In the Journal of Sex and Marital Therapy

Abstract

This paper critically examines the scientific and ethical underpinnings of gender-affirming care, particularly for minors. While major medical organizations endorse such interventions as medically necessary, the evidence supporting their long-term safety and efficacy remains limited. Research into hormonal, neuroanatomic, and genetic influences reveals a strong biological basis for gender identity, challenging social constructionist arguments. There is a lack of robust, long-term studies that definitively demonstrate the outcomes of gender-affirming medical treatments, such as puberty blockers or hormone therapy, for minors. Questions remain about how these interventions affect physical health (e.g., bone density, fertility) and mental well-being over decades. These gaps in the evidence, particularly for adolescents, raise ethical concerns about the appropriateness of irreversible medical treatments. This analysis highlights the tension between the social constructivist framework of gender and the medicalization of gender dysphoria. It explores the implications of rising desistance rates, co-occurring mental health conditions, and increasing non-binary identities within current clinical paradigms. Drawing on evidence from cases involving gender detransitioning, the impact of hormones, and neurological development in both straight, gay, and trans individuals, the paper underscores the importance of cautious, evidence-based approaches that prioritize psychological maturity and comprehensive mental health assessments. Ultimately, the paper advocates for rigorous longitudinal research, enhanced mental health evaluations, and the development of noninvasive therapeutic options in particular anda reevaluation of treatment models to ensure ethically sound and scientifically supported care for individuals experiencing gender dysphoria.