Management of the Gender Dysphoric Adolescent

Michelle K Stanford, MD

President Catholic Medical Association USA

I would like to start by stressing the IMPORTANCE OF HANDLING ANYONE WHO IS CLOSE TO YOU EXPERIENCING GENDER DYSPHORIA WITH TENDERNESS AND COMPASSION, Telling the TRUTH WITH LOVE. If I can share one thing, I have learned from working with patients and families with this struggle, there is significant pain and suffering that they are experiencing. So we must lead with God’s Mercy and love when helping people in this area.

We begin by asking God for his Heartfelt Mercy for people who are affected by gender dysphoria – who struggle to know and understand their God given identity as a son or daughter of God. We should pray for those who struggle as well as medical professionals who are participating in these harmful treatments.

We no longer live in an age of Christendom but one of mission territory. As Christians, this gives us the opportunity to be the light in this darkness. How we love others should be an example of God’ s love to people who suffer from confusion around their sexuality/gender identity.

We can gain some understanding from a document that Pope Fracis approved, entitled “Declaration “Dignitas Infinita” on Human Dignity. “This dignity of every human being can be understood as “infinite” as JPII affirmed in a meeting for people living with various limitations or disabilities. He said this shows how human dignity transcends all outward appearances and specific aspects of people’s lives.” … (19) “Jesus brought the great novelty of recognizing the dignity of every person, especially those who are considered, “unworthy”. This new principle in human history -which emphasizes that individuals are even more “worthy” of our respect and love when they are weak, scorned or suffering, even to the point of losing the human “figure” – has changed the face of the world.”

The document comments specifically on the gender ideology, “It needs to be emphasized that “biological sex and the socio-cultural role of sex (gender) can be distinguished but not separated.” “Therefore, all attempts to obscure reference to the ineliminable sexual difference between man and woman are to be rejected: “We cannot separate the masculine and feminine from God’s work of creation, which is prior to all our decisions and experiences, and where biological elements exist which are impossible to ignore. Only by acknowledging and accepting this difference in reciprocity can each person fully discover themselves, their dignity and their identity.”

WE ARE HAVE BEEN EXPERCING A CRISIS IN OUR YOUTH AROUND THE UNDERSTANDING OF BIOLOGICAL SEX.

Gender dysphoria refers to the feeling that one’s gender is not in agreement with one’s biological sex. Gender dysphoria is the experience of “disconnect” between the objective reality of the child’s body and the child’s subjective self-perception that is accompanied by emotional distress.

You will often hear the term – “gender affirming care”, this refers to a patient care model that begins with social transitions, puberty blockers, sex steroid hormones and ultimately surgical procedures to permanently alter sexual organs.

Here are some facts about the safety and efficacy of current management approaches.

Prior to the widespread use of transgender interventions, most gender dysphoric youth resolved their dysphoria by young adulthood. BEFORE the current medical interventions where introduced the medical studies around youth experiencing distress over their biological sex – 80-98% of the time with NO INTERVENTION the distress resolved naturally
Lack of objective diagnostic criteria – most patients self-diagnose themselves as there is not confirmatory test or questionnaire that can give confirmation.
There is evidence that transgender interventions harm adolescents.

These interventions include: Social transition, puberty blockers, cross sex hormones and surgery.

It is often cited by gender affirming physicians that puberty blockers are “temporary and reversible”. Not only are they not fully reversible, they cause harm.

In the spring of 2024 National Health Service of England, released the Cass Report,” The review was conducted Dr Hilary Cass, a former president of The Royal College of Pediatrics and Child Health. Dr Cass reviewed all available research papers and conducted an extensive program of engagement with young people, parents, clinicians and other associated professionals. The review stated that the current studies show “no reliable evidence base upon which to make clinical decisions” and it “identifies several possible irreversible consequences when children are given puberty blockers.” The report found that most of the 23 clinical guidelines reviewed were not independent or evidence-based.

Some of the harms associated with gender affirming interventions include:

● Medical harms of puberty blockers when used for gender dysphoria include emotional distress, new-onset psychiatric illness, reduced bone density, permanent sexual dysfunction and the possibility of permanent sterility (if used in early puberty then combined with or followed by cross-sex hormones).

● Medical harms of cross-sex hormones include cardiovascular disease, high blood pressure, heart attack, blood clots, stroke, diabetes, and cancer (breast, ovarian, cervical, uterine and prostate)

Surgical transitions include: mastectomy, hysterectomy, phalloplasty and vaginoplasty. Surgeries maim healthy tissue and destroy healthy organs. The American Society of Plastics Surgeons released a statement that there is not enough evidence to support “gender affirming care” for minors. This is the first secular medical society in the US to speak up on the harms of the current interventions.

