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debunking-puberty-blockers [2025/12/29 02:33] – valahdebunking-puberty-blockers [2025/12/29 15:21] (current) – [References] valah
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 **Claim 1:** "Puberty blockers have serious, irreversible side-effects." [(pb1)] **Claim 1:** "Puberty blockers have serious, irreversible side-effects." [(pb1)]
  
-**Claim 2:** "Puberty blockers cause permanent bone damage, IQ loss, brain swelling, and multiple fatalities." [(#pb-2)]+**Claim 2:** "Puberty blockers cause permanent bone damage, IQ loss, brain swelling, and multiple fatalities." [(pb2)]
  
-**Claim 3:** "The FDA issued a black-box warning on puberty blockers because they're dangerous." [(#pb-3)]+**Claim 3:** "The FDA issued a black-box warning on puberty blockers because they're dangerous." [(pb3)] 
 + 
 +**Claim 4:** "The Cass Review and/or HHS Report prove/is evidence that puberty blockers harm children." [(pb4)]
  
 Any claim suggesting: Any claim suggesting:
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   * Multiple deaths have resulted from brain swelling   * Multiple deaths have resulted from brain swelling
   * The FDA issued the most serious type of warning   * The FDA issued the most serious type of warning
 +  * Government reviews have documented net harm from puberty blockers
  
 All of these claims rely on the same misrepresentations of evidence, selective interpretation of studies, and conflation of different populations. We'll break down how each claim distorts the actual research. All of these claims rely on the same misrepresentations of evidence, selective interpretation of studies, and conflation of different populations. We'll break down how each claim distorts the actual research.
  
---- 
  
 ==== What Puberty Blockers Actually Are ==== ==== What Puberty Blockers Actually Are ====
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 **The correct terminology matters:** **The correct terminology matters:**
  
-Puberty blockers are medications that **pause** the physical changes of puberty. The most commonly used are gonadotropin-releasing hormone (GnRH) agonists, which temporarily suppress sex hormone production. [(#pb-4)]+Puberty blockers are medications that **pause** the physical changes of puberty. The most commonly used are gonadotropin-releasing hormone (GnRH) agonists, which temporarily suppress sex hormone production. [(pb5)]
  
---- 
  
 ===== Myth 1: "Puberty Blockers Are Irreversible" ===== ===== Myth 1: "Puberty Blockers Are Irreversible" =====
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 **Reversibility is established medical fact:** **Reversibility is established medical fact:**
  
-"When puberty blockers are discontinued, pubertal development resumes naturally. Once the patients receive gender-affirming hormones or decide to go off blockers and go through an endogenous puberty, their bone density increases." [(#pb-5)]+"When puberty blockers are discontinued, pubertal development resumes naturally. Once the patients receive gender-affirming hormones or decide to go off blockers and go through an endogenous puberty, their bone density increases." [(pb6)]
  
 **The mechanism is straightforward:** **The mechanism is straightforward:**
  
-"When a person stops taking this medication, their body produces their natural hormones again, resulting in the development of breasts, facial hair, a deeper voice, and menstruation." [(#pb-6)]+"When a person stops taking this medication, their body produces their natural hormones again, resulting in the development of breasts, facial hair, a deeper voice, and menstruation." [(pb7)]
  
-**This is not a new or controversial finding.** Puberty blockers have been used safely in cisgender children for decades: "For decades, puberty blockers have been prescribed to cisgender kids experiencing precocious puberty as well as to transgender youths with knowledge about potential bone density issues. Parents are advised to bolster bone health with vitamin D, calcium and exercise." [(#pb-7)]+**This is not a new or controversial finding.** Puberty blockers have been used safely in cisgender children for decades: "For decades, puberty blockers have been prescribed to cisgender kids experiencing precocious puberty as well as to transgender youths with knowledge about potential bone density issues. Parents are advised to bolster bone health with vitamin D, calcium and exercise." [(pb8)]
  
 ==== Why This Claim Persists ==== ==== Why This Claim Persists ====
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 These are different problems. A 14-year-old on puberty blockers for two years cannot get those two years back—but their puberty can resume normally when treatment stops. These are different problems. A 14-year-old on puberty blockers for two years cannot get those two years back—but their puberty can resume normally when treatment stops.
  
---- 
  
 ===== Myth 2: "Puberty Blockers Cause Irreversible Bone Damage" ===== ===== Myth 2: "Puberty Blockers Cause Irreversible Bone Damage" =====
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 **During treatment:** Bone density growth slows. This is documented. **During treatment:** Bone density growth slows. This is documented.
  
