklet.pdf |access-date=August 27, 2013 |publisher=[[American Psychological Association]] |quote=Be it further resolved that APA recognizes the efficacy, benefit, and necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments |url-status=live |archive-date=January 21, 2022 |archive-url=https://web.archive.org/web/20220121154251/https://www.apa.org/about/policy/booklet.pdf}}</ref>

=== Children ===
{{Main|Gender dysphoria in children}}

Medical, scientific, and governmental organizations have opposed [[conversion therapy]], defined as treatment viewing gender nonconformity as pathological and something to be changed, instead supporting approaches that affirm children's diverse gender identities.<ref name="Lambda">{{cite web |title=Health and Medical Organization Statements on Sexual Orientation, Gender Identity/Expression and 'Reparative Therapy' |url=https://www.lambdalegal.org/publications/health-and-med-orgs-stmts-on-sex-orientation-and-gender-identity |website=lambdalegal.org |publisher=[[Lambda Legal]] |access-date=January 14, 2022 |archive-date=June 15, 2017 |archive-url=https://web.archive.org/web/20170615154255/https://www.lambdalegal.org/publications/health-and-med-orgs-stmts-on-sex-orientation-and-gender-identity |url-status=live}}</ref><ref name="HRC">{{cite web |title=Policy and Position Statements on Conversion Therapy |url=http://www.hrc.org/resources/policy-and-position-statements-on-conversion-therapy |website=[[Human Rights Campaign]] |access-date=April 12, 2017 |archive-date=April 27, 2017 |archive-url=https://web.archive.org/web/20170427021742/http://www.hrc.org/resources/policy-and-position-statements-on-conversion-therapy |url-status=live}}</ref><ref name="APA_Position_2018">{{cite web |title=Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies) |url=https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Conversion-Therapy.pdf |archive-url=https://web.archive.org/web/20211210052014/https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Conversion-Therapy.pdf |archive-date=10 December 2021 |date=December 2018 |author=American Psychiatric Association |publisher=[[American Psychiatric Association]] |quote=While many might identify as questioning, queer, or a variety of other identities, 'reparative' or conversion therapy is based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill and should change ... APA encourages legislation which would prohibit the practice of 'reparative' or conversion therapies that are based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill(references omitted)|author-link=American Psychiatric Association}}</ref> People are more likely to keep having gender dysphoria the more intense their gender dysphoria, cross-gendered behavior, and verbal identification with the desired/experienced gender are (i.e. stating that they ''are'' a different gender rather than ''wish to be'' a different gender).<ref name="Ristori">{{cite journal |vauthors=Ristori J, Steensma TD |title=Gender dysphoria in childhood |journal=[[International Review of Psychiatry]] |volume=28 |issue=1 |pages=13–20 |date=January 2, 2016 |pmid=26754056 |doi=10.3109/09540261.2015.1115754 |s2cid=5461482}}</ref>

Professionals who treat gender dysphoria in children sometimes prescribe [[puberty blocker]]s to delay the onset of puberty until a child is believed to be old enough to make an informed decision on whether hormonal or surgical gender reassignment is in their best interest.<ref>''The Transgendered Child: A Handbook for Families and Professionals'' (Brill and Pepper, 2008){{full citation needed|date=May 2016}}{{page needed|date=May 2016}}</ref><ref name="Alleyne">{{cite news |vauthors=Alleyne R |date=April 15, 2011 |title=Puberty blocker for children considering sex change |work=[[The Daily Telegraph]] |url=https://www.telegraph.co.uk/news/health/news/8454002/Puberty-blocker-for-children-considering-sex-change.html |url-access=subscription |url-status=live |access-date=December 1, 2020 |archive-url=https://ghostarchive.org/archive/20220111/https://www.telegraph.co.uk/news/health/news/8454002/Puberty-blocker-for-children-considering-sex-change.html |archive-date=January 11, 2022}}{{cbignore}}</ref> Short-term side effects of puberty blockers include headaches, fatigue, insomnia, muscle aches and changes in breast tissue, mood, and weight.<ref>{{Cite web |title=Puberty Blockers |url=https://www.stlouischildrens.org/conditions-treatments/transgender-center/puberty-blockers |access-date=August 18, 2022 |website=www.stlouischildrens.org |language=en |archive-url=https://web.archive.org/web/20220701000713/https://www.stlouischildrens.org/conditions-treatments/transgender-center/puberty-blockers |archive-date=July 1, 2022}}</ref> Research on the long-term effects on brain development, cognitive function, fertility, and sexual function is limited.<ref name="Reuters-2022">{{Cite news |date=October 6, 2022 |title=As children line up at gender clinics, families confront many unknowns |language=en |work=[[Reuters]] |url=https://www.reuters.com/investigates/special-report/usa-transyouth-care/ |access-date=October 10, 2022 |archive-url=https://web.archive.org/web/20221006130806/https://www.reuters.com/investigates/special-report/usa-transyouth-care/ |archive-date=October 6, 2022}}</ref><ref name="autogenerated1">{{cite journal |vauthors=Rosenthal SM |title=Transgender youth: current concepts |journal=[[Annals of Pediatric Endocrinology & Metabolism]] |volume=21 |issue=4 |pages=185–192 |date=December 2016 |pmid=28164070 |pmc=5290172 |doi=10.6065/apem.2016.21.4.185 |quote=The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development.}}</ref><ref name="deVries2012">{{cite journal |vauthors=de Vries AL, Cohen-Kettenis PT |title=Clinical management of gender dysphoria in children and adolescents: the Dutch approach |journal=[[Journal of Homosexuality]] |volume=59 |issue=3 |pages=301–320 |date=2012 |pmid=22455322 |doi=10.1080/00918369.2012.653300 |s2cid=11731779}}</ref>

