Treatment of children & adolescents

What is ROGD:

Littman L. "Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports". PLoS One. 2018 13

e0202330. doi: 10.1371/journal.pone.0202330. eCollection 2018.

(Fundamental paper on soscial contagion of GD with a "Jungian" approach)

Lisa Marchiano (2017) Outbreak: On Transgender Teens and Psychic Epidemics, Psychological Perspectives, 60:3, 345-366

Weir, Erica (2005). "Mass sociogenic illness". Canadian Medical Association Journal. 172: 36.

No evidence that hormone treatment and "gender correction" results in improved health or quality of life

(A meta study of 100 studies of primary significance. The study was requested by UK, West-Midlands Health Services and The Guardian to evaluate the health benefit of "sex reassignments". Conclusion: No significant health benefit, many poor studies with "agenda")

ARIF study (Univ Birmingham, professional statistics centre)

genderchallenge: Artikler. See also

(page 3 , chapter 1.4 par 3 "There is little evidence based knowledge pertaining to effects of health care for persons who suffer from gender dysphoria". Norwegian)

"Rett til rett Kjønn", 2015, (Rapport from Norwegian Helsedirektoratet ) 

(Health Technology Assessment from Sweden, region West, 2018, concludes majority of studies very poor, low quality medical treatment evidence.

Lack of evidence  for improved "quality of life"). 

Gender affirmation surgery for gender dysphoria - effects and risks
Georgas K, Beckman U, Bryman I, Elander A, Jivegård L, Mattelin E, Olsen Ekerhult T, Persson J, Sandman L, Selvaggi G, Stadig I,

Vikberg Adania U, Strandell A

(BMJ journal, British Medical Journal,  international editors with base in at Univ Oxford, publish their "evidence-based-medicine" editorials as Blog.

Conclusion: Treatment of adolescents is not evidence based and must be judged experimental).

Gender-affirming hormone in children and adolescents, Posted on 25th February 2019

(Review on the Web-Site, "")

Paul Dirks,  "Transition as treatment: the best studies show the worst outcomes",  Jan 11, 2019.

(Chief Psychiatrist, Johns Hopkins Medical Center, after 40 years of "Sex reassignment surgery". Conclusion: We should stop reassignment surgery).

Paul McHugh, "Transgender Surgery Isn't the Solution", Wall St Journal, 13 may, 2016.

(Royal College of General Practitioners, GP's association in GB,  warn that treatment of children and adolescents with gender incongruence / dysphoria lacks medical scientific evidence and is associated with considerable risks).

Review of their 12 page report in Daily Mail 7 Juli 2019.

Most children grow out of gender incongruence during puberty (but puberty blockers will trap 100% of them in gender dysphoria!)

(Review of 11 studies which all reach the same unequivocal  conclusion.  60- 90% children "grow out" of gender dysphoria).

James Cantor, Sexology Today, "Do trans- kids stay trans- when they grow up?" 2016. January 11.

Extensive comment:  James Cantor, Sexology Today, 2017, 15 december

(63% grow out of dysphosira, part of Cantors analysis above, and GB National Health Service  conclude 84% grow out of dysphoria).

Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., 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 and Adolescent Psychiatry, 52, 582–590.

British National Health Service  analysis

(Puberty blockers resulted in that 100% of  treated children remained in gender dysphosria)

Paul W. Hruz, Lawrence S. Mayer, and Paul R. McHugh, "Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria

The New Atlantis. 2017. 52: pp. 3-36

(Warning that also an affirmativ treatment such as "social transitioning" may consolidate Gender Dysphoria. From the renomated group in Amsterdam) 

Annelou L. C. de Vries MD PhD & Peggy T. Cohen-Kettenis PhD (2012) Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach, Journal of Homosexuality, 59:3, 301-320,

(Discussion of the criticism and ambiguieties in evaluation of number of "desisters")

Kenneth J. Zucker (2018): The myth of persistence: Response to “A criticalcommentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018), International Journal of Transgenderism,DOI: 10.1080/15532739.2018.1468293

Suicide risk or psychiatric problems don't decrease after gender change surgery and hormonal treatment 

(No significant difference in psychiatric problems/disease before and after sex reassignment. Retrospectiv study including a high percentage of all transpersons in Denmark, but only a small group of these had recieved psychiatric evaluation and diagnosis).

Simonsen RK, Giraldi A, Kristensen E, Hald GM. Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality. Nord J Psychiatry. 2016;70:241-7. 