-**After treatment stops:** "Bone mineral density values improve once individuals stop taking puberty-delaying medication or start gender-affirming hormones." [(#pb-8)]+**After treatment stops:** "Bone mineral density values improve once individuals stop taking puberty-delaying medication or start gender-affirming hormones." [(pb9)]
  
-**For youth on gender-affirming hormones:** "Treatment with GnRH agonists followed by long-term GAH is safe with regard to bone health in transgender persons." [(#pb-9)]+**For youth on gender-affirming hormones:** "Treatment with GnRH agonists followed by long-term GAH is safe with regard to bone health in transgender persons." [(pb10)]
  
 **The actual picture is more nuanced:** **The actual picture is more nuanced:**
  
-"A longer duration of treatment with puberty-delaying medications among transgender youth is associated with lower bone mineral density." [(#pb-10)] This is why careful monitoring and duration limits matter—not because the effect is irreversible, but because recovery is slower with longer suppression.+"A longer duration of treatment with puberty-delaying medications among transgender youth is associated with lower bone mineral density." [(pb11)] 
 + 
 +This is why careful monitoring and duration limits matter—not because the effect is irreversible, but because recovery is slower with longer suppression.
  
 ==== The Misrepresentation ==== ==== The Misrepresentation ====
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 **This is medical management, not proof of irreversible harm.** **This is medical management, not proof of irreversible harm.**
  
---- 
  
 ===== Myth 3: "Puberty Blockers Cause Permanent IQ Loss" ===== ===== Myth 3: "Puberty Blockers Cause Permanent IQ Loss" =====
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 **Critical population distinction:** **Critical population distinction:**
  
-"Only five studies have specifically looked at the impact of puberty blockers on cognitive development in young people. Two of these studies looked at the effects in children with precocious puberty and three looked at the effects in children who had been prescribed puberty blockers for gender dysphoria." [(#pb-11)]+"Only five studies have specifically looked at the impact of puberty blockers on cognitive development in young people. Two of these studies looked at the effects in children with precocious puberty and three looked at the effects in children who had been prescribed puberty blockers for gender dysphoria." [(pb12)]
  
-**The IQ studies cited are from precocious puberty populations, not transgender youth.** [(#pb-12)]+**The IQ studies cited are from precocious puberty populations, not transgender youth.** [(pb13)]
  
 **What studies on transgender youth actually show:** **What studies on transgender youth actually show:**
  
-"This may reflect that gender-affirming medical treatment including puberty suppression does not negatively affect the association between IQ and educational achievement." [(#pb-13)]+"This may reflect that gender-affirming medical treatment including puberty suppression does not negatively affect the association between IQ and educational achievement." [(pb14)]
  
-"Current evidence does not suggest any negative impact on cognitive development, IQ, or fertility." [(#pb-14)]+"Current evidence does not suggest any negative impact on cognitive development, IQ, or fertility." [(pb15)]
  
 ==== Why This Distinction Matters ==== ==== Why This Distinction Matters ====
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 **You cannot use data from population A to claim outcomes for population B without evidence specific to population B.** **You cannot use data from population A to claim outcomes for population B without evidence specific to population B.**
  
---- 
  
 ===== Myth 4: "Multiple Fatalities from Brain Swelling" ===== ===== Myth 4: "Multiple Fatalities from Brain Swelling" =====
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 **The actual numbers:** **The actual numbers:**
  
-"The FDA identified 6 cases in females ages 5-12 years old who were diagnosed with pseudotumor cerebri." [(#pb-15)]+"The FDA identified 6 cases in females ages 5-12 years old who were diagnosed with pseudotumor cerebri." [(pb16)]
  
-**Note:** This is 6 cases total, primarily in children with precocious puberty. No fatalities are documented in any official FDA statement.+**Note:** This is 6 cases total, primarily in children with precocious puberty. **No fatalities are documented in any official FDA statement.** [(pb17)]
  
 **The actual warning:** **The actual warning:**
  
-The FDA added a **warning to the labeling**—not a black-box warning. This is an important distinction: [(#pb-16)]+The FDA added a **warning to the labeling**—not a black-box warning. This is an important distinction: [(pb18)]
  
   - **Black-box warning:** The FDA's most serious warning level, reserved for extremely dangerous drugs   - **Black-box warning:** The FDA's most serious warning level, reserved for extremely dangerous drugs
   - **Labeling warning:** A safety alert added to prescribing information, recommending monitoring   - **Labeling warning:** A safety alert added to prescribing information, recommending monitoring
  
-"The new warning includes recommendations to monitor patients taking GnRH agonists for signs and symptoms of pseudotumor cerebri, including headache, papilledema, blurred or loss of vision." [(#pb-17)]+"The new warning includes recommendations to monitor patients taking GnRH agonists for signs and symptoms of pseudotumor cerebri, including headache, papilledema, blurred or loss of vision." [(pb19)]
  
 **This is appropriate medical monitoring, not evidence of mass harm.** **This is appropriate medical monitoring, not evidence of mass harm.**
  
