Gender-affirming care for transgender adolescents has evolved significantly since the 1980s, with more youth seeking care today than ever before. Despite growing recognition of gender diversity, access to care remains limited due to long waitlists and systemic barriers.

Recent studies show that gender diversity is not rare, with 1.2–2.7% of high school students identifying as transgender and up to 9% expressing some level of gender diversity. Additionally, more adolescents assigned female at birth (AFAB) are initiating care at higher rates than those assigned male at birth (AMAB).

Developmental Considerations in Adolescence:

Adolescence is a critical period marked by physical, cognitive, and emotional growth. Decision-making skills continue to develop, meaning that young people need supportive, well-informed guidance when exploring gender identity and treatment options.

Some key points regarding gender identity development:

• For some, gender identity is clear from childhood, while others recognize their identity during puberty or later.
• Both biological and psychosocial factors contribute to gender identity.
• Longitudinal studies show stability in gender identity among those who receive gender-affirming care in adolescence

Evidence on Gender-Affirming Treatment for Adolescents

• Medical treatments (such as puberty blockers and hormones) have been associated with improved mental health, reduced gender dysphoria, and better overall well-being.
• Puberty suppression gives adolescents time to explore their identity without the distress of irreversible pubertal changes.
• Gender-affirming hormone therapy (GAHT) has been linked to lower rates of depression, anxiety, and suicidal ideation.
• Surgical interventions are rare in adolescence but may be appropriate after thorough evaluation.

Research indicates that adolescents who receive comprehensive assessments before treatment generally do well, with low rates of regret. While detransition can occur, most who detransition do not regret treatment but instead see it as part of their gender exploration.

 For some young children, gender expression can be fluid. However, research shows that gender dysphoria that persists or intensifies into adolescence is unlikely to change. The idea that most gender-diverse children will “grow out of it” is based on outdated, flawed studies that confused gender identity with gender nonconformity (e.g., tomboy behavior).

• Adolescents who experience gender dysphoria during puberty overwhelmingly continue to identify as transgender in adulthood.
• The de Vries et al. (2014) study followed transgender adolescents who underwent puberty blockers, hormone therapy, and surgery. None regretted transition, and their gender identities remained stable into adulthood.
• Early social transition (name, pronouns, clothing) allows exploration in a fully reversible way, helping young people understand their identity before making any medical decisions.

If your child is expressing a persistent and consistent gender identity different from their assigned sex, it is unlikely to be a passing phase.

The WPATH Standards of Care recommend a multidisciplinary approach involving mental health professionals, medical providers, and families. Core recommendations include:

1. Ethical and Professional Standards

• Providers should be licensed, trained, and knowledgeable in gender identity development, adolescent psychology, and neurodivergent care.
• Ongoing professional development is essential.

2. Supportive and Affirming Care

• Exploration of gender should be open and non-directive, allowing youth to express their identity without pressure toward any particular outcome.
• Families, schools, and communities should be involved in fostering acceptance, which is linked to better mental health outcomes.

3. Comprehensive Biopsychosocial Assessment

• A thorough evaluation should assess mental health, cognitive maturity, gender history, and social support before recommending medical interventions.
• Reparative or conversion therapy is explicitly discouraged due to its harmful effects.

4. Medical Considerations

• Puberty blockers (GnRH agonists) can be prescribed once an adolescent reaches Tanner stage 2 of puberty.
• Gender-affirming hormones can be initiated when:
  • Gender incongruence is persistent and well-documented.
  • The adolescent demonstrates emotional and cognitive maturity.
  • Any co-occurring mental health concerns are managed.
  • The adolescent understands the effects on fertility and reproductive health.
• Surgical interventions are recommended only after at least 12 months of hormone therapy, unless hormones are medically contraindicated or undesired.

5. Mental Health Considerations

• TGD adolescents often face higher rates of depression, anxiety, and suicidality, largely due to external stigma and rejection rather than inherent pathology.
• Mental health concerns should be addressed, but they do not need to be "cured" before gender-affirming care can proceed.
• Neurodivergent TGD youth may need additional support and structured decision-making processes.

