New Findings Challenge ‘gender-affirming Care’ For Children

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

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

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

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

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

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

Serious Medical Risks and Unknowns

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

The scientific support for gender-transition treatments in minors is exceedingly weak.

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

This embrace of early gender transitions for minors in the United States is increasingly at odds with trends in Europe. The HHS report notes that several countries have recently reversed course after reviewing the evidence. For example, the United Kingdom has banned the routine use of puberty blockers, and Sweden and Finland have likewise tightened access to hormones and now prioritize therapeutic counseling. In many countries, health authorities now recommend “psychosocial approaches, rather than hormonal or surgical interventions, as the primary treatment” for adolescents with gender dysphoria​.

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

Can Minors Truly Consent?

The report also raises disturbing ethical questions about whether young people can truly consent to these life-altering interventions. Adolescents—who are still maturing and often highly distressed—may not fully grasp the lifelong consequences of choosing infertility or altered sexual function at age 14 or 15.

One physician quoted in the review admitted that discussing fertility with a teen is like “talking to a blank wall” and that ​​“they’d be like, ew, kids, babies, gross.” This candid observation shows the challenge of obtaining meaningful informed consent from minors who are unlikely to be able to make responsible choices that will affect their future selves.

Given the profound unknowns and risks involved, the ethical duty to “do no harm” should lead physicians and parents to proceed with the utmost caution. Rushing vulnerable youth into irreversible treatment, without long-term data or true informed consent, is reckless and irresponsible.

Better Approach

The HHS review points to talk therapy and other noninvasive treatments as effective, underutilized options for youth with gender dysphoria. In contrast to immediate medical affirmation, talk therapy allows clinicians to explore a child’s feelings and address any underlying issues in a safe, supportive setting. The report notes Finland and Sweden—the two countries with the strongest evidence-based guidelines—recommend that “psychotherapy, not hormones or surgeries, should be the standard of care” for adolescents with gender-related distress.

Many teens identifying as transgender have co-occurring mental health struggles, and treating those problems can often either alleviate the gender dysphoria or put it in perspective. At a minimum, talk therapy gives families time for careful assessment and individualized care, rather than rushing every young patient down the same medical path.

Unfortunately, in the United States, this kind of exploratory therapy has often been neglected or even discouraged under the affirmative model. The HHS report’s findings encourage a renewed emphasis on psychological support as the first-line treatment, since it carries far less risk and respects the whole child’s well-being. Christian parents should, of course, be wary of relying on secular therapists who are likely to endorse or encourage gender confusion.

Speaking the Truth in Love

Christians will find that the report’s conclusions align with a biblical understanding of human sexuality and the body. Scripture teaches that God created human beings male and female (Gen. 1:27; Matt 19:4) and that each person is “fearfully and wonderfully made” by God (Ps. 139:13–14). Our sex is therefore an integral part of God’s good design, not an accident that can be changed at will.

Our sex is an integral part of God’s good design, not an accident that can be changed at will.

We acknowledge that in a fallen world, some individuals feel deep conflict between their inner sense of self and their biological sex, and that this can be a genuine form of suffering. But our response shouldn’t be to endorse harmful measures that deny the reality of the body. Instead, we’re called to “[speak] the truth in love” (Eph. 4:15): affirming individuals’ inherent dignity and worth, while gently encouraging them to embrace the Creator’s design for their life.

The HHS report provides clarity that can help Christians respond to the transgender issue with compassion and conviction. Knowing that these medical interventions lack a solid evidentiary foundation and carry serious dangers should embolden us to lovingly question the rush to put children on the path to “transitioning.” We can encourage approaches that protect children’s bodies and futures, such as guiding families to seek therapy first instead of immediately starting harmful interventions. By standing on Scripture’s teaching and the insights of trustworthy research, we can model a Christlike response that holds together love and truth for the good of our children.