Medically transitioning has less health risks than not treating gender dysphoria

The argument

Many studies and institutions such as the American Medical Association and the American Psychiatric Association have acknowledged that gender dysphoria is highly distressing and that it can be dangerous if left untreated. Transgender kids are generally at much higher risks of self harm, anxiety, depression and suicide, but a 2016 study showed that transgender teenagers who are supported in their transition are no more depressed and only slightly more anxious than cisgender peers. Some people argue that the risks associated with medically transitioning are greater than those associated with untreated gender dysphoria. However, the risks are quite low in comparison to developing depression, anxiety, and self harm or suicidal tendencies. If the minor chooses to take puberty blockers, the only possible health risk is that the minor could have lower than average bone density. Yet, doctors who prescribe puberty blockers are acutely aware of this possible risk and regularly check bone density while the child/adolescent is taking the medication. Even though their bone density could be lower than average, this deficit is not linked with any severe health risks. This is also reversible; when the medication is stopped (whether that be because the individual no longer identifies as transgender or because they are switching to hormone replacement therapy), the individual will regain normal bone density after a few years. Gender-affirming hormone therapies, like taking estrogen or testosterone, are generally only prescribed to patients who are at least 16 years old. Gender-affirming hormones can change an individual's body in ways that are not easily reversed, such as changes in body hair growth and body fat redistribution. Some of these changes may be completely irreversible. However, one should keep in mind that these changes are cosmetic. The changes do not pose any health risks. Thus, as long as the individual is sure that gender-affirming hormones is what they want, there aren't really any associated risks. Making sure that the individual is definitely transgender and that hormones are definitely what they want can be done through extensive counseling, and most doctors will not even prescribe hormones unless the individual has been "insistent, persistent, and consistent" about their gender identity for at least six months. There is the chance that the individual could change their mind about their gender in the future, but in that case they can take measures to mitigate the cosmetic changes caused by hormone therapy. Other kinds of medical transition are rare for minors, and genital surgeries are not offered at all to non-adults. Overall, the types of transition procedures that are available to minors are very safe, especially compared to leaving gender dysphoria untreated.

Premises

Counter-arguments

Some clinicians and health authorities reply that the long-term evidence base for paediatric medical transition is weaker and more contested than the argument suggests — a dispute about treatment protocols, not about whether trans people are valid. Recent systematic reviews (notably the UK's Cass Review) found the evidence for puberty blockers and hormones in minors to be of low quality. They note that several European systems — Sweden, Finland and the UK's NHS — have restricted puberty blockers for minors to research settings, citing uncertainty about long-term outcomes, effects on bone density and fertility, and the difficulty of predicting which children will persist in a trans identity. On this view, describing the risks as clearly low understates genuine clinical uncertainty, and caution is warranted.

Rejecting the premises

[Rejecting P1] Critics argue the cited safety evidence is thinner and more contested than claimed; recent systematic reviews (the Cass Review) rated the long-term evidence for paediatric transition as low quality. [Rejecting P2] Puberty blockers are not as clearly low-risk or fully reversible as stated — several European health systems (Sweden, Finland, the UK NHS) have restricted them for minors to research settings over developmental and bone-density concerns. [Rejecting P3] Predicting which children will persist in a trans identity is difficult, so critics argue that starting semi-reversible or irreversible interventions early carries real uncertainty the argument understates.