(Suicide risk does not decrease after after sex reassignment. ca x20 higher than “normal” population)

Dhejne C, Lichtenstein P, Boman M, Johansson AL, Långström N, Landén M.

"Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden". PLoS One. 2011. 6:e16885.

Adams N, Hitomi M, Moody C.  "Varied Reports of Adult Transgender Suicidality: Synthesizing and Describing the Peer-Reviewed and Gray Literature". Transgend Health. 2017. 2:60-75.

Big risks and medical side effects from puberty blockers and hormone treatment

(Report from Brittish National Health Service, Tavistock 2019. No eviden´ce for positive effects of puberty blockers for girls. On the contrary, suicidal ideation, dysphoria, self-mutilation).

(Blog review of peer reviewed articles on risks of hormone treatment, puberty blockers, irreversible effects on fertility. Many top renowned psychologists / Psychiatrists behind this web-site).


(Transsexuals with hormone treatment 2-3 times more likely develop stroke. Confirms earlier conclusion from Nat.Ist.Health, NIH,USA)

Nienke M. Nota , Chantal M. Wiepjes , Christel J.M. de Blok , Louis J.G. Gooren , Baudewijntje P.C. Kreukels , Martin den Heijer

"Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy
Results From a Large Cohort Study". Circulation. 2019. 139:1461–1462

Getahun D, Nash R, et al. "Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study". Ann Intern Med. 2018. 169:205-213.

(Memory impairent with puberty blockers)

Schneider MA, Spritzer PM, Soll BMB, Fontanari AMV, Carneiro M, Tovar-Moll F, Costa AB, da Silva DC, Schwarz K,, Anes M, Tramontina S, Lobato MIR. "Brain Maturation, Cognition and Voice Pattern in a Gender Dysphoria Case under Pubertal Suppression". Front Hum Neurosci. 2017. 11:528.

Mul D, Versluis-den Bieman HJ, Slijper FM, Oostdijk W, Waelkens JJ, Drop SL. "Psychological assessments before and after treatment of early puberty in adopted children". Acta Paediatr. 2001. 90:965-71.

(Press Release, Endocrinologists warn for side-effects from puberty blockers and Hormones).

Ladilaw MK et al.  "Endocrinologists Warn of Grave Dangers, Sterility Caused by Puberty Blockers and Hormones for Child and Adolescent Gender Dysphoria  Jan 2019

Chew D, Anderson J, Williams K, et al. "Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review. Pediatrics". 2018. 141(4):e20173742

(Literature review. Conclusion "..protocol is founded upon an unscientific gender ideology, lacks an evidence base, and violates the long-standing ethical principle of “First do no harm.”)

"Gender Dysphoria in Children. American College of Pediatricians". nov 2018

(The risk for ischemic stroke for transwomen treated with oestrogen increases by 250% compared with comtrol group of men)

Getahun D, Nash R, Flanders WD, Baird TC, Becerra-Culqui TA, Cromwell L, Hunkeler E, Lash TL, Millman A, Quinn VP, Robinson B, Roblin D, Silverberg MJ, Safer J, Slovis J, Tangpricha V, Goodman M. "Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study" Ann Intern Med. 2018 169:205-213.

Very high comorbidity with Psychiatric problems

(78% college students in the  US with gender incongruence have "mental health outcomes", psychological issues)

Lipson SK, Raifman J, Abelson S, Reisne SL "Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses" Am J Prev Med 2019; 57:293−301.

(The percentages denote how many gender dysphoric patients that show psychiatric problems. MtF=Male-to-Female, FtM = Female-to-Male).

(This study shows that also for girls is there a very high "comorbidity", This has changed to the worse in the past 10 years).

75%. MtF & FtM, Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N. "Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development". Child Adolesc Psychiatry Ment Health. 2015 Apr 9;9:9. doi: 10.1186/s13034-015-0042-y. eCollection 2015.

(Attachment problems were investigated and about 88% psychiatric diagnosis comorbidity is reported. The mental health issues precede development of GD, contradicting that they develop from social stigma).

Kozlowska K., et al. "Attachment Patterns in Children and Adolescents With Gender Dysphoria" 2021 january Front. Psychol.

30% MtF

Goddard JC, Vickery RM, Qureshi A, Summerton DJ, Khoosal D, Terry TR. "Feminizing genitoplasty in adult transsexuals: early and long-term surgical results". BJU Int. 2007;100:607-613. reassignment surgery (30).