Dr. Steve Williams, the president of the association, points out how the situation in America had become ‘political’, while the UK and European countries had banned the procedure for children due to a lack of evidence on efficacy and harms.

● There are no long-term studies of medical and surgical interventions for gender dysphoria in youth.

May 1, 2025, the United States released Department for Health and Human Services released Treatment for Pediatric Gender Dysphoria: Review of evidence-based practices. The report’s findings are like the Cass review that gender affirming interventions are supported by low or very low-quality evidence and the potential for irreversible harm is substantial.

SOCIAL affirmation (pronouns and cross dressing)

The National Health Service Guidelines from the UK recognize that social transition is not a neutral act and is a form of therapy. NHS strongly advises against social transition of children, only after families and children accept informed consent.

AROUND the WORLD: – In addition to the UK report we discussed above:

Several European nations have reversed course on medical and surgical interventions for gender dysphoric youth due to risk for irreversible harm and low evidence of any benefit.

The following countries have published papers in their medical journals or enacted laws prohibiting or restricting both medical and surgical procedures on gender dysphoric youth before age 16.

The following information is taken from the Biological Integrity website’s handout, Top Studies on the Science Against Transgender Interventions:

England (UK) – Hiliary Kass independent review showing uncertainty that hormone therapy was beneficial – in 2022 they closed the world’s largest pediatric gender clinic. In June 2023 – hormone treatment only allowed for research purposes; psychosocial support first line. 2024 – they released their final report

Sweden – In February 2022, Sweden’s National Board of Health and Welfare (NBHW) released updated guidelines for the care of gender dysphoric children, citing increased incidence of detransitioners and young adults with transition-related regret.

Finland – In June 2020, Finland’s Council for Choices for Healthcare (COHERE) issued new guidelines stating that psychotherapy should be the first line of treatment for gender dysphoric youth, noting that a comprehensive review of the evidence showed medical evidence for pediatric transition is inconclusive and medical gender reassignment was not sufficient to improve mental health functioning.3

limiting hormones to those > 2 years of gender identity difficulties that persist, no surgical transition under 18. State that psychosocial support is first line

France – In March 2022, The National Academy of Medicine in France noted the driving mechanisms creating the phenomena of rapid onset gender dysphoria, blaming excessive engagement with social media, greater social acceptability, and influence within social circles.4 ● Children desiring transition should receive extended psychological support in a multidisciplinary setting, given the risk of overdiagnosis and increasing incidence of detransitioners.

● Families should receive robust education and informed consent regarding the side effects of puberty blockers and cross-sex hormones and the irreversibility of treatments, especially surgery.

● The report highlighted impacts on bone growth and weakening, risk of sterility, emotional and intellectual consequences as well as the irreversibility of surgeries.

● The Academy urged parents to be vigilant regarding the addictive role of social media which harms the psychological development of children and contributes to the sense of gender incongruence

Australia and New Zealand

The RANZCP (Royal Australian and New Zealand College of Psychiatrists) is the first Psychiatric group to recognize the lack of evidence-based research regarding treatment for gender dysphoria.

● In August 2021 released its first position statement addressing the mental health needs of people with GD, noting polarized views and mixed evidence regarding treatment options for people presenting with gender identity concerns and a paucity of evidence” regarding treatment.

● Until high quality research-based evidence is available regarding endocrine and surgical interventions, exploratory psychotherapy should be the first-line treatment for youth suffering from gender confusion, to explore the full spectrum of mental illness, family history and context in which gender dysphoria has arisen to formulate personalized individual counseling.

Denmark

In July 2023, the Journal of the Danish Medical Association published a discussion regarding their reticence to proceed with medical transition of gender dysphoric minors, citing increased numbers of gender dysphoric youth with comorbid psychiatric disease, influence of social environments on children, uncertainty regarding side effects of treatments, and growing incidence of detransitioners. While official guidelines have not been created, Denmark offered medical transition treatment to only 6% of patients in 2022 as opposed to 65% of patients in 2018.

Norway

In March 2023, the Norwegian Healthcare Investigation Board (NHIB/UKOM) declared that evidence for transgender interventions is deficient, and the long-term effects are little known, especially in the teenage population which may be suffering transient gender distress. Youth gender transition will become an exception, no longer an automatic right when children claim to have gender dysphoria.

Counseling and support can be effective in resolving conflicts in gender identity.

(high incidence of anxiety, depression, Autism (one study in Finland found 26% had Autism) or other mood disorders in children and teens with gender dysphoria symptoms). Adolescents who think they are transgender have experienced frequent childhood traumas and/or suffered from mental illness prior to developing signs of gender dysphoria.

