Readings on Youth Gender Transition

This is a very brief introduction to the scientific literature bearing on medical and social gender transition for youth.   These are just a few of the most relevant papers to read if you’re new to the field.  Their bibliographies are a good guide to going deeper.

The Dutch Studies

In the 1990s clinicians at VU University in the Netherlands began experimenting with medical induction of opposite sex physical characteristics in minors.   Their approach sought to increase the ability of adult transsexuals to ‘pass’ as the opposite sex by blocking natural puberty at an early stage, then introducing exogenous cross-sex hormones and finishing with surgery. They published two influential papers in 2011 and 2014 describing preliminary outcomes.  The ‘Dutch Protocol’ they introduced was subsequently adopted by many new youth gender transition clinics in North America and Western Europe.  These papers are still widely cited as the best evidence for the safety and effectiveness of the medical protocol they describe.




The most comprehensive critical response so far was published in 2023.  It examines not just the original pair of Dutch papers, but much subsequent research that claims to confirm their results.  Its large bibliography identifies the majority of widely cited pro-gender-affirmation medical papers.



The US Medical Associations

Between 2010 and 2020 the number of youth gender clinics and their patients increased exponentially.  Among the causes were like social factors like new social media targeting teens.  However this was also the period during which a number of major American medical societies published position papers endorsing medical transition for minors and a radical new on-demand approach known as “gender affirmation”.  The following two papers in particular have created the impression that medical transition for minors is established to be safe and effective care.


In 2017 the Endocrine Society published a position paper describing the endocrine interventions involved in the Dutch Protocol but left it up to mental health clinicians to diagnose the need for these treatments. 



In 2018 a single psychiatrist just out of residency wrote a position paper for the American Academy of Pediatrics that explicitly argued for gender affirmation, which has become the dominant treatment philosophy of North American providers.



The Rafferty paper was rife with errors in its interpretation of the literature it cited, as pointed out in the following rebuttal.  Nonetheless, the AAP refused to correct the paper and has attempted to suppress critical discussion among its membership.



Most medical treatments are offered on the basis of being part of an established standard of care whose likely benefits are well understood to outweigh the likely drawbacks.  However, some risky and unproven treatments, for example those addressing fatal conditions with no known effective treatment, are offered on the basis of “informed consent.”  The patient is told the state of knowledge regarding the treatment and permitted to decide whether or not to go forward.  The medical interventions advocated for by the Endocrine Society and AAP position papers are offered to youth and adults on the basis of “informed consent” because, contrary to claims in popular media, there is insufficient evidence that they are safe or effective treatments for any objectively diagnosable disease or disorder.  The following paper examines the appropriateness of using informed consent in this way.