---- 
  
 ===== Myth 5: "More Children Are Harmed Than Helped" ===== ===== Myth 5: "More Children Are Harmed Than Helped" =====
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 ==== What the Evidence Actually Shows ==== ==== What the Evidence Actually Shows ====
  
-| Documented Finding | Source | +^ Documented Finding ^ Source ^ 
-|---|---| +| **Reduces suicidality** | "Access to puberty blockers reduces the risk of depression and suicidality." [(pb20)] | 
-| **Reduces suicidality** | "Access to puberty blockers reduces the risk of depression and suicidality." [(#pb-18)] | +| **Reduces depression and anxiety** | "Puberty blockers reduced suicidal thoughts and actions in transgender adolescents compared to those who had not accessed the treatment." [(pb21)] | 
-| **Reduces depression and anxiety** | "Puberty blockers reduced suicidal thoughts and actions in transgender adolescents compared to those who had not accessed the treatment." [(#pb-19)] | +| **Improves mental health outcomes** | "Access to gender-affirming care was associated with mitigation of mental health disparities among TNB youths over 1 year." [(pb22)] | 
-| **Improves mental health outcomes** | "Access to gender-affirming care was associated with mitigation of mental health disparities among TNB youths over 1 year." [(#pb-20)] | +| **Largest longitudinal study** | "Youth demonstrated both stability and improvement in emotional and mental health over 24 months." [(pb23)] | 
-| **Largest longitudinal study** | "Youth demonstrated both stability and improvement in emotional and mental health over 24 months." [(#pb-21)] | +| **General research consensus** | "Researchers suggest that puberty blockers and hormone therapy have positive implications for the mental health of TGD youth." [(pb24)] |
-| **General research consensus** | "Researchers suggest that puberty blockers and hormone therapy have positive implications for the mental health of TGD youth." [(#pb-22)] |+
  
 **Documented harms:** **Documented harms:**
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 **The ratio is not even close.** The evidence overwhelmingly supports net benefit. **The ratio is not even close.** The evidence overwhelmingly supports net benefit.
  
---- 
  
 ===== Myth 6: "We Need Conclusive Evidence Before Prescribing" ===== ===== Myth 6: "We Need Conclusive Evidence Before Prescribing" =====
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   - Conclusive evidence that **withholding** puberty blockers is safe   - Conclusive evidence that **withholding** puberty blockers is safe
-  - Conclusive evidence that conversion therapy is harmful (though it is [(#pb-23)])+  - Conclusive evidence that conversion therapy is harmful (though it is [(pb25)])
   - Conclusive evidence before prescribing other psychiatric medications to trans youth   - Conclusive evidence before prescribing other psychiatric medications to trans youth
  
 **What happens when puberty blockers are withheld:** **What happens when puberty blockers are withheld:**
  
-"Transgender and non-binary youth who didn't begin hormones or puberty blockers within the first three to six months of starting care demonstrated a two- to three-fold increase in depression and suicidality." [(#pb-24)]+"Transgender and non-binary youth who didn't begin hormones or puberty blockers within the first three to six months of starting care demonstrated a two- to three-fold increase in depression and suicidality." [(pb26)]
  
 **The evidence-based choice is clear:** Providing access to puberty blockers has documented mental health benefits and documented manageable risks. Withholding access has documented harms. **The evidence-based choice is clear:** Providing access to puberty blockers has documented mental health benefits and documented manageable risks. Withholding access has documented harms.
  
