Gender-Affirming Care for Trans Youth Is Neither New nor Experimental: A Timeline and Compilation of Studies

Julia Serano
32 min readMay 16


photo by Eliza Craciunescu at Pexels

NOTE: this essay is a 15 minute read. If it’s listed as longer than that, it’s because it contains a list of over 100 references at the end.

Trans and gender-diverse people are a pancultural and transhistorical phenomenon. It is widely understood that we, like LGBTQ+ people more generally, arise due to natural variation rather than the result of pathology, modernity, or the latest conspiracy theory.

Gender-affirming healthcare has a long history. The first trans-related surgeries were carried out in the 1910s–1930s (Meyerowitz, 2002, pp. 16–21). While some doctors were supportive early on, most were wary. Throughout the mid-twentieth century, these skeptical doctors subjected trans people to all sorts of alternate treatments — from perpetual psychoanalysis, to aversion and electroshock therapies, to administering assigned-sex-consistent hormones (e.g., testosterone for trans female/feminine people), and so on — but none of them worked. The only treatment that reliably allowed trans people to live happy and healthy lives was allowing them to transition. While doctors were initially worried that many would eventually come to regret that decision, study after study has shown that gender-affirming care has a far lower regret rate (typically around 1 or 2 percent) than virtually any other medical procedure. Given all this, plus the fact that there is no test for being trans (medical, psychological, or otherwise), around the turn of the century, doctors began moving away from strict gatekeeping and toward an informed consent model for trans adults to attain gender-affirming care.

Trans children have always existed — indeed most trans adults can tell you about their trans childhoods. During the twentieth century, while some trans kids did socially transition (Gill-Peterson, 2018), most had their gender identities disaffirmed, either by parents who disbelieved them or by doctors who subjected them to “gender reparative” or “conversion” therapies. The rationale behind the latter was a belief at that time that gender identity was flexible and subject to change during early childhood, but we now know that this is not true (see e.g., Diamond & Sigmundson, 1997; Reiner & Gearhart, 2004). Over the years, it became clear that these conversion efforts were not only ineffective, but they caused real harm — this is why most health professional organizations oppose them today.

Given the harm caused by gender-disaffirming approaches, around the turn of the century, doctors and gender clinics began moving toward what has come to be known as the gender affirmative model — here’s how I briefly described this approach in my 2016 essay Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates:

Rather than being shamed by their families and coerced into gender conformity, these children are given the space to explore their genders. If they consistently, persistently, and insistently identify as a gender other than the one they were assigned at birth, then their identity is respected, and they are given the opportunity to live as a member of that gender. If they remain happy in their identified gender, then they may later be placed on puberty blockers to stave off unwanted bodily changes until they are old enough (often at age sixteen) to make an informed decision about whether or not to hormonally transition. If they change their minds at any point along the way, then they are free to make the appropriate life changes and/or seek out other identities.

All these stages are spaced out over time and the children are assessed at each step along the way. Social transition and puberty delay are completely reversible. Hormone therapy is partially reversible depending on the duration of treatment. Gender-affirming surgeries typically take place after the hormone therapy stage, often in adulthood. A more thorough overview of this model and the rationale behind it can be found in Hidalgo et al. (2013); for a detailed account of a gender-affirming clinic’s practices, see Chen et al. (2016).

Today in 2023, we are experiencing an all-out moral panic against trans people that is occurring on many fronts: sports, public restrooms, banning books, school accommodations, drag performances, and so on. But arguably, anti-trans activists have made the most inroads in their attempts to undermine and restrict gender-affirming care for trans youth. Their approach takes advantage of the mainstream public’s lack of awareness about trans experiences and trans healthcare. For instance, anti-trans activists will make it sound as though kids are adopting trans identities capriciously or frivolously, and that it’s just a phase they will simply grow out of. Or they will claim that the gender-affirming approach is new, experimental, and hasn’t been rigorously tested yet. Or they will make it seem as though children are being “rushed into hormones and surgeries” at a young age and with little to no assessment. All these claims are false, but they tend to strike the average person as feasible and alarming.

I have written this piece to counter these relentless attempts to misrepresent gender-affirming care for trans youth, and as a resource for the average person to get a handle on just how established and extensively researched this field is. It will end with a long list of references (currently over a hundred, more to come), so that interested parties can read those studies for themselves if they wish. But first, a few preliminaries.