A review published in ''Child and Adolescent Mental Health'' found that puberty blockers are reversible, and that they are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.<ref name="pubmed.ncbi.nlm.nih.gov">{{cite journal |vauthors=Rew L, Young CC, Monge M, Bogucka R |title=Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature |journal=[[Child and Adolescent Mental Health]] |volume=26 |issue=1 |pages=3–14 |date=February 2021 |pmid=33320999 |doi=10.1111/camh.12437 |url=https://pubmed.ncbi.nlm.nih.gov/33320999/ |access-date=June 5, 2022 |url-status=live |quote=Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. |s2cid=229282305 |archive-url=https://web.archive.org/web/20220520212910/https://pubmed.ncbi.nlm.nih.gov/33320999/ |archive-date=May 20, 2022}}</ref>

According to the [[American Psychiatric Association]], "Due to the dynamic nature of puberty development, lack of gender-affirming interventions (i.e. social, psychological, and medical) is not a neutral decision; youth often experience worsening dysphoria and negative impact on mental health as the incongruent and unwanted puberty progresses. Trans-affirming treatment, such as the use of puberty suppression, is associated with the relief of emotional distress, and notable gains in psychosocial and emotional development, in trans and gender diverse youth".<ref name="APA-Position">{{Cite web |url=https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Transgender-Gender-Diverse-Youth.pdf |archive-url=https://web.archive.org/web/20201207160233/https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Transgender-Gender-Diverse-Youth.pdf |archive-date=December 7, 2020 |url-status=live |title=Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth}}</ref>

In its position statement published December 2020, the [[Endocrine Society]] stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care. They noted a decrease in suicidal ideation among youth who have access to gender-affirming care and comparable levels of depression to cisgender peers among socially transitioned pre-pubertal youth.<ref name="endocrine-society-2020">{{Cite web |date=December 15, 2020 |title=Transgender Health: An Endocrine Society Position Statement |url=https://www.endocrine.org/advocacy/position-statements/transgender-health |access-date=June 15, 2022 |website=www.endocrine.org |publisher=The Endocrine Society |language=en |archive-url=https://web.archive.org/web/20201225153455/https://www.endocrine.org/advocacy/position-statements/transgender-health |archive-date=December 25, 2020}}</ref> In its 2017 guideline on treating those with gender dysphoria, it recommends puberty blockers be started when the child has started puberty ([[Tanner scale|Tanner Stage 2]] for breast or genital development) and cross-sex hormones be started at 16, though they note "there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD/gender incongruence". They recommend a multidisciplinary team of medical and mental health professionals manage the treatment for those under 18 and recommend "monitoring clinical pubertal development every 3 to 6 months and laboratory parameters every 6 to 12 months during sex hormone treatment".<ref name="Hembree">{{cite journal |vauthors=Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG |display-authors=6 |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=[[The Journal of Clinical Endocrinology and Metabolism]] |volume=102 |issue=11 |pages=3869–3903 |date=November 2017 |pmid=28945902 |doi=10.1210/jc.2017-01658 |doi-access=free}}</ref>