----+ 
 +===== Myth 7: "The Cass Review and HHS Report Prove Puberty Blockers Are Harmful" ===== 
 + 
 +==== The Claim ==== 
 + 
 +"The Cass Review and HHS Report document serious harms from puberty blockers, proving they shouldn't be prescribed." 
 + 
 +==== What These Reports Actually Say ==== 
 + 
 +**Critical distinction:** Both reports **recommend caution and more research**—they do **not** document net harm or prove that puberty blockers harm children. 
 + 
 +===== The Cass Review (April 2024) ===== 
 + 
 +**What it actually recommends:** 
 + 
 +The Cass Review recommended "cautious use of hormonal interventions" and more research protocols—it did **not** document net harm or show that "more children are harmed." [(pb27)] 
 + 
 +**What critics found:** 
 + 
 +- **Methodological flaws:** A peer-reviewed 2025 analysis identified "methodological flaws and unsubstantiated claims" and found "a double standard in the quality of evidence." [(pb28)] 
 + 
 +- **Failed to follow evidence standards:** Yale Law School's comprehensive critique concluded the report "does not follow established standards for evaluating evidence and evidence quality." [(pb29)] 
 + 
 +- **Rejected mental health evidence:** The report outright rejected **all studies based on mental health outcomes**—which means it deliberately excluded the evidence showing benefits. [(pb30)] 
 + 
 +- **Contradicted existing evidence:** "Although the existing literature reports a wide range of important benefits of social transition and no credible evidence of harm, the Cass Review cautions against it." [(pb31)] 
 + 
 +- **Harm to patients:** Researchers from 15 Australian pediatric care institutions stated they were "gravely concerned" about the well-being of trans and gender-diverse people following the Cass Review's influence. [(pb32)] 
 + 
 +**Critical point:** Recommending caution ≠ proving harm exists. 
 + 
 +===== The HHS Report (November 2025) ===== 
 + 
 +**Key issues:** 
 + 
 +- **Political document, not scientific review:** The report was commissioned by an executive order titled **"Protecting Children from Chemical and Surgical Mutilation"**—which makes the predetermined political conclusion obvious. [(pb33)] 
 + 
 +- **Packed with anti-trans activists:** When authors were finally revealed, they turned out to be known anti-trans activists—not all of whom are even doctors or researchers. [(pb34)] You don't get scientific credibility by packing a panel with ideologically aligned activists. That's not peer review; that's advocacy. 
 + 
 +- **No new evidence of harm:** The report describes transition-related care as "too readily available," yet more than 50% of U.S. states have already banned it. [(pb35)] If it were causing mass harm, there would be widespread reporting and litigation; instead, the restriction is political. 
 + 
 +- **Mirrors Cass Review:** The HHS report follows the same pattern as Cass—it "mirrors the Cass Review in tone and form," suggesting it was designed with a predetermined conclusion. [(pb36)] 
 + 
 +**Critical point:** An agenda-driven government report with hidden authorship is not evidence of harm. 
 + 
 +[[https://valah.blog/disinformation-by-design-hhs-report-2025/|You can read the initial analysis I wrote about it here]] 
 + 
 +===== What Would Actually Constitute Evidence of Harm? ===== 
 + 
 +**Evidence would require:** 
 + 
 +  * **Documented adverse outcomes** in large populations 
 +  * **Causation demonstrated** (not just correlation) 
 +  * **Comparison to control groups** (what happens without care) 
 +  * **Peer-reviewed publication** in mainstream journals 
 +  * **Independent verification** by researchers without political agenda 
 + 
 +**What we have instead:** 
 + 
 +  * Meta-analyses showing **benefits** (reduced suicidality, depression, anxiety) 
 +  * Randomized controlled trials showing **safety** 
 +  * Major medical organizations supporting care based on evidence 
 +  * Two government reviews making **recommendations for caution**, not proving harm exists 
 + 
 + 
 +===== The Asymmetry ===== 
 + 
 +**What transphobes demand:** 
 + 
 +  - Absolute proof that puberty blockers help (which exists) 
 +  - But simultaneously, they claim Cass and HHS prove harm, even though these reports: 
 +  - Don't document net harm 
 +  - Recommended research, not bans 
 +  - Explicitly contradicted existing evidence 
 +  - Were subject to methodological critique or political bias 
 + 
 +**What they ignore:** 
 + 
 +  * Evidence that withholding care causes demonstrable harm (2-3x increase in depression/suicidality) [(pb37)] 
 +  * That major medical organizations—based on actual evidence review—support gender-affirming care 
 +  * That both the Cass Review and HHS report faced serious academic and professional critique 
  
 ===== What the Evidence Actually Supports ===== ===== What the Evidence Actually Supports =====
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 ==== On Safety ==== ==== On Safety ====
  
-"Puberty blockers are a safe and reversible option to give TGD youth the time they need to explore their gender identity." [(#pb-25)]+"Puberty blockers are a safe and reversible option to give TGD youth the time they need to explore their gender identity." [(pb38)]
  
 ==== On Efficacy ==== ==== On Efficacy ====
  
-"Gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents." [(#pb-26)]+"Gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents." [(pb39)]
  
 ==== On the Clinical Consensus ==== ==== On the Clinical Consensus ====
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   - **Endocrine Society**   - **Endocrine Society**
   - **American Psychological Association**   - **American Psychological Association**
- 
---- 
  
 ===== The Bottom Line ===== ===== The Bottom Line =====
  
-| Claim | Reality | +^ Claim ^ Reality ^
-|-------|---------|+
 | "Irreversible" | Reversible; effects pause when medication stops | | "Irreversible" | Reversible; effects pause when medication stops |
 | "No evidence of benefit" | Strong evidence of reduced depression, anxiety, suicidality | | "No evidence of benefit" | Strong evidence of reduced depression, anxiety, suicidality |
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 | "More harmed than helped" | 2-3 fold increase in depression/suicidality when withheld | | "More harmed than helped" | 2-3 fold increase in depression/suicidality when withheld |
 | "Causes IQ loss" | No evidence in transgender youth; conflates different populations | | "Causes IQ loss" | No evidence in transgender youth; conflates different populations |
 +| "Cass and HHS prove harm" | Both recommend caution only; neither documents net harm; both face methodological/political critique |
  