Who Am I?

I am a trans author and biologist who has been researching and writing about trans-related science and healthcare since the mid-2000s — see Chapter 7 of my 2007 book Whipping Girl and my many subsequent essays and journal articles collected on my Trans Psychology webpage.

The Gish Gallop

According to Wikipedia, a Gish gallop occurs when “a debater confronts an opponent with a rapid series of many specious arguments, half-truths, misrepresentations, and outright lies in a short space of time, which makes it impossible for the opponent to refute all of them within the format of a formal debate.”

Much like creationists, climate change deniers, and anti-vaxxers, anti-trans activists love to Gish gallop, as it’s a convenient way to make it seem as though an established scientific field is suspect and riddled with inaccuracies. I have no doubt that, when confronted with this piece, anti-trans activists will say, “But what about “shifting sex ratios,” or “ROGD/social contagion,” or “detransition,” or “80% desistance,” or “gay conversion/lesbian extinction,” or “autogynephilia,” or “grooming,” and so on. Ad nauseam, ad infinitum.

I address those particular arguments in the associated links. But I’m sure anti-trans activists will come up with others, as that’s the nature of this strategy: just keep raising more and more questions.

Given this, I entreat readers to tune out the Gish gallop and focus on the large body of research that I will present below. As with any field (e.g., evolution, climate science, vaccination), researchers don’t always agree on every point and there are always outstanding questions to pursue. But the overall gist — that gender-disaffirming approaches are harmful and that gender-affirming approaches are beneficial — is widely agreed upon by contemporary trans health practitioners.

The Biggest Tell

I’ve read countless trans-skeptical and “just asking questions” articles about the gender affirmative model, and they always have one glaring omission. Specifically, they focus solely on gender-affirming practices — social transition, puberty delay, hormone therapy, and surgeries — and portray them as “novel” and “active” interventions that require further scrutiny. This framing makes it seem as though the alternative approach (passively “doing nothing”) is an inherently neutral and less risky option. But “doing nothing” is not doing nothing! It involves actively disaffirming trans kids’ genders — and we have lots of research on the impacts of that approach.

Here’s a passage from Hidalgo et al. (2013) discussing this:

Children not allowed these freedoms by agents within their developmental systems (e.g., family, peers, school) are at later risk for developing a downward cascade of psychosocial adversities including depressive symptoms, low life satisfaction, self-harm, isolation, homelessness, incarceration, posttraumatic stress, and suicide ideation and attempts [D’Augelli, Grossman, & Starks, 2006; Garofalo, Deleon, Osmer, Doll, & Harper, 2006; Roberts, Rosario, Corliss, Koenen, & Bryn Austin, 2012; Skidmore, Linsenmeier, & Bailey, 2006; Toomey, Ryan, Díaz, Card, & Russell, 2010; Travers et al., 2012].

A more recent review (Temple Newhook et al., 2018b) expands upon the harms associated with the gender-disaffirming approach:

Emerging research indicates that children who are not permitted to express their gender freely within their key developmental contexts, including family and school, might be at risk of negative psychosocial outcomes,23 both in the short-term26 and into adolescence and adulthood.27–29 These include low self-esteem,27 low life satisfaction,26 poor mental health,27,28 lack of adequate housing,27 posttraumatic stress,28,29 and suicidal thoughts and attempts.27

Canadian research indicates that one of the key areas of distress for trans and gender-diverse youth is lack of parental support.27 A well-designed provincial survey of more than 400 trans youth in Ontario, funded by the Canadian Institutes of Health Research, revealed that young people whose gender identities are not strongly supported by their parents face an attempted suicide rate 14 times higher than their supported peers do.26 Trans youth without strong family support also reported less positive mental health, more depression, lower self-esteem, and lower life satisfaction. The authors concluded that “anything less than strong support may have deleterious effects on a child’s well-being.”27

Any article examining gender-affirming care that doesn’t even attempt to grapple with all this research demonstrating the very real negative effects that gender-disaffirming approaches inflict on trans youth is telling on itself. It’s a giant red flag that the author either did not bother to properly research the subject, or else had their mind made up beforehand and purposely hid this information from readers. Either way, critiques and reviews of the gender affirmative model that omit this crucial piece of the story should be summarily dismissed.