The [[World Professional Association for Transgender Health]]'s Standards of Care 8, published in 2022, declare puberty blocking medication as "medically necessary", and recommends them for usage in transgender adolescents once the patient has reached Tanner stage 2 of development, and state that longitudinal data shows improved outcomes for transgender patients who receive them.<ref>{{cite journal |vauthors=Coleman E, Radix AE, Bouman WP, Brown GR, de Vries AL, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HF, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TL, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BP, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J |display-authors=6 |title=Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 |journal=[[International Journal of Transgender Health]] |volume=23 |issue=Suppl 1 |pages=S1–S259 |year=2022 |pmid=36238954 |pmc=9553112 |doi=10.1080/26895269.2022.2100644}}</ref> Some medical professionals disagree that adolescents are cognitively mature enough to make a decision with regard to hormone therapy or surgery, and advise that irreversible genital procedures should not be performed on individuals under the age of legal consent in their respective country.<ref name="Maddux2">{{cite book |url=https://books.google.com/books?id=eOlzCgAAQBAJ&pg=PA464 |title=Psychopathology: Foundations for a Contemporary Understanding |vauthors=Maddux JE, Winstead BA |publisher=[[Routledge]] |year=2015 |isbn=978-1317697992 |pages=464–465}}</ref>

A review commissioned by the UK Department of Health found that there was very low certainty of quality of evidence about puberty blocker outcomes in terms of mental health, quality of life and impact on gender dysphoria.<ref>{{Cite web|title=Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria |url=https://arms.nice.org.uk/resources/hub/1070905/attachment|url-status=live|access-date=2 April 2021 |quote=The critical outcomes for decision making are the impact on gender dysphoria, mental health and quality of life. The quality of evidence for these outcomes was assessed as very low certainty using modified GRADE.|archive-date=2 April 2021|archive-url= https://web.archive.org/web/20210402083804/https://arms.nice.org.uk/resources/hub/1070905/attachment}}</ref> The Finnish government commissioned a review of the research evidence for treatment of minors and the [[Ministry of Social Affairs and Health|Finnish Ministry of Health]] concluded that there are no research-based health care methods for minors with gender dysphoria.<ref>{{Cite web |title=Finnish guidelines for treatment of child and adolescent gender dysphoria |date=March 2021 |url=https://palveluvalikoima.fi/documents/1237350/22895008/Alaik%C3%A4iset_suositus.pdf/c987a74c-dfac-d82f-2142-684f8ddead64/Alaik%C3%A4iset_suositus.pdf|url-status=live|access-date=22 April 2021 |website=Council for Choices in Health Care (COHERE)|quote=Terveydenhuoltolain mukaan (8§) terveydenhuollon toiminnan on perustuttava näyttöön ja hyviin hoito- ja toimintakäytäntöihin. Alaikäisten osalta tutkimusnäyttöön perustuvia terveydenhuollon menetelmiä ei ole.|quote-page=6|trans-quote=According to the Health Care Act (Section 8), health care activities must be based on evidence and good care and operating practices. There are no research-based health care methods for minors. [translation provided by Wikipedia]|archive-date=3 December 2020|archive-url=https://web.archive.org/web/20201203061437/https://palveluvalikoima.fi/documents/1237350/22895008/Alaik%C3%A4iset_suositus.pdf/c987a74c-dfac-d82f-2142-684f8ddead64/Alaik%C3%A4iset_suositus.pdf}}</ref> Nevertheless, they recommend the use of puberty blockers for minors on a case-by-case basis, and the [[American Academy of Pediatrics]] state that "pubertal suppression in children who identify as TGD [transgender and gender diverse] generally leads to improved psychological functioning in adolescence and young adulthood."<ref>{{cite journal | vauthors = Rafferty J | title = Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents | journal = [[Pediatrics (journal)|Pediatrics]] | volume = 142 | issue = 4 | pages = e20182162 | date = October 2018 | pmid = 30224363 | doi = 10.1542/peds.2018-2162 | doi-access = free }}</ref>