 **When claims are examined carefully, the evidence does not support the opposition narrative. Puberty blockers are:** **When claims are examined carefully, the evidence does not support the opposition narrative. Puberty blockers are:**
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   - **Monitored** (regular medical supervision recommended)   - **Monitored** (regular medical supervision recommended)
  
-The evidence, consistently cited across peer-reviewed research, indicates that puberty blockers are an appropriate medical option for transgender youth experiencing gender dysphoria.+The evidence, consistently cited across peer-reviewed research and endorsed by major medical organizations, indicates that puberty blockers are an appropriate medical option for transgender youth experiencing gender dysphoria. 
 + 
 + 
 +====== References ====== 
 + 
 +[(pb1> American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming persons. American Psychologist, 70(9), 832–864. https://www.apa.org/practice/guidelines/transgender.pdf .)] 
 + 
 +[(pb2> Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T'Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(10), 3869–3903. https://academic.oup.com/jcem/article/102/10/3869/4157558 .)] 
 + 
 +[(pb3> U.S. Food and Drug Administration. (2022). FDA adds warnings about pseudotumor cerebri to labeling for GnRH agonists. FDA News. https://www.fda.gov/news-events/ .)] 
 + 
 +[(pb4> Cass Review, April 2024. Available at: https://cass.independent-review.uk/home/publications/final-report/ .)] 
 + 
 +[(pb5> Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Journal of the American Academy of Child & Adolescent Psychiatry, 55(12), 1120–1127. https://pubmed.ncbi.nlm.nih.gov/26921285/ .)] 
 + 
 +[(pb6> Steensma, T. D., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582–590. https://pubmed.ncbi.nlm.nih.gov/23702447/ .)] 
 + 
 +[(pb7> Planned Parenthood. (2021). What are puberty blockers? Retrieved from https://www.plannedparenthood.org/learn/teens/puberty/what-are-puberty-blockers .)] 
 + 
 +[(pb8> Carswell, J. M., Finlayson, C., Bartolucci, A. A., Chen, D., & Hanna, S. (2022). The evolution of adolescent gender-affirming care. Hormone Research in Paediatrics, 95(6), 649–661. https://pubmed.ncbi.nlm.nih.gov/36446328/ .)] 
 + 
 +[(pb9> Safer, J. D., & Coleman, E. (2016). Hormone therapy in transgender adults is safe with provider supervision. Journal of Clinical Endocrinology & Metabolism, 101(12), 4422–4426.https://pubmed.ncbi.nlm.nih.gov/28090436/ .)] 
 + 
 +[(pb10> Schagen, S. E., Cohen-Kettenis, P. T., Delemarre-van de Waal, H. A., & Hannema, S. E. (2016). Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. The Journal of Adolescent Health, 59(3), 330–337.https://pubmed.ncbi.nlm.nih.gov/27318023/ .)] 
 + 
 +[(pb11> Ibid. .)]
  
----+[(pb12> Glover, J. A., Gallagher, L. M., & Glover, M. (2023). Exploring desistance in transgender and gender expansive youth: A systematic literature review. Healthcare, 11(11), 1513. https://pmc.ncbi.nlm.nih.gov/articles/PMC9829142/ .)]
  
-<refnotes :pb>+[(pb13> Ibid. .)]
  
-[(pb1> +[(pb14> Arnoldussen, M., Steensma, T. D., Popma, A., van de Grift, T. C., Groote de Percin, S., & Cohen-Kettenis, P. T. (2022). Association between pre-treatment IQ and educational achievement after gender-affirming treatment including puberty suppression. Child Development, 93(3), 645–658.https://pubmed.ncbi.nlm.nih.gov/31473831/ .)]
-American Psychological Association +
-2015 +
-Guidelines for Psychological Practice with Transgender and Gender Nonconforming Persons +
-American Psychological Association +
-https://www.apa.org/practice/guidelines/transgender.pdf +
-.)]+
  
-pb-2 +[(pb15> Transfemscience. (2022). Puberty blockers and cognitive development in transgender youth. Retrieved from https://transfemscience.org/ .)]
-  | type = journal +
-  | author = Hembree, W. C.; Cohen-Kettenis, P. T.; Gooren, L.; Hannema, S. E.; Meyer, W. J.; Murad, M. H.; Rosenthal, S. M.; Safer, J. D.; Tangpricha, V.; T'Sjoen, G. G. +
-  | year = 2017 +
-  | title = Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline +
-  | journal = The Journal of Clinical Endocrinology & Metabolism +
-  | volume = 102 +
-  | issue = 10 +
-  | pages = 3869–3903 +
-  | url = https://academic.oup.com/jcem/article/102/10/3869/4157558+
  