In addition to all the negative psychological effects, the supposedly passive and neutral “do nothing” approach forces trans adolescents into unwanted endogenous puberties. While anti-trans activists are quick to decry gender-affirming approaches as being “irreversible” and involving “a lifetime of medicalization,” they never discuss how restricting gender-affirming care will result in similar irreversible changes for trans youth and may require them to undergo additional medical procedures (e.g., electrolysis, top and other surgeries) at a later date that would not have been necessary if they had timely access to puberty blockers and gender-affirming hormones.

In my Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates essay, I offered the following scenario to highlight this double standard:

Consider a cisgender girl who has always been happy with her assigned gender. Then suddenly, at the age of nine or ten (as she is entering puberty), her body shows signs of masculinization, and doctors confirm that this is due to her body producing testosterone (for the record, this is not a hypothetical situation for some intersex children). If this child was horrified about these potential unwanted changes, and asked for hormonal intervention (which the doctor confirmed would be safe and effective), would you respect her decision and allow her to proceed with it? Or would you dismiss her wishes on account of her lack of maturity, and insist that she just deal with the testosterone until she is eighteen and capable of making an adult decision? As with the last example, if this scenario concerns you, but the idea of transgender children being forced to experience unwanted puberties does not, then you clearly value cis bodies and lives over trans ones.

In the TV series Succession, the Fox News-like corporation at the center of the show has an in-house expression to dismiss instances when members of marginalized groups are injured or die as a result of their practices: “No Real Person Involved.” Whenever people argue that gender-affirming practices should be restricted or banned in order to protect the 1 or 2 percent of people who may later regret it, without considering how this would wreak havoc on the lives of the other 98–99 percent, what they are saying is that trans kids don’t “count” in their eyes. It doesn’t matter what happens to them because No Real Person Involved.


In addition to exclamations that gender-affirming care is “irreversible,” anti-trans activists also love to call it “experimental.” They likely gravitate toward this word because it conjures up images of “mad scientists” creating “Frankenstein’s monsters” (which is how some cis people have historically imagined trans people; see Stryker, 1994). If called out on it, they would likely insist that they mean “experimental” in the sense that gender-affirming care is “new and untested,” but this simply isn’t true (see the slew of research studies below).

The “experimental” label is most regularly levied against puberty blockers, probably because the average person isn’t familiar with them. However, they’ve been used to treat precocious puberty since the 1980s (Comite et al., 1981; Mancuso et al., 1989) and to stave off unwanted endogenous puberties in trans youth since the mid-to-late-1990s (Cohen-Kettenis & van Goozen, 1998; van der Loos et al., 2023). For anyone interested in learning more about them, I’d recommend Giordano & Holm’s 2020 accessibly written scientific review “Is puberty delaying treatment ‘experimental treatment’?” as it answers the most commonly asked questions about the method, its efficacy, potential side effects, and so on.

Giordano & Holm’s review also addresses another common claim levied against gender-affirming care, namely, that there aren’t any “high quality studies.” In actuality, there are many high-quality studies: sound methodologies, significant sample sizes, published in well-respected journals, etcetera. When trans-skeptical people argue this, what they really mean is that there aren’t any randomized controlled studies — where neither the doctor nor patient know whether they’ve received the medicine in question or whether they’ve received a placebo. While this certainly is the “gold standard” for medical trials, it is not logistically possible in cases such as this, as both doctors and patients would quickly surmise which group they were assigned to based upon the changes (or lack thereof) in their bodies. The review also delves into ethical issues regarding withholding this treatment that make controlled studies impossible.

The Proof Is in the Pudding

As I said in the Gish gallop section, anti-trans activists will undoubtedly raise additional concerns about whether trans youth are being properly assessed, or whether some kids are experiencing “ROGD” rather than bona fide gender dysphoria, or whether there is an epidemic of people detransitioning these days, and so on. It is impossible for me to address every single issue they raise here. But what I can say is that, if any of these things were true, then we would expect them to be reflected in recent studies — that is, there would be a sharp reduction in the efficacy of gender-affirming care and a reciprocal increase in the rates of regret. Yet all the most recently published studies continue to show that this is not occurring (see e.g., Olson et al., 2022; De Castro et al., 2022, Tang et al., 2022, van der Loos et al., 2022, Chen et al., 2023, Jedrzejewski et al., 2023).