6. Ongoing Support and Transition to Adult Care

• Adolescents should receive continuous care through medical and psychological support until they transition to adult healthcare providers.
• Providers must ensure that youth and families are fully informed about treatment options, risks, and benefits.

While waiting may seem like the safest option, doing nothing is not neutral. Delaying care can lead to severe distress and worsened mental health outcomes.

• Puberty is irreversible.
  • Once puberty progresses, certain changes (like voice deepening or skeletal growth) cannot be undone.
  • Many trans youth experience intense distress at the onset of unwanted pubertal changes.
• Mental health risks are significantly higher for trans youth denied care.
  • Transgender youth are at a much higher risk of suicide, depression, and self-harm when they cannot access gender-affirming care.
  • A 56 percent reduction in suicide attempt risk is observed when a trans youth’s chosen name and pronouns are respected.
• Waiting can make transition more difficult.
  • Adults who transition later often need more invasive surgeries to correct changes from unwanted puberty.
  • Earlier intervention leads to better psychological and physical outcomes.

In short, waiting is not a neutral decision—it is a decision that can have lasting negative consequences.

 Will my child regret their decision?

• Research shows low rates of regret when care is provided through comprehensive assessment.
• Detransition is rare and often not due to regret, but rather evolving gender understanding or external pressures.

Does social influence cause gender dysphoria?

• There is no credible evidence that social contagion causes transgender identity.
• Some youth may identify later in adolescence due to increased awareness, access to information, and social safety.

Is gender-affirming care experimental?

• While research is ongoing, existing studies strongly support the safety and effectiveness of gender-affirming care.
• Lack of treatment (forcing puberty) is not a neutral act—it can lead to severe distress and long-term harm.

Final Thoughts

Gender-affirming care for adolescents is evidence-based, ethical, and rooted in the fundamental right of young people to access healthcare that aligns with their needs. Comprehensive assessments ensure that care decisions are thoughtful, individualized, and supportive of long-term well-being. Parents play a critical role in providing affirmation, asking informed questions, and supporting their child through this process.

For more information, consider consulting:

• Medical and mental health professionals specializing in transgender care
• Research and guidelines from professional organizations like WPATH, the Endocrine Society, and the American Academy of Pediatrics
• Community organizations that provide resources and support for families with transgender youth

Long-term studies show overwhelmingly positive outcomes for youth who receive gender-affirming medical care.

However, like all studies of trans healthcare, most research is plagued by fairly low sample sizes when compared with research on other treatments that are applicable to a broader subset of the general population.

The most robust longitudinal research comes from the Dutch model, where youth who received puberty blockers and hormones showed:

• Reduced gender dysphoria
• Lower rates of depression and anxiety
• Improved social and educational outcomes
• Better quality of life compared to those who did not receive care

Additionally:

• Delaying treatment can lead to worse mental health outcomes, including increased suicidality
• Starting puberty blockers before irreversible pubertal changes (like voice deepening or breast development) can significantly reduce the need for future surgeries
• There is no evidence that gender-affirming care negatively impacts brain development

The science is clear: When properly assessed, gender-affirming care leads to improved well-being and stability.