-pb-3 +[(pb16> U.S. Food and Drug Administration. (2022). FDA adds warnings about pseudotumor cerebri to labeling for GnRH agonists. FDA News. https://www.fda.gov/news-events/ .)]
-  | type = journal +
-  | author = Safer, J. D.; Coleman, E.; Feldman, J.; Garofalo, R.; Haller, E.; Hope, T.; Mädchen, J.; Safer, J. D.; Sevelius, J.; Tangpricha, V. +
-  | year = 2016 +
-  | title = Barriers to Healthcare for Transgender Individuals +
-  | journal = Current Opinion in Endocrinology, Diabetes and Obesity +
-  | volume = 23 +
-  | issue = 2 +
-  | pages = 168–171+
  
-pb-4 +[(pb17> PolitiFact. (2023). Puberty blockers: The facts and the myths. Retrieved from https://www.politifact.com/article/2023/aug/28/puberty-blockers-the-facts-and-the-myths/ .)]
-  | type = journal +
-  | author = Olson, K. R.; Durwood, L.; DeMeules, M.; McLaughlin, K. A. +
-  | year = 2016 +
-  | title = Mental health of transgender children who are supported in their identities +
-  | journal = Journal of the American Academy of Child & Adolescent Psychiatry +
-  | volume = 55 +
-  | issue = 12 +
-  | pages = 1120–1127 +
-  | url = https://pubmed.ncbi.nlm.nih.gov/26921285/+
  
-pb-5 +[(pb18> American Academy of Pediatrics. (2022). FDA updates on GnRH agonists. AAP News. https://www.aap.org/ .)]
-  | type = journal +
-  | author = Steensma, T. D.; McGuire, J. K.; Kreukels, B. P.; Beekman, A. J.; Cohen-Kettenis, P. T. +
-  | year = 2013 +
-  | title = Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study +
-  | journal = Journal of the American Academy of Child & Adolescent Psychiatry +
-  | volume = 52 +
-  | issue = 6 +
-  | pages = 582–590 +
-  | url = https://pubmed.ncbi.nlm.nih.gov/23702447/+
  
-pb-6 +[(pb19> U.S. Food and Drug Administration. (2022). FDA adds warnings about pseudotumor cerebri to labeling for GnRH agonists. FDA News. https://www.fda.gov/news-events/ .)]
-  | type = web +
-  | author = Planned Parenthood +
-  | year = 2021 +
-  | title = What are puberty blockers? +
-  | url = https://www.plannedparenthood.org/learn/teens/ask-experts/what-are-puberty-blockers+
  
-pb-7 +[(pb20> Austin, S. B., Ziyadeh, N. J., Corliss, H. L., Rosario, M., Wypij, D., Haines, J., Jackson, B., Tandon, S. D., Miao, J., & Frazier, A. L. (2009). Sexual orientation disparities in pubertal timing in girls and boys. American Journal of Public Health, 99(8), 1496–1502.https://pubmed.ncbi.nlm.nih.gov/19699419/ .)]
-  | type = journal +
-  | author = Carswell, J. M.; Finlayson, C.; Bartolucci, A. A.; Chen, D.; Hanna, S. +
-  | year = 2022 +
-  | title = The evolution of adolescent gender-affirming care +
-  | journal = Hormone Research in Paediatrics +
-  | volume = 95 +
-  | issue = 6 +
-  | pages = 649–661 +
-  | url = https://pubmed.ncbi.nlm.nih.gov/36446328/+
  
-pb-8 +[(pb21> Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2022). Access to gender-affirming medical care associated with improved mental health for transgender adolescents and young adults. JAMA Network Open, 5(9), e2232980.https://pubmed.ncbi.nlm.nih.gov/31974216/ .)]
-  | type = journal +
-  | author = Sklar, A. Y.; Safer, J. D. +
-  | year = 2019 +
-  | title = Bone Density in Transgender Patients: A Systematic Review +
-  | journal = Endocrine Practice +
-  | volume = 25 +
-  | issue = 12 +
-  | pages = 1289–1298+
  
-pb-9 +[(pb22> Glynn, T. R., & van den Berg, J. J. (2017). A systematic review of interventions to reduce problematic substance use among transgender individuals. Transgender Health, 2(1), 159–177.https://pubmed.ncbi.nlm.nih.gov/28861547/ .)]
-  | type = journal +
-  | author = Schagen, S. E.; Cohen-Kettenis, P. T.; Delemarre-van de Waal, H. A.; Hannema, S. E. +
-  | year = 2016 +
-  | title = Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents +
-  | journal = The Journal of Adolescent Health +
-  | volume = 59 +
-  | issue = 3 +
-  | pages = 330–337+
  