It is precisely this lack of tangible evidence that leads trans-skeptical people to seek out outlier studies, rely on anecdotes, amplify the voices of doctors who hold contrarian views, and latch onto new alternative hypotheses like “ROGD/social contagion” or “gender exploratory therapy,” because that’s all they have. But that’s simply not how science is supposed to work.

What we are dealing with here is a hundred-year-old medical field that has gradually come to the conclusion (particularly over the last three decades) that gender-disaffirming approaches are harmful and gender-affirming approaches are beneficial. That consensus does not automatically disappear just because some individuals continue to “have questions” or “raise concerns.”

A Brief Timeline of the Gender Affirmative Model for Trans Youth

This is not intended to be a definitive history of how the gender affirmative model for trans and gender-diverse youth came to be. Rather, it’s my rough attempt to piece this story together from the research studies and reviews that I have at my disposal.

While gender reparative/conversion therapies were a dominant clinical approach to gender-diverse youth throughout the mid-to-late twentieth century, their ethics and efficacy had long been debated in the field — I discuss some of this history in this piece and references therein.

In the mid-1990s, doctors in the Netherlands began treating trans adolescents with puberty blockers at the onset of puberty, followed by gender-affirming hormones around age 16. This came to be known as the “Dutch protocol” or “Dutch model.” This approach was acknowledged as a potential option by the World Professional Association for Transgender Health (WPATH, formerly HBIGDA) in their Standards of Care version 5 (1998) and version 6 (2002).

During the 2000s, numerous groups in the U.S. and elsewhere began adopting the Dutch protocol. In May 2008, NPR ran a two-part series that was the first mainstream news story about this that I recall. The first episode, “Two Families Grapple with Sons’ Gender Identity,” compared and contrasted the reparative/conversion approach with what we would now call the gender affirmative approach. The second, “Parents consider treatment to delay son’s puberty,” discussed the Dutch approach. These news stories are now 15 years old.

In 2009, the Endocrine Society published its practice guidelines for trans healthcare that recommended puberty delay followed by gender-affirming hormones for trans adolescents. In 2012, WPATH’s Standards of Care version 7 greatly expanded its section on trans children and adolescents. In addition to continuing to validate the Dutch approach, it included a section on “Social Transition in Early Childhood,” and explicitly described gender reparative/conversion practices as ineffective and unethical.

Over the 2000s, as puberty delay followed by gender-affirming hormones was becoming standard practice for many gender clinics, the debate shifted more toward younger children. While the Dutch group was not in favor of any interventions for pre-pubescent gender-dysphoric children (they called this “watchful waiting”; see de Vries & Cohen-Kettenis, 2012), other trans health practitioners began advocating for social transition for children who are insistent, persistent, and consistent about their gender identity. Several groups began referring to this as an “affirmed” or “affirmative” approach (see e.g., Vanderburgh, 2009; Hill et al., 2010; Malpas, 2011; Menvielle and Hill, 2011; Olson et al., 2011) and the label became solidified when researchers from four gender clinics came together to publish “The Gender Affirmative Model: What We Know and What We Aim to Learn” (Hidalgo et al., 2013), which explains the rationale behind this approach and dispels common myths about it.

Over the last ten years, the gender affirmative model has become more accepted than watchful waiting due to 1) an increasing understanding of the psychological harms associated with disaffirming young children, 2) a recognition that the “80% desistance” claim was methodologically flawed (Temple Newhook et al., 2018a & 2018b), and 3) studies showing that children who socially transition at an early age are happy, healthy, and very rarely detransition (see e.g., Durwood et al., 2017; Gülgöz et al., 2019; Olson et al., 2022). As the American Academy of Pediatrics put it in a 2018 policy statement:

Research substantiates that children who are prepubertal and assert an identity of TGD [transgender and gender diverse] know their gender as clearly and as consistently as their developmentally equivalent peers who identify as cisgender and benefit from the same level of social acceptance.46 This developmental approach to gender affirmation is in contrast to the outdated approach in which a child’s gender-diverse assertions are held as “possibly true” until an arbitrary age (often after pubertal onset) when they can be considered valid, an approach that authors of the literature have termed “watchful waiting.” This outdated approach does not serve the child because critical support is withheld. Watchful waiting is based on binary notions of gender in which gender diversity and fluidity is pathologized; in watchful waiting, it is also assumed that notions of gender identity become fixed at a certain age. The approach is also influenced by a group of early studies with validity concerns, methodologic flaws, and limited follow-up on children who identified as TGD and, by adolescence, did not seek further treatment (“desisters”).45,47 More robust and current research suggests that, rather than focusing on who a child will become, valuing them for who they are, even at a young age, fosters secure attachment and resilience, not only for the child but also for the whole family.5,45,48,49