In the [[United States]], several states have introduced or are considering legislation that would prohibit the use of puberty blockers in the treatment of transgender children.<ref name="Safer">{{cite news |vauthors=Safer JD |title=Controversial pubertal blocker legislation may bring unintended consequences for children |work=Healio |date=February 17, 2020 |url=https://www.healio.com/news/endocrinology/20200217/controversial-pubertal-blocker-legislation-may-bring-unintended-consequences-for-children |access-date=15 December 2020 |url-status=live |archive-date=December 30, 2020 |archive-url=https://web.archive.org/web/20201230155709/https://www.healio.com/news/endocrinology/20200217/controversial-pubertal-blocker-legislation-may-bring-unintended-consequences-for-children}}</ref> The [[American Medical Association]],<ref>{{Cite web |url=https://www.ama-assn.org/print/pdf/node/66096 |title=AMA fights to protect health care for transgender patients |date=March 26, 2021 |publisher=American Medical Association |series=State Advocacy Update |access-date=June 29, 2021 |archive-date=June 29, 2021 |archive-url=https://web.archive.org/web/20210629100649/https://www.ama-assn.org/print/pdf/node/66096 |url-status=live}}</ref> the [[Endocrine Society]],<ref>{{Cite web |url=https://www.endocrine.org/news-and-advocacy/news-room/2019/transgender-custody-statement |title=Endocrine Society urges policymakers to follow science on transgender health: Texas custody case prompts unfounded claims |date=October 28, 2019 |location=Washington, DC |website=Endocrine Society |type=Press release |access-date=June 11, 2021 |url-status=live |archive-date=June 11, 2021 |archive-url=https://web.archive.org/web/20210611144435/https://www.endocrine.org/news-and-advocacy/news-room/2019/transgender-custody-statement}}</ref> the [[American Psychological Association]],<ref>{{Cite web |url=https://www.apa.org/pi/lgbt/resources/policy/issues/gender-affirmative-care |title=Criminalizing Gender Affirmative Care with Minors: Suggested Discussion Points With Resources to Oppose Transgender Exclusion Bills |website=American Psychological Association |access-date=2021-06-29 |url-status=live |archive-date=2021-06-29 |archive-url=https://web.archive.org/web/20210629100650/https://www.apa.org/pi/lgbt/resources/policy/issues/gender-affirmative-care}}</ref> the [[American Academy of Child and Adolescent Psychiatry]]<ref>{{Cite web |title=AACAP Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse Youth |website=[[American Academy of Child and Adolescent Psychiatry]] |date=November 8, 2019 |url=https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx |access-date=June 29, 2021 |archive-date=June 7, 2021 |archive-url=https://web.archive.org/web/20210607005936/https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx |url-status=live}}</ref> and the [[American Academy of Pediatrics]]<ref>{{Cite news |title=FAQ: What you need to know about transgender children |vauthors=Schmidt S |newspaper=[[The Washington Post]] |date=April 22, 2021 |url=https://www.washingtonpost.com/dc-md-va/2021/04/22/transgender-child-sports-treatments/ |url-status=live |access-date=June 29, 2021 |archive-date=16 June 2021 |archive-url=https://web.archive.org/web/20210616184819/https://www.washingtonpost.com/dc-md-va/2021/04/22/transgender-child-sports-treatments/}}</ref> oppose bans on puberty blockers for transgender children. In the UK, in the case of ''[[Bell v Tavistock]]'', an appeal court, overturning the original decision, ruled that children under 16 could give consent to receiving puberty blockers.<ref>{{cite news |vauthors=Siddique H |title=Appeal court overturns UK puberty blockers ruling for under-16s |work=[[The Guardian]] |date=17 September 2021 |url=https://www.theguardian.com/society/2021/sep/17/appeal-court-overturns-uk-puberty-blockers-ruling-for-under-16s-tavistock-keira-bell |access-date=September 17, 2021 |archive-date=September 17, 2021 |archive-url= https://web.archive.org/web/20210917131838/https://www.theguardian.com/society/2021/sep/17/appeal-court-overturns-uk-puberty-blockers-ruling-for-under-16s-tavistock-keira-bell |url-status=live}}</ref> In 2022, the [[National Board of Health and Welfare]] in [[Sweden]] issued new guidelines recommending that puberty blockers only be given in "exceptional cases" and said that their use was grounded in "uncertain science." Instead, they recommended child psychiatric treatment, psychosocial interventions, and suicide prevention measures to be offered by clinicians.<ref>{{cite news |vauthors=Milton J |date=February 23, 2022 |title=Swedish health board wants doctors to stop prescribing life-saving puberty blockers |work=[[PinkNews]] |url=https://www.pinknews.co.uk/2022/02/23/sweden-trans-healthcare-puberty-blockers/ |access-date=October 12, 2022}}</ref><ref>{{cite news |vauthors=Ghorayshi A |date=July 28, 2022 |title=England Overhauls Medical Care for Transgender Youth |work=[[The New York Times]] |url=https://www.nytimes.com/2022/07/28/health/transgender-youth-uk-tavistock.html |access-date=October 12, 2022}}</ref>

