Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research.

Abstract

Transgender and gender-expansive (TGE) youth often experience gender dysphoria, defined as distress related to a mismatch between one's gender identity and physical development. This study summarizes the rapidly evolving state of evidence on interventions for gender dysphoria and related health problems in TGE youth. The authors conducted a systematic review of studies that assessed interventions for gender dysphoria in TGE youth (age 25 or younger), published from 1990 to 2023, and summarized the amount, clinical significance, and certainty of evidence available. The authors reviewed and summarized the available evidence for beneficial and harmful outcomes associated with intervention categories currently recommended as the standards of care (i.e., gender-affirming psychosocial, hormonal, surgical, and reproductive health interventions) for addressing gender dysphoria and related health problems, as well as proposed alternatives to the standards of care (gender identity and expression change efforts and treatment for co-occurring mental disorders to reduce gender dysphoria). Across intervention categories and outcomes, limitations in the available evidence made it difficult to estimate with certainty the strength (and sometimes direction) of associations between intervention and outcome. Yet practitioners and policymakers can incorporate the best available science when making decisions about health care for TGE youth using evidence-informed approaches to account for these conditions of uncertainty. The authors also discuss implications for researchers seeking to improve this body of evidence so that it provides greater certainty about intervention effects and has greater practice and policy relevance.