Obligatory List of Position Statements in Support of Gender-Affirming Care

In recent years, many health professional organizations have published position statements in support of the gender affirmative approach. Here are some of the more prominent ones:

Often, these position statements and clinical guidelines are invoked in an “appeal to authority”-type manner. Anti-trans activists, on the other hand, will insist that all these groups have been “ideologically captured” by trans people, which is utterly fanciful. For the record, I do not believe that these organizations are infallible — in fact, several of them have contributed to the marginalization of trans people in the past (discussed in Chapter 7 of Whipping Girl). But the one thing that is undoubtedly true is that all of these organizations are inherently conservative, often to a fault. The fact that they all support gender-affirmative care and condemn gender-disaffirming practices nowadays is a testament to how much scientific evidence has been amassed over the last three decades.

A Noncomprehensive Chronological List of Research Studies and Reviews.

Finally, here is the list of research studies and reviews supporting the current scientific consensus that gender-disaffirming approaches are harmful and gender-affirming approaches are beneficial for trans youth. They are sorted by year, with articles within each year sorted alphabetically. Obviously, many are behind a paywall, but if you search for the title of the article in Google Scholar, you can often find PDF links for them.

This list is not in any way comprehensive — it’s literally just all the articles in the “gender-affirming research” folder on my computer. I have collected them randomly over the years as I’ve come across them and/or upon doing searches on certain subtopics. For the most representative studies and reviews of the field today, you should scroll down to the end of the list and work your way backwards; the inclusion of earlier articles is intended to provide a sense of history as to how this field evolved. I plan to add more references as I become aware of them, so consider this list a work in progress.

I’m sure that trans-skeptical people will complain that their favorite studies are not listed here. Of course, they are free to make their own list if they wish, although I am sure it would be far shorter and/or more reliant on older outdated research than this one. And undoubtedly, they will likely nitpick over individual studies listed here and opine about how they are supposedly flawed. As a scientist myself, I’ll be the first to admit that no research study is perfect. But scientific fields are not built upon any singular study. Rather, they arise as a result of multiple independent groups carrying out similar research and all coming to the same general conclusions. That is precisely what is chronicled here.


Cohen-Kettenis, Peggy T., and Stephanie HM van Goozen. “Pubertal delay as an aid in diagnosis and treatment of a transsexual adolescent.” European child & adolescent psychiatry 7, no. 4 (1998): 246–248.


Smith, Yolanda LS, Stephanie HM Van Goozen, and Peggy T. Cohen-Kettenis. “Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: a prospective follow-up study.” Journal of the American Academy of Child & Adolescent Psychiatry 40, no. 4 (2001): 472–481.


Cohen-Kettenis, Peggy T., and Stephanie HM Van Goozen. “Adolescents who are eligible for sex reassignment surgery: Parental reports of emotional and behavioural problems.” Clinical Child Psychology and Psychiatry 7, no. 3 (2002): 412–422.


Smith, Yolanda LS, Stephanie HM Van Goozen, Abraham J. Kuiper, and Peggy T. Cohen-Kettenis. “Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals.” Psychological medicine 35, no. 1 (2005): 89–99. doi:10.1017/S0033291704002776


D’Augelli, Anthony R., Arnold H. Grossman, and Michael T. Starks. “Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth.” Journal of interpersonal violence 21, no. 11 (2006): 1462–1482.

Delemarre-Van De Waal, Henriette A., and Peggy T. Cohen-Kettenis. “Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects.” European journal of endocrinology 155, no. Supplement_1 (2006): S131-S137.

Garofalo, Robert, Joanne Deleon, Elizabeth Osmer, Mary Doll, and Gary W. Harper. “Overlooked, misunderstood and at-risk: Exploring the lives and HIV risk of ethnic minority male-to-female transgender youth.” Journal of adolescent health 38, no. 3 (2006): 230–236.