=== Psychological treatments ===
{{Main|Psychotherapy}}
Until the 1970s, psychotherapy was the primary treatment for gender dysphoria and generally was directed to helping the person adjust to their assigned sex. Psychotherapy is any therapeutic interaction that aims to treat a psychological problem. Psychotherapy may be used in addition to biological interventions, although some clinicians use only psychotherapy to treat gender dysphoria.<ref name="treatment review">{{cite journal |vauthors=Gijs L, Brawaeys A |year=2007 |title=Surgical Treatment of Gender Dysphoria in Adults and Adolescents: Recent Developments, Effectiveness, and Challenges |journal=[[Annual Review of Sex Research]] |volume=18 |issue=178–224|pages=178–224 |doi=10.1080/10532528.2007.10559851 }}</ref> Psychotherapeutic treatment of GD involves helping the patient to adapt to their gender incongruence or to explorative investigation of confounding co-occurring<ref name=":3">{{cite journal | vauthors = Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N | title = Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development | journal = [[Child and Adolescent Psychiatry and Mental Health]] | volume = 9 | pages = 9 | date = 2015 | pmid = 25873995 | pmc = 4396787 | doi = 10.1186/s13034-015-0042-y | doi-access = free }}</ref><ref>{{Cite web |website=Swedish National Board of Health and Welfare |date=Feb 2020 |title=Development of the diagnosis gender dysphoria |language=sv |url=https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2020-2-6600.pdf |url-status=live |access-date=March 13, 2021 |archive-date=March 8, 2021 |archive-url=https://web.archive.org/web/20210308184807/https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2020-2-6600.pdf}}</ref><ref>{{cite journal | vauthors = Kozlowska K, Chudleigh C, McClure G, Maguire AM, Ambler GR | title = Attachment Patterns in Children and Adolescents With Gender Dysphoria | journal = Frontiers in Psychology | volume = 11 | pages = 582688 | date = 2021-01-12 | pmid = 33510668 | pmc = 7835132 | doi = 10.3389/fpsyg.2020.582688 | doi-access = free }}</ref><ref>{{cite journal | vauthors = D'Angelo R, Syrulnik E, Ayad S, Marchiano L, Kenny DT, Clarke P | title = One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria | journal = Archives of Sexual Behavior | volume = 50 | issue = 1 | pages = 7–16 | date = January 2021 | pmid = 33089441 | pmc = 7878242 | doi = 10.1007/s10508-020-01844-2 }}</ref> mental health issues. Attempts to alleviate GD by changing the patient's gender identity to reflect assigned sex have been ineffective and are regarded as [[conversion therapy]] by most health organizations.<ref name="Lambda" /><ref name="merck manual">{{cite book|author=George R. Brown, MD|title=The Merck Manual of Diagnosis and Therapy|title-link=Merck Manual of Diagnosis and Therapy|date=July 20, 2011|publisher=[[Merck & Co.]], Inc.|isbn=978-0-911910-19-3|editor1=Robert S. Porter, MD|edition=19th|location=[[Whitehouse Station, NJ]], USA|pages=1740–1747|chapter=Chapter 165 Sexuality and Sexual Disorders|display-editors=etal}}</ref>{{rp|1741}}

=== Biological treatments ===
{{Main|Gender-affirming care}}
Biological treatments physically alter [[Primary sex characteristic|primary]] and [[Secondary sex characteristic|secondary]] sex characteristics to reduce the discrepancy between an individual's physical body and gender identity.<ref name="care guidelines">{{cite journal | vauthors = Bockting W, Knudson G, Goldberg J |date=January 2006|title=Counselling and Mental Health Care of Transgender Adults and Loved Ones|journal=International Journal of Transgenderism |volume=9|issue=3–4 |pages=35–82 |doi=10.1300/J485v09n03_03 |s2cid=71503744|quote=As per Figure 1, delusions about sex or gender, dissociative disorders, thought disorders, or obsessive or compulsive features should be evaluated and treated prior to proceeding with hormone therapy or surgery. Thought disorders, dissociative disorders, and obsessive-compulsive disorders can, rarely, cause a transient wish for sex reassignment which disappears or significantly lessens when the underlying mental health condition is treated. It is important to treat these disorders before proceeding with hormones or surgery to ensure that the desire for alteration of primary or secondary sex characteristics is not a temporary desire.}} See also [https://www.wpath.org/publications/soc WPATH Standards of Care, version 7] {{Webarchive|url=https://web.archive.org/web/20150814230505/http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care%2C%20V7%20Full%20Book.pdf |date=2015-08-14 }}, page 23: "The role of mental health professionals includes making reasonably sure that the gender dysphoria is not secondary to or better accounted for by other diagnoses." And the paradigmatic [http://dx.doi.org/10.1080/00918369.2012.653300 Dutch model] {{Webarchive|url=https://web.archive.org/web/20220609011001/https://www.tandfonline.com/doi/abs/10.1080/00918369.2012.653300 |date=2022-06-09 }} for consideration of comorbid conditions before proceeding with treatment for childhood onset.</ref> Biological treatments for GD are typically undertaken in conjunction with psychotherapy; however, the [[HBIGDA-SOC|WPATH Standards of Care]] state that psychotherapy should not be an absolute requirement for biological treatments.<ref name="SOC28">{{cite web |title=Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People |url=https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf |publisher=World Professional Association for Transgender Health |access-date=15 March 2021 |pages=28–29 |archive-date=18 March 2021 |archive-url=https://web.archive.org/web/20210318100049/https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf |url-status=live }}</ref>

