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Adolescents and gender
Puberty is for almost everyone a phase of discomfort with one's own body. Breast growth, menstruation, facial hair, voice change, acne, sexual feelings, doubts about one's place in the group — it all comes with the territory. The fact that an adolescent feels temporarily alienated from their own body is therefore not an indication of an innate wrong sex; in many cases it is a normal developmental phase.
An explosive, recent rise — and no one knows exactly why
Until around 2010 gender dysphoria in adolescents was rare, occurred mainly in boys from early childhood and developed gradually. Since 2012 the picture has changed radically: a tenfold increase in presentations at gender care clinics in Western countries, strongly shifted to adolescent girls without a prior history of gender dysphoria, often in clusters within friend groups and with intensive social media use as a common denominator.
This sudden, internationally comparable rise is hard to explain from a stable biological phenomenon. Social, cultural and media-driven factors play an important role according to a growing number of researchers. See also Social media and gender and Rapid Onset Gender Dysphoria.
Cass Review: the scientific basis is weak
The Cass Review (Hilary Cass, 2024, commissioned by the British NHS) is the most thorough independent investigation to date. The conclusion is stark: the evidence base under current paediatric gender care — puberty blockers and cross-sex hormones for minors — is of exceptionally low quality. The claim that treatment saves lives or prevents suicide is not supported by evidence. Cass Review (full report).
Comparable conclusions have been drawn by the Swedish SBU and the Finnish COHERE guidelines (Finland, 2020). Sweden, Finland, Norway, Denmark and the United Kingdom have substantially adjusted their policy and now only prescribe puberty blockers in research settings — or in the UK no longer at all. UK permanent ban on puberty blockers.
Puberty blockers are not a "pause button"
For a long time puberty blockers (GnRH analogues) were presented as a "reversible pause button": a child gets respite and can think things through in freedom. This picture is misleading. The most striking effect in the original Dutch Protocol and in all later cohorts: virtually all children who start blockers go on to cross-sex hormones — and thus ultimately to permanent sterilisation, loss of sexual function and lifelong medication. A "pause" therefore does not exist in practice; it is a one-way street.
In addition there are indications of negative effects on bone density, brain maturation, height growth and later sexual function. Research on this is limited and methodologically weak, as the Cass Review concludes.
Psychological co-morbidity and the tendency towards a single explanation
Many young people presenting at gender clinics have other problems at the same time: depression, anxiety disorders, eating disorders, autism spectrum disorder, trauma, ADHD or a history of bullying. International research points to a strong over-representation of autism and of girls with a history of sexual boundary violations. The risk in this picture is that "gender" is seized upon as an overarching explanation for everything that is difficult — while the underlying problems remain untreated.
The cognitive reality of an adolescent brain
The adolescent brain only fully matures around the age of 25. Decisions about irreversible medical interventions — loss of fertility, sexual function, undergoing lifelong hormone therapy — are often asked at an age at which the brain is not yet able to oversee such consequences fully. That is not a reproach to the young person; it is a fact that must weigh heavily.