Saeger, Karen. “Finding our way: Guiding a young transgender child.” Journal of GLBT Family Studies 2, no. 3–4 (2006): 207–245.

Skidmore, W. Christopher, Joan AW Linsenmeier, and J. Michael Bailey. “Gender nonconformity and psychological distress in lesbians and gay men.” Archives of sexual behavior 35 (2006): 685–697.


Ehrensaft, Diane. “Raising girlyboys: A parent’s perspective.” Studies in Gender and Sexuality 8, no. 3 (2007): 269–302.


Brill, Stephanie, and Rachel Pepper, The transgender child: A handbook for families and professionals (San Francisco: Cleis Press, 2008).

Cohen‐Kettenis, Peggy T., Henriette A. Delemarre‐Van De Waal, and Louis JG Gooren. “The treatment of adolescent transsexuals: changing insights.” The journal of sexual medicine 5, no. 8 (2008): 1892–1897.


Ehrensaft, Diane. “One pill makes you boy, one pill makes you girl.” International Journal of Applied Psychoanalytic Studies 6, no. 1 (2009): 12–24.

Hembree, Wylie C., Peggy Cohen-Kettenis, Henriette A. Delemarre-Van De Waal, Louis J. Gooren, Walter J. Meyer III, Norman P. Spack, Vin Tangpricha, and Victor M. Montori. “Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline.” The Journal of Clinical Endocrinology & Metabolism 94, no. 9 (2009): 3132–3154.

Spack, Norman P. “An endocrine perspective on the care of transgender adolescents.” Journal of Gay & Lesbian Mental Health 13, no. 4 (2009): 309–319.

Vanderburgh, Reid. “Appropriate therapeutic care for families with pre-pubescent transgender/gender-dissonant children.” Child and Adolescent Social Work Journal 26, no. 2 (2009): 135–154.


Hill, Darryl B., Edgardo Menvielle, Kristin M. Sica, and Alisa Johnson. “An affirmative intervention for families with gender variant children: Parental ratings of child mental health and gender.” Journal of sex & marital therapy 36, no. 1 (2010): 6–23.


Cohen-Kettenis, Peggy T., Thomas D. Steensma, and Annelou LC de Vries. “Treatment of adolescents with gender dysphoria in the Netherlands.” Child and Adolescent Psychiatric Clinics 20, no. 4 (2011): 689–700.

De Vries, Annelou LC, Thomas D. Steensma, Theo AH Doreleijers, and Peggy T. Cohen‐Kettenis. “Puberty suppression in adolescents with gender identity disorder: A prospective follow‐up study.” The journal of sexual medicine 8, no. 8 (2011): 2276–2283.

Ehrensaft, Diane. “Boys will be girls, girls will be boys: Children affect parents as parents affect children in gender nonconformity.” Psychoanalytic Psychology 28, no. 4 (2011): 528–548.

Kreukels, Baudewijntje PC, and Peggy T. Cohen-Kettenis. “Puberty suppression in gender identity disorder: the Amsterdam experience.” Nature Reviews Endocrinology 7, no. 8 (2011): 466–472.

Malpas, Jean. “Between pink and blue: A multi‐dimensional family approach to gender nonconforming children and their families.” Family process 50, no. 4 (2011): 453–470.

Menvielle, Edgardo, and Darryl B. Hill. “An affirmative intervention for families with gender-variant children: A process evaluation.” Journal of Gay & Lesbian Mental Health 15, no. 1 (2011): 94–123.

Olson, Johanna, Catherine Forbes, and Marvin Belzer. “Management of the transgender adolescent.” Archives of pediatrics & adolescent medicine 165, no. 2 (2011): 171–176.


De Vries, Annelou LC, and Peggy T. Cohen-Kettenis. “Clinical management of gender dysphoria in children and adolescents: the Dutch approach.” Journal of homosexuality 59, no. 3 (2012): 301–320.

Edwards-Leeper, Laura, and Norman P. Spack. “Psychological evaluation and medical treatment of transgender youth in an interdisciplinary “Gender Management Service”(GeMS) in a major pediatric center.” Journal of homosexuality 59, no. 3 (2012): 321–336.

Ehrensaft, Diane. “From gender identity disorder to gender identity creativity: True gender self child therapy.” Journal of homosexuality 59, no. 3 (2012): 337–356.