Hormonal treatments have been shown to reduce a number of symptoms of psychiatric distress associated with gender dysphoria.<ref name = Neuroimaging>{{cite journal | vauthors = Altinay M, Anand A | title = Neuroimaging gender dysphoria: a novel psychobiological model | journal = Brain Imaging and Behavior | volume = 14 | issue = 4 | pages = 1281–1297 | date = August 2020 | pmid = 31134582 | doi = 10.1007/s11682-019-00121-8 | url = https://link.springer.com/article/10.1007/s11682-019-00121-8 | url-status = live | quote = A recently published study (Colizzi et al. 2014), where 118 patients were followed before and 12 months after HRT revealed that 14% of the patients had comorbid Axis-I psychiatric diagnosis. Psychiatric distress and impairment were found to be higher in the beginning phase of the study but after HRT, there was a significant improvement in major depressive disorder, anxiety and functional impairment. Similarly, Fisher and colleagues' (Fisher et al. 2013) 2013 paper suggests that the dysfunction and impairment in the transgender population is highly associated with lack of HRT, which may suggest that at least a fraction of the impairment that was documented as comorbid Axis-I psychiatric disorders could in fact be impairment from GD. Finally, a metanalysis done by Dhejne and colleagues (Dhejne et al. 2016) reviewed 38 longitudinal studies that investigated psychiatric comorbidities pre and post gender affirmation treatments in transgender people with GD. The results of this analysis indicate that depression and GAD do have higher prevalence in transgender population but this finding was isolated to baseline (pre-gender affirmation treatments) where after gender affirmation therapies, rate of psychiatric comorbidities decreased to cisgender population levels | s2cid = 167207854 | archive-url = https://web.archive.org/web/20211021113310/https://link.springer.com/article/10.1007/s11682-019-00121-8 | archive-date = 2021-10-21 }}</ref> A WPATH commissioned systematic review of the outcomes of hormone therapy "found evidence that gender-affirming hormone therapy may be associated with improvements in [quality of life] scores and decreases in depression and anxiety symptoms among transgender people." The strength of the evidence was low due to methodological limitations of the studies undertaken.<ref>{{cite journal | vauthors = Baker KE, Wilson LM, Sharma R, Dukhanin V, McArthur K, Robinson KA | title = Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review | journal = Journal of the Endocrine Society | volume = 5 | issue = 4 | pages = bvab011 | date = April 2021 | pmid = 33644622 | pmc = 7894249 | doi = 10.1210/jendso/bvab011 | quote = This systematic review of 20 studies found evidence that gender-affirming hormone therapy may be associated with improvements in QOL scores and decreases in depression and anxiety symptoms among transgender people. Associations were similar across gender identity and age. The strength of evidence for these conclusions is low due to methodological limitations. | doi-access = free }}</ref> Some literature suggests that gender-affirming surgery is associated with improvements in quality of life and decreased incidence of depression.<ref>{{cite journal | vauthors = Wernick JA, Busa S, Matouk K, Nicholson J, Janssen A | title = A Systematic Review of the Psychological Benefits of Gender-Affirming Surgery | journal = The Urologic Clinics of North America | volume = 46 | issue = 4 | pages = 475–486 | date = November 2019 | pmid = 31582022 | doi = 10.1016/j.ucl.2019.07.002 | url = https://www.sciencedirect.com/science/article/pii/S0094014319300497 | access-date = 2021-12-27 | series = Gender Affirming Surgery | s2cid = 201997501 }}</ref> Those who choose to undergo gender-affirming surgery report high satisfaction rates with the outcome, though these studies have limitations including risk of bias (lack of randomization, lack of controlled studies, self-reported outcomes) and high loss to follow up.<ref name=":5" /><ref>{{cite journal | vauthors = Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, Erwin PJ, Montori VM | title = Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes | journal = Clinical Endocrinology | volume = 72 | issue = 2 | pages = 214–231 | date = February 2010 | pmid = 19473181 | doi = 10.1111/j.1365-2265.2009.03625.x | url = https://pubmed.ncbi.nlm.nih.gov/19473181/ | access-date = 2021-07-17 | url-status = live | quote = The evidence in this review is of very low quality9, 10 due to the serious methodological limitations of included studies. Studies lacked bias protection measures such as randomization and control groups, and generally depended on self-report to ascertain the exposure (i.e. hormonal therapy was self-reported as opposed to being extracted from medical records). Our reliance on reported outcome measures may also indicate a higher risk of reporting bias within the studies. Statistical heterogeneity of the results was also significant. | s2cid = 19590739 | archive-url = https://web.archive.org/web/20210717025223/https://pubmed.ncbi.nlm.nih.gov/19473181/ | archive-date = 2021-07-17 }}</ref><ref>{{cite journal | vauthors = Sutcliffe PA, Dixon S, Akehurst RL, Wilkinson A, Shippam A, White S, Richards R, Caddy CM | display-authors = 6 | title = Evaluation of surgical procedures for sex reassignment: a systematic review | journal = Journal of Plastic, Reconstructive & Aesthetic Surgery | volume = 62 | issue = 3 | pages = 294–306; discussion 306–308 | date = March 2009 | pmid = 18222742 | doi = 10.1016/j.bjps.2007.12.009 | url = https://pubmed.ncbi.nlm.nih.gov/18222742/ | access-date = 2021-07-17 | url-status = live | quote = The evidence concerning gender reassignment surgery in both MTF and FTM transsexism has several limitations in terms of: (a) lack of controlled studies, (b) evidence has not collected data prospectively, (c) high loss to follow up and (d) lack of validated assessment measures. Some satisfactory outcomes were reported, but the magnitude of benefit and harm for individual surgical procedures cannot be estimated accurately using the current available evidence. | archive-url = https://web.archive.org/web/20210717025221/https://pubmed.ncbi.nlm.nih.gov/18222742/ | archive-date = 2021-07-17 }}</ref>