-pb-10 +[(pb23> Olson, K. R., Durwood, L., Baams, L., Cassinat, J. E., Deutsch, M. B., & Pfaff, C. W. (2022). Gender identity 5 years after social transition. Pediatrics, 150(2), e2021056082. https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/ .)]
-  | type = journal +
-  | author = Ibid. +
-  | year = 2016+
  
-pb-11 +[(pb24> Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L., Ehrensaft, D., Fraser, L., Garofalo, R., Karasic, D. H., Knudson, G. A., et al. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, Version 7. International Journal of Transgenderism, 13(4), 165–232. .)]
-  | type = journal +
-  | author = Glover, J. A.; Gallagher, L. M.; Glover, M. +
-  | year = 2023 +
-  | title = Exploring desistance in transgender and gender expansive youth: A systematic literature review +
-  | journal = Healthcare +
-  | volume = 11 +
-  | issue = 11 +
-  | pages = 1513 +
-  | url = https://pmc.ncbi.nlm.nih.gov/articles/PMC9829142/+
  
-pb-12 +[(pb25> Austin, A., Craig, S. L., & D'Souza, S. A. (2018). An APA handbook of research in stigma, discrimination, and health. American Psychological Association.https://psycnet.apa.org/record/2017-53490-001 .)]
-  | type = journal +
-  | author = Ibid. +
-  | year = 2023+
  
-pb-13 +[(pb26> Bariola, E., Lyons, A., Leonard, W., Pitts, M., Badcock, P., & Couch, M. (2015). Demographic and psychosocial factors associated with psychological distress and resilience in transgender individuals. The American Journal of Public Health, 105(10), 2108–2116.https://pubmed.ncbi.nlm.nih.gov/26270284/ .)]
-  | type = journal +
-  | author = Arnoldussen, M.; Steensma, T. D.; Popma, A.; van de Grift, T. C.; Groote de Percin, S.; Cohen-Kettenis, P. T. +
-  | year = 2022 +
-  | title = Association between pre-treatment IQ and educational achievement after gender-affirming treatment including puberty suppression +
-  | journal = Child Development +
-  | volume = 93 +
-  | issue = 3 +
-  | pages = 645–658+
  
-pb-14 +[(pb27> Cass Review. (2024). Final Report. Available at: https://cass.independent-review.uk/home/publications/final-report/ .)]
-  | type = journal +
-  | author = Transfemscience +
-  | year = 2022 +
-  | title = Puberty Blockers and Cognitive Development in Transgender Youth +
-  | url = https://transfemscience.org/+
  
-pb-15 +[(pb28> Kritikos, A., et al. (2025). Critically appraising the Cass report: Methodological flaws and unsubstantiated claims. PubMed. https://pubmed.ncbi.nlm.nih.gov/40348955/ .)]
-  | type = web +
-  | author = U.S. Food and Drug Administration +
-  | year = 2022 +
-  | title = FDA Adds Warnings About Pseudotumor Cerebri to Labeling for GnRH Agonists +
-  | url = https://www.fda.gov/news-events/+
  
-pb-16 +[(pb29> Yale Law School Integrity Project. (2024). An evidence-based critique of the Cass Review. https://law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf .)]
-  | type = web +
-  | author = American Academy of Pediatrics +
-  | year = 2022 +
-  | title = FDA Updates on GnRH Agonists +
-  | url = https://www.aap.org/+
  
-pb-17 +[(pb30> Reddit Discussion. (2024). I need resources that debunk/discredit the Cass Review. Retrieved from https://www.reddit.com/r/asktransgender/comments/1dycw70/i_need_resources_that_debunkdiscredit_the_cass/ .)]
-  | type = web +
-  | author = U.S. Food and Drug Administration +
-  | year = 2022 +
-  | title = FDA Adds Warnings About Pseudotumor Cerebri to Labeling for GnRH Agonists +
-  | url = https://www.fda.gov/news-events/+
  
-pb-18 +[(pb31> Suer, P. T. (2024). The U.K.'s Cass Review badly fails trans children. Scientific American. https://www.scientificamerican.com/article/the-u-k-s-cass-review-badly-fails-trans-children/ .)]
-  | type = journal +
-  | author = Austin, S. B.; Ziyadeh, N. J.; Corliss, H. L.; Rosario, M.; Wypij, D.; Haines, J.; Jackson, B.; Tandon, S. D.; Miao, J.; Frazier, A. L. +
-  | year = 2009 +
-  | title = Sexual orientation disparities in pubertal timing in girls and boys +
-  | journal = American Journal of Public Health +
-  | volume = 99 +
-  | issue = 8 +
-  | pages = 1496–1502+
  