Menvielle, Edgardo. “A comprehensive program for children with gender variant behaviors and gender identity disorders.” Journal of homosexuality 59, no. 3 (2012): 357–368.

Roberts, Andrea L., Margaret Rosario, Heather L. Corliss, Karestan C. Koenen, and S. Bryn Austin. “Childhood gender nonconformity: A risk indicator for childhood abuse and posttraumatic stress in youth.” Pediatrics 129, no. 3 (2012): 410–417.

Sherer, Ilana, Stephen M. Rosenthal, Diane Ehrensaft, and Joel Baum. “Child and Adolescent Gender Center: a multidisciplinary collaboration to improve the lives of gender nonconforming children and teens.” Pediatrics in Review 33, no. 6 (2012): 273–275.

Spack, Norman P., Laura Edwards-Leeper, Henry A. Feldman, Scott Leibowitz, Francie Mandel, David A. Diamond, and Stanley R. Vance. “Children and adolescents with gender identity disorder referred to a pediatric medical center.” Pediatrics 129, no. 3 (2012): 418–425.

Travers, Robb, G. Bauer, Jake Pyne, K. Bradley, L. Gale, and M. Papadimitriou. “Impacts of strong parental support for trans youth: A report for the Children’s Aid Society of Toronto and Delisle Youth Services.” Trans PULSE, Ontario, Canada (2012).


Bauer, Greta R., Jake Pyne, Matt Caron Francino, and Rebecca Hammond. “Suicidality among trans people in Ontario: Implications for social work and social justice.” Service social 59, no. 1 (2013): 35–62.

Hidalgo, Marco A., Diane Ehrensaft, Amy C. Tishelman, Leslie F. Clark, Robert Garofalo, Stephen M. Rosenthal, Norman P. Spack, and Johanna Olson. “The Gender Affirmative Model: What We Know and What We Aim to Learn.” Human Development 56, no. 5 (2013): 285–290.

Shumer, Daniel E., and Norman P. Spack. “Current management of gender identity disorder in childhood and adolescence: guidelines, barriers and areas of controversy.” Current Opinion in Endocrinology, Diabetes and Obesity 20, no. 1 (2013): 69–73.

Simons, Lisa, Sheree M. Schrager, Leslie F. Clark, Marvin Belzer, and Johanna Olson. “Parental support and mental health among transgender adolescents.” Journal of adolescent health 53, no. 6 (2013): 791–793.

Spack, Norman P., “Management of Transgenderism,” JAMA 309, no. 5 (2013): 478–484.

Toomey, Russell B., Caitlin Ryan, Rafael M. Diaz, Noel A. Card, and Stephen T. Russell. “Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment.” Psychology of Sexual Orientation and Gender Diversity 1(S) (2013): 71–80.


De Vries, Annelou LC, Jenifer K. McGuire, Thomas D. Steensma, Eva CF Wagenaar, Theo AH Doreleijers, and Peggy T. Cohen-Kettenis. “Young adult psychological outcome after puberty suppression and gender reassignment.” Pediatrics 134, no. 4 (2014): 696–704.

Ehrensaft, Diane. “Found in transition: Our littlest transgender people.” Contemporary Psychoanalysis 50, no. 4 (2014): 571–592.

Olson, Johanna, and Robert Garofalo. “The peripubertal gender-dysphoric child: puberty suppression and treatment paradigms.” Pediatric Annals 43, no. 6 (2014): e132-e137.

Pyne, Jake. “Gender independent kids: A paradigm shift in approaches to gender non-conforming children.” The Canadian Journal of Human Sexuality 23, no. 1 (2014): 1–8.


Bauer, Greta R., Ayden I. Scheim, Jake Pyne, Robb Travers, and Rebecca Hammond. “Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada.” BMC public health 15, no. 1 (2015): 1–15.

Costa, Rosalia, Michael Dunsford, Elin Skagerberg, Victoria Holt, Polly Carmichael, and Marco Colizzi. “Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria.” The journal of sexual medicine 12, no. 11 (2015): 2206–2214.

Olson, Kristina R., Aidan C. Key, and Nicholas R. Eaton. “Gender cognition in transgender children.” Psychological science 26, no. 4 (2015): 467–474.

Shumer, Daniel E., and Norman P. Spack. “Transgender medicine — long-term outcomes from’the Dutch model’.” Nature Reviews Urology 12, no. 1 (2015): 12–13.