Disagreement among practitioners regarding treatment of adolescents is in part due to the lack of long-term data.<ref name ="Kaltiala-Heino" >{{cite journal |vauthors=Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L |title=Gender dysphoria in adolescence: current perspectives |journal=[[Adolescent Health, Medicine and Therapeutics]] |volume=9 |pages=31–41 |date=March 2, 2018 |pmid=29535563 |pmc=5841333 |doi=10.2147/AHMT.S135432 |quote="for the majority of adolescent-onset cases, GD presented in the context of severe mental disorders and general identity confusion. In such situations, appropriate treatment for psychiatric comorbidities may be warranted before conclusions regarding gender identity can be drawn."; "There is still no clear consensus regarding hormonal treatment for adolescents because long-term data are unavailable"; "In a nationwide long-term follow-up study of adult cases, psychiatric morbidity, suicide attempts and suicide mortality persisted as elevated after juridical and medical SR." |doi-access=free}}</ref> Young people qualifying for biomedical treatment according to the Dutch model<ref>{{cite journal |vauthors=Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ |title=The treatment of adolescent transsexuals: changing insights |journal=The Journal of Sexual Medicine |volume=5 |issue=8 |pages=1892–1897 |date=August 2008 |pmid=18564158 |doi=10.1111/j.1743-6109.2008.00870.x |url=https://pubmed.ncbi.nlm.nih.gov/18564158/ |access-date=April 14, 2021 |url-status=live |archive-url=https://web.archive.org/web/20210413032947/https://pubmed.ncbi.nlm.nih.gov/18564158/ |archive-date=April 13, 2021}}</ref><ref>{{cite journal |vauthors=de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT |title=Young adult psychological outcome after puberty suppression and gender reassignment |journal=Pediatrics |volume=134 |issue=4 |pages=696–704 |date=October 2014 |pmid=25201798 |doi=10.1542/peds.2013-2958 |url=https://pubmed.ncbi.nlm.nih.gov/25201798/ |access-date=April 14, 2021 |url-status=live |s2cid=18155489 |archive-url=https://web.archive.org/web/20210413032943/https://pubmed.ncbi.nlm.nih.gov/25201798/ |archive-date=April 13, 2021}}</ref> (including having GD from early childhood which intensifies at puberty and absence of co-occurring psychiatric conditions that could challenge diagnosis or treatment) found reduction in gender dysphoria, although limitations to these outcome studies have been noted, such as lack of controls or considering alternatives like psychotherapy.<ref>{{cite journal |vauthors=Zucker KJ |title=Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues |journal=[[Archives of Sexual Behavior]] |volume=48 |issue=7 |pages=1983–1992 |date=October 2019 |pmid=31321594 |doi=10.1007/s10508-019-01518-8 |url=https://doi.org/10.1007/s10508-019-01518-8 |access-date=April 14, 2021 |url-status=live |quote=In the Dutch model, several factors were identified in deeming adolescent eligibility for early biomedical treatment. According to Cohen-Kettenis, Delemarre-van de Waal, and Gooren (2008), these included the following: (1) the presence of gender dysphoria from early childhood on; (2) an exacerbation of the gender dysphoria after the first signs of puberty; (3) the absence of psychiatric comorbidity that would interfere with a diagnostic evaluation or treatment; (4) adequate psychological and social support during treatment; and (5) a demonstration of knowledge of the sex/gender reassignment process. Several studies have reported on the benefits of this therapeutic protocol in reducing gender dysphoria (e.g., de Vries et al., 2014, which is the best study to date). Of course, one should bear in mind some of the limitation to these outcome studies, including the fact that not all assessed adolescents were deemed eligible for the treatment protocol (and thus we know relatively little about the longer-term outcomes of these youth) and that study designs have not included alternative treatment options (such as psychosocial therapy) or even being assigned to a wait-list control condition |s2cid=197663705 |archive-url=https://web.archive.org/web/20220609011010/https://link.springer.com/article/10.1007/s10508-019-01518-8 |archive-date=June 9, 2022}}</ref>{{unreliable medical source|reason=Author is, and was at the time of publication, editor-in-chief of this journal. This may count as self-published.|date=September 2024}}