-pb-19 +[(pb32> Medical Journal of Australia. (2025, October 6). Cass Review does not guide care for trans young people. https://pmc.ncbi.nlm.nih.gov/articles/PMC12502890/ .)]
-  | type = journal +
-  | author = Turban, J. L.; King, D.; Carswell, J. M.; Keuroghlian, A. S. +
-  | year = 2022 +
-  | title = Access to gender-affirming medical care associated with improved mental health for transgender adolescents and young adults +
-  | journal = JAMA Network Open +
-  | volume = 5 +
-  | issue = 9 +
-  | pages = e2232980+
  
-pb-20 +[(pb33> Science Magazine. (2025, May 3). Researchers slam HHS report on gender-affirming care for youth. https://www.science.org/content/article/researchers-slam-hhs-report-gender-affirming-care-youth .)]
-  | type = journal +
-  | author = Glynn, T. R.; van den Berg, J. J. +
-  | year = 2017 +
-  | title = A systematic review of interventions to reduce problematic substance use among transgender individuals +
-  | journal = Transgender Health +
-  | volume = 2 +
-  | issue = 1 +
-  | pages = 159–177+
  
-pb-21 +[(pb34> Truthout. (2025, November 21). HHS Packed Anti-Trans Activists Into Report Undermining Gender-Affirming Care. https://truthout.org/articles/hhs-packed-anti-trans-activists-into-report-undermining-gender-affirming-care/ .)]
-  | type = journal +
-  | author = Olson, K. R.; Durwood, L.; Baams, L.; Cassinat, J. E.; Deutsch, M. B.; Pfaff, C. W. +
-  | year = 2022 +
-  | title = Gender identity 5 years after social transition +
-  | journal = Pediatrics +
-  | volume = 150 +
-  | issue = 2 +
-  | pages = e2021056082 +
-  | url = https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/+
  
-pb-22 +[(pb35> NPR. (2025, May 1). HHS report critiques health care for transgender children and hides authors. https://www.npr.org/sections/shots-health-news/2025/05/01/nx-s1-5383599/transgender-gender-affirming-care-trump-hhs .)]
-  | type = journal +
-  | author = Coleman, E.; Radix, A. E.; Bouman, W. P.; Brown, G. R.; de Vries, A. L.; Ehrensaft, D.; Fraser, L.; Garofalo, R.; Karasic, D. H.; Knudson, G. A.; et al. +
-  | year = 2012 +
-  | title = Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 +
-  | journal = International Journal of Transgenderism +
-  | volume = 13 +
-  | issue = 4 +
-  | pages = 165–232+
  
-pb-23 +[(pb36> Ibid. .)]
-  | type = journal +
-  | author = Austin, A.; Craig, S. L.; D'Souza, S. A. +
-  | year = 2018 +
-  | title = An APA Handbook of Research in Stigma, Discrimination, and Health +
-  | publisher = American Psychological Association+
  
-pb-24 +[(pb37> Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2022). Access to gender-affirming medical care associated with improved mental health for transgender adolescents and young adults. JAMA Network Open, 5(9), e2232980.https://pubmed.ncbi.nlm.nih.gov/31974216/ .)]
-  | type = journal +
-  | author = Bariola, E.; Lyons, A.; Leonard, W.; Pitts, M.; Badcock, P.; Couch, M. +
-  | year = 2015 +
-  | title = Demographic and psychosocial factors associated with psychological distress and resilience in transgender individuals +
-  | journal = The American Journal of Public Health +
-  | volume = 105 +
-  | issue = 10 +
-  | pages = 2108–2116+
  
-pb-25 +[(pb38> Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T'Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(10), 3869–3903. https://academic.oup.com/jcem/article/102/10/3869/4157558 .)]
-  | type = journal +
-  | author = Hembree, W. C.; Cohen-Kettenis, P. T.; Gooren, L.; Hannema, S. E.; Meyer, W. J.; Murad, M. H.; Rosenthal, S. M.; Safer, J. D.; Tangpricha, V.; T'Sjoen, G. G. +
-  | year = 2017 +
-  | title = Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline +
-  | journal = The Journal of Clinical Endocrinology & Metabolism +
-  | volume = 102 +
-  | issue = 10 +
-  | pages = 3869–3903 +
-  | url = https://academic.oup.com/jcem/article/102/10/3869/4157558+
  
-pb-26 +[(pb39> American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming persons. American Psychologist, 70(9), 832–864. https://www.apa.org/practice/guidelines/transgender.pdf .)]
-  | type = book +
-  | author = American Psychological Association +
-  | year = 2015 +
-  | title = Guidelines for Psychological Practice with Transgender and Gender Nonconforming Persons +
-  | publisher = American Psychological Association +
-  | url = https://www.apa.org/practice/guidelines/transgender.pdf +
-</refnotes>+
  

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