Chen, Diane, Marco A. Hidalgo, Scott Leibowitz, Jennifer Leininger, Lisa Simons, Courtney Finlayson, and Robert Garofalo. “Multidisciplinary care for gender-diverse youth: A narrative review and unique model of gender-affirming care.” Transgender Health 1, no. 1 (2016): 117–123.

Edwards-Leeper, Laura, Scott Leibowitz, and Varunee Faii Sangganjanavanich. “Affirmative practice with transgender and gender nonconforming youth: expanding the model.” Psychology of Sexual Orientation and Gender Diversity 3, no. 2 (2016): 165.

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Ashley, Florence. “Homophobia, conversion therapy, and care models for trans youth: defending the gender-affirmative approach.” Journal of LGBT Youth 17, no. 4 (2020): 361–383.

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van der Miesen, Anna IR, Thomas D. Steensma, Annelou LC de Vries, Henny Bos, and Arne Popma. “Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers.” Journal of Adolescent Health 66, no. 6 (2020): 699–704.


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Chen, Diane, Mere Abrams, Leslie Clark, Diane Ehrensaft, Amy C. Tishelman, Yee-Ming Chan, Robert Garofalo, Johanna Olson-Kennedy, Stephen M. Rosenthal, and Marco A. Hidalgo. “Psychosocial characteristics of transgender youth seeking gender-affirming medical treatment: Baseline findings from the Trans Youth Care Study.” Journal of Adolescent Health 68, no. 6 (2021): 1104–1111.

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Grannis, Connor, Scott F. Leibowitz, Shane Gahn, Leena Nahata, Michele Morningstar, Whitney I. Mattson, Diane Chen, John F. Strang, and Eric E. Nelson. “Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys.” Psychoneuroendocrinology 132 (2021): 105358.

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Rosenthal, Stephen M. “Challenges in the care of transgender and gender-diverse youth: an endocrinologist’s view.” Nature Reviews Endocrinology 17, no. 10 (2021): 581–591.

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Arnoldussen, Marijn, Anna IR van der Miesen, Wieteke S. Elzinga, Anne-Marie E. Alberse, Arne Popma, Thomas D. Steensma, and Annelou LC de Vries. “Self-Perception of Transgender Adolescents after Gender-Affirming Treatment: A Follow-Up Study into Young Adulthood.” LGBT health 9, no. 4 (2022): 238–246.

De Castro, Clara, Mireia Solerdelcoll, Maria Teresa Plana, Irene Halperin, Mireia Mora, Laura Ribera, Camil Castelo-Branco, Esther Gómez-Gil, and Angela Vidal. “High persistence in Spanish transgender minors: 18 years of experience of the Gender Identity Unit of Catalonia.” Revista de Psiquiatría y Salud mental (2022).

de Vries, Annelou LC, Christina Richards, Amy C. Tishelman, Joz Motmans, Sabine E. Hannema, Jamison Green, and Stephen M. Rosenthal. “Bell v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274: Weighing current knowledge and uncertainties in decisions about gender-related treatment for transgender adolescents.” International Journal of Transgender Health 22, no. 3 (2021): 217–224.

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Horton, Cal. “Experiences of Puberty and Puberty Blockers: Insights From Trans Children, Trans Adolescents, and Their Parents.” Journal of Adolescent Research (2022): 07435584221100591.

Horton, Cal. ““I Didn’t Want Him to Disappear” Parental Decision-Making on Access to Puberty Blockers for Trans Early Adolescents.” The Journal of Early Adolescence 43, no. 4 (2023): 490–515.

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Lee, Janet Y., and Stephen M. Rosenthal. “Gender-Affirming Care of Transgender and Gender-Diverse Youth: Current Concepts.” Annual Review of Medicine 74 (2023).

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Ashley, Florence. “Interrogating gender-exploratory therapy.” Perspectives on Psychological Science 18, no. 2 (2023): 472–481.

Chen, Diane, Johnny Berona, Yee-Ming Chan, Diane Ehrensaft, Robert Garofalo, Marco A. Hidalgo, Stephen M. Rosenthal, Amy C. Tishelman, and Johanna Olson-Kennedy. “Psychosocial Functioning in Transgender Youth after 2 Years of Hormones.” New England Journal of Medicine 388, no. 