49% MtF

Löwenberg H, Lax H, Neto RR, Krege S. "Complications, subjective satisfaction and sexual experience by gender reassignment surgery in male-to-female transsexual". Z Sexualforsch. 2010;23:328-347.

46.9% MtF, (Citation from the article: "The authors of the study stress the great importance of including personality assessment in standard GID diagnostic procedures, as presence or absence of psychiatric disease comorbidity is one of the contributing factors to the successful or unsuccessful SRS outcome" ).

Hess J. et al. "It is also possible that the positive results of our survey represent patients’ wish for social desirability rather than the real situation". Dtsch Arztebl Int. 2014 Nov; 111(47): 795-801.

66.6% MtF, 46% FtM.

Duišin D, Batinić B, Barišić J, Djordjevic ML, Vujović S, Bizic M."Personality disorders in persons with gender identity disorder."

ScientificWorldJournal. 2014;2014:809058. doi: 10.1155/2014/809058. Epub 2014 May 13.

77% MtF,  23% FtM.

Madeddu F, Prunas A, Hartmann D. "Prevalence of axis II disorders in a sample of clients undertaking psychiatric evaluation for sex reassignment surgery". Psychiatric Quarterly. 2009. 80:261-267

Myth that specific brain regions of trans persons are more like the self identified gender. 

(The variability of brin regions is so large so there is no region that is "male" or "female")

Joel D, Berman Z, Tavor I, Wexler N, Gaber O, Stein Y, Shefi N, Pool J, Urchs S, Margulies DS, Liem F, Hänggi J, Jäncke L, Assaf Y. "Sex beyond the genitalia: The human brain mosaic". Proc Natl Acad Sci U S A. 2015 112:15468-73. 

(Computer programs can separate male and female brains in one of two distinct classes with 93% accuracy for each individual).

Anderson NE et al., Machine learning of brain gray matter differentiates sex in a large forensic sample. Hum Brain Mapp 2019 40:1496-150

(Claims that there are differences in male and female brain structures are wrong) 

Jäncke L1, Mérillat S, Liem F, Hänggi J. "Brain size, sex, and the aging brain". Hum Brain Mapp. 2015 36:150-69. 

Savic I, Arver S. Sex dimorphism of the brain in male-to-female transsexuals. Cereb Cortex. 2011 21:2525-33.

Autistic symptoms common for gender dysphoria, many regretters

("Around 35% of referred young people present with moderate to severe autistic traits".   A "British Medical Journals" publication)

Butler G, De Graaf N, Wren B, Carmichael P. Assessment and support of children and adolescents with gender dysphoria. Arch Dis Child 2018 (accessed 22 may 2019)

(Many references in his review, one of the foremost research centres for transsexualism, gender incongruence).

van der Miesen AIR, de Vries ALC, Steensma TD, Hartman CA. "Autistic Symptoms in Children and Adolescents with Gender Dysphoria". J Autism Dev Disord. 2018. 48:1537-1548

Strang JF, Powers MD, Knauss M, Sibarium E, Leibowitz SF, Kenworthy L, Sadikova E, Wyss S, Willing L, Caplan R, Pervez N, Nowak J, Gohari D, Gomez-Lobo V, Call D, Anthony LG. "They Thought It Was an Obsession: Trajectories and Perspectives of Autistic Transgender and Gender-Diverse Adolescents". J Autism Dev Disord. 2018;48:4039-4055.

(US Survey, More than 27,000 responders. 11% MtF officially detransitioned, regretters likely many fold more. x5 higher than what ANOVA/ Karolinska report). 

Quora: How common is it for transgender people to regret their gender transition, possibly to the point of transitioning back? 

Summary of the US Survey:  

(UK NHS, Tavistock: 9,5% "openly" regret. Adolescents that developed dysphoria).
Churcher Clarke, A., Spiliadis, A. ‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties. 2019.

Extensive psychiatric evaluation (by clinical Psychiatrist ecxperts) must precede affirmative treatment

(The strong assertion/conclusion from Endocrinological Society in their International Guidelines. The paper is authored by many of the internationally recognized most experienced and active centres in research and treatment of transsexualism /gender incongruence).

Wylie C Hembree Peggy T Cohen-Kettenis Louis Gooren Sabine E Hannema Walter J Meyer M Hassan Murad Stephen M Rosenthal Joshua D Safer Vin Tangpricha Guy G T’Sjoen.

"Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism, 102: 3869–3903,