• Roberts, C. M., Klein, D. A., Adirim, T. A., Schvey, N. A., & Hisle-Gorman, E. (2022). Continuation of gender-affirming hormones among transgender adolescents and adults. The Journal of Clinical Endocrinology & Metabolism, 107(9), e3937-e3943.
• Turban, J. L., Dolotina, B., Freitag, T. M., King, D., & Keuroghlian, A. S. (2023). Age of Realization and Disclosure of Gender Identity Among Transgender Adults. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 72(6), 852–859. https://doi.org/10.1016/j.jadohealth.2023.01.023
• Leibowitz, S., & de Vries, A. L. C. (2016). Gender dysphoria in adolescence. International Review of Psychiatry, 28(1), 21–35. https://doi.org/10.3109/09540261.2015.1124844
• Arnoldussen, M., Steensma, T. D., Popma, A., van der Miesen, A. I. R., Twisk, J. W. R., & de Vries, A. L. C. (2020). Re-evaluation of the Dutch approach: Are recently referred transgender youth different compared to earlier referrals? European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-020-01691-5
• Aitken, M., Steensma, T. D., Blanchard, R., VanderLaan, D. P., Wood, H., Fuentes, A., & Zucker, K. J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. Journal of Sexual Medicine, 12(3), 756–763. https://doi.org/10.1111/jsm.12817
• Bauer, G. R., Pacaud, D., Couch, R., Metzger, D. L., Gale, L., Gotovac, S., et al. (2021). Transgender youth referred to clinics for gender-affirming medical care in Canada. Pediatrics, 148(1), e2020047266. https://doi.org/10.1542/peds.2020-047266
• Clark, T. C., Lucassen, M. F., Bullen, P., Denny, S. J., Fleming, T. M., Robinson, E. M., & Rossen, F. V. (2014). The health and well-being of transgender high school students: Results from the New Zealand adolescent health survey. Journal of Adolescent Health, 55(1), 93–99. https://doi.org/10.1016/j.jadohealth.2013.11.008
• Cohen-Kettenis, P. T., & Klink, D. (2015). Adolescents with gender dysphoria. Best Practice & Research Clinical Endocrinology & Metabolism, 29(4), 485–495. https://doi.org/10.1016/j.beem.2015.04.005
• de Graaf, N. M., Carmichael, P., Steensma, T. D., Zucker, K. J., & Cohen-Kettenis, P. T. (2018). Psychological functioning in adolescents referred to specialist gender identity clinics across Europe: A clinical comparison study between four clinics. European Child & Adolescent Psychiatry, 27(7), 909–919. https://doi.org/10.1007/s00787-018-1244-2
• de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., 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
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According to longitudinal data from the Dutch model, and studies since then, probably not.

• The de Vries et al. (2014) study found zero cases of regret in transgender adolescents who underwent puberty blockers, hormone therapy, and surgery.
• Detransition is rare (1-2 percent) and often happens due to external pressures like discrimination, family rejection, or lack of access to care, not because the person was never really trans.
• People who detransition rarely regret having transitioned in the first place—many say it was a necessary step in their gender exploration. The oft-publicized stories of detransitioners function primarily in service of political agendas, and are sometimes directly funded by conservative political action organizations.

The real regret we see in studies comes from transgender adults who were denied care in adolescence, leading to severe distress and worsened mental health.

• Evaluations with providers who should be licensed, trained, and knowledgeable in gender identity development, adolescent psychology, and neurodivergent care.
• A thorough evaluation should assess mental health, cognitive maturity, gender history, and social support before recommending medical interventions.
• History collection - birth, medical history, developmental history, gender identity development, mental health history, pubertal timeline, family history - particularly clotting disorders, cancer, or early heart disease
• Physical exam if young person is able/not distressed
  • Examination for pubertal staging
• Baseline labs
• Treatment goals - puberty blockade, menses cessation, hormone treatment
• Counseling - timing, fertility, risks/benefits of treatments

It’s a rare phenomenon (1-2%), but it can happen. However, one important caveat is that the definition of detransition is broader than “I thought I was trans, but I’m not.” Most people who detransition do so not because they “aren’t really trans after all,” but for a variety of other reasons, such as family/external pressure, lack of safety, or further development of gender identity beyond their original stated identity (e.g., transmale —> genderfluid).

Given the amount of anti-trans bias still present in research, it’s challenging to find reliable sources of information on the prevalence of detransition and how important a factor it is to consider for youth seeking care. The most trustworthy source at this time is a Canadian researcher named Kinnon Ross Mackinnon, at York University.

Here are two of his papers exploring the topic of detransition with the nuance and context required to accurately explore the phenomenon (clicking on the title will open the study in a new page).

• Detransition needs further understanding, not controversy
• Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments

Study PDFs: 

Click on the title of each study below to open the PDF in a new page

• Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach 
• Do Clinical Data from Transgender Adolescents Support the Phenomenon of “Rapid Onset Gender Dysphoria”?  
• Adherence to Gender Affirming Hormone Therapy in Transgender Adolescents and Adults: A Retrospective Cohort Study 
• Sex Reassignment of Adolescent Transsexuals: A Follow-up Study
• AAP Policy Statement 2023

Click on the title below to open the presentation in a new page

• Gender-Affirming Medical Care for Adolescents
• Navigating Controversy & Misinformation