In its position statement published December 2020, the [[Endocrine Society]] stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care. They noted a decrease in suicidal ideation among youth who have access to gender-affirming care and comparable levels of depression to cisgender peers among socially transitioned pre-pubertal youth.<ref name="endocrine-society-2020"/>

A review published in ''Child and Adolescent Mental Health'' found that puberty blockers are fully reversible, and that they are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.<ref name="pubmed.ncbi.nlm.nih.gov"/>

More rigorous studies are needed to assess the effectiveness, safety, and long-term benefits and risks of hormonal and surgical treatments.<ref name=":5">{{cite journal |vauthors=Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG |display-authors=6 |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=[[Journal of Clinical Endocrinology and Metabolism]] |volume=102 |issue=11 |pages=3869–3903 |date=November 2017 |pmid=28945902 |doi=10.1210/jc.2017-01658 |quote="In the future, we need more rigorous evaluations of the effectiveness and safety of endocrine and surgical protocols.Specifically, endocrine treatment protocols for GD/gender incongruence should include the careful assessment of the following: (1) the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development); [...] and (4) the risks and benefits of gender-affirming hormone treatment in older transgender people." "Future research is needed to ascertain the potential harm of hormonal therapies (176)." "The satisfaction rate with surgical reassignment of sex is now very high (187)." "Owing to the lack of controlled studies, incomplete follow-up, and lack of valid assessment measures, evaluating various surgical approaches and techniques is difficult." "Several postoperative studies report significant long-term psychological and psychiatric pathology (259–261)." "We need more studies with appropriate controls that examine long-term quality of life, psychosocial outcomes, and psychiatric outcomes to determine the long-term benefits of surgical treatment." | doi-access = free }}</ref> For instance, a 2020 Cochrane review found insufficient evidence to determine whether feminizing hormones were safe or effective, due to the lack of "completed studies that met [their] inclusion criteria."<ref>{{cite journal |vauthors=Haupt C, Henke M, Kutschmar A, Hauser B, Baldinger S, Saenz SR, Schreiber G |title=Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women |journal=[[The Cochrane Database of Systematic Reviews]] |volume=2020 |issue=11 |pages=CD013138 |date=November 2020 |pmid=33251587 |pmc=8078580 |doi=10.1002/14651858.cd013138.pub2 |quote=We found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition.}}</ref> Several studies have found significant long-term psychological and psychiatric pathology after surgical treatments.<ref name=":5" />

In 2021, a review published in ''Plastic and Reconstructive Surgery'' found that about 1% (95% [[confidence interval|CI]] <1%–2%) of people who undergo gender-affirming surgery regret the decision. It concluded that "There is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population."<ref>{{cite journal |vauthors=Bustos VP, Bustos SS, Mascaro A, Del Corral G, Forte AJ, Ciudad P, Kim EA, Langstein HN, Manrique OJ |display-authors=6 |title=Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence |journal=Plastic and Reconstructive Surgery. Global Open |volume=9 |issue=3 |pages=e3477 |date=March 2021 |pmid=33968550 |pmc=8099405 |doi=10.1097/GOX.0000000000003477 }}</ref>