Australia study – High rates of comorbid mental health disorders: anxiety (63.3%), depression (62.0%), behavioral disorders (35.4%)

A developmentally-informed approach that supports the child’s sense of dignity and self-worth and recognizes that gender dysphoria can arise from many causes with multiple paths to resolution. Working with a counselor to help identify these issue can be very helpful.

The risk of suicide in adults after gender transition with hormones and surgery remains nearly 20 times higher than the background population. There is currently NO scientific evidence to support that gender affirming treatment reduces the risk of suicide for youth.

● Three systematic reviews of the world scientific literature found no evidence that puberty blockers and cross-sex hormones reduce the risk of suicide.

● 22% of gender dysphoric patients attempt suicide — a similar incidence for autistic patients and patients suffering from depression or anxiety.

● A long term study in Sweden of transgender adults who underwent hormones and surgeries revealed a suicide rate 19 times that of the general population.

In 2024 study published on patients that underwent vaginoplasty (plastic surgery done on males to attempt to create a vaginal opening – showed double risk of suicide AFTER the procedure.

Inability for youth to have informed consent for life altering treatments. It is not something their brain can comprehend at their stage in development. They are subjecting themselves to lifelong medicalization from the ongoing complications related to hormones and surgical transition.

De-transitioning

Many de-transitioners are speaking out that they regret the decision and permanent surgical effects they will live with forever. People in this category are often left alone with no one to care for them as the clinics who started them on hormones will no longer care for them if they change their mind. Across the US there are several lawsuits that have recently been filed by detransitioners.

Lawsuits

-Isabelle Ayala, 20 years old, is one such example – she is suing her doctors and the American Academy of Pediatrics for having “knowingly lied about the impact of the radical sex-change treatments it recommends.” Ayala was put on testosterone treatments as a fourteen-year-old female. There are many other lawsuits like this that are currently underway.

Prisha Mosley, who received testosterone injections and a double mastectomy, believes her medical care was mishandled and that she was manipulated by therapists and activists . She has a lawsuit against the physicians who recommended these treatments.

– Texas Attorney General Ken Paxton sued a North Texas doctor violating Texas law by providing prohibited “gender transition” treatments to nearly two dozen minors.

Senate Bill 14, a Texas law that took effect in September 2023 and was upheld by the Texas Supreme Court in June 2024, prohibits “gender transition” medical interventions such as surgeries, puberty blockers, and cross-sex hormones for minors.

-20 state attorneys general this wrote a letter demanding that the American Academy of Pediatrics (AAP) retract false statements that gender transition procedures such as puberty blockers and cross-sex hormones for children are “reversible.”

We need to STOP harming youth with gender affirming interventions. The evidence is poor AND confirms poor outcomes.

HELPFUL TIPS FOR PARENTS IF YOUR CHILD IS EXPERIENCING GENDER IDENTITY PROBLEMS:

Stay connected

-Children struggling with gender dysphoria can feel isolated from family and peers. Make sure your child knows you care about them and what’s going on in their life.

-Have a minimum of 5 meals a week together as a family without TV, phones, or other distractions. Many of the same tips we discussed for anxiety apply here.

-DON’T LECTURE, ARGUE OR FREAK OUT – LISTEN to them and ask questions like, “When did you start experiencing these feelings? Where is this coming from? What was going on in your life when this started? What things trigger these feelings or discomfort? When do you find yourself feeling the most dysphoric (clothing, social situations, etc) Then Thank them for sharing with you. Let them know you love them and will not abandon them.

Get engaged

-Help your child find their interests and hobbies. Focus on their strengths. Consider cooking, art, choir, sports, and academic clubs.

-Take the opportunity to learn who they are

-Remember there are different ways to be male or female. Get rid or cookie cutter/stereotype models of masculinity or femininity. Helping someone find their unique way to express themselves and who they are.

Know who they know

-A solid support system is critical for your child. Get to know your child’s friends and have open discussions with your child about the importance of friendships that will build them up rather than bring them down.

Common pitfalls

-Keep electronics out of bedrooms and unmonitored areas. Avoid social media (Instagram, Snapchat, Facebook, Tic Tok, etc) as your child’s brain is developing. They are unprepared to navigate this flood of cultural influence while also trying to define their sense of self.

-Whether you feel it or not, your child looks up to you! Be a good example by limiting your screen use.

Counseling

-Depression, anxiety, and suicidal thinking commonly accompany gender dysphoria and should be taken seriously.

-Find a counselor you trust to help your child become mentally resilient. Given the above facts about the poor evidence for gender transition, I recommend finding a counselor who will affirm your child and teach them to accept themselves instead of changing themselves.

OTHER RESOURCES FOR PARENTS: