Editing Gender dysphoria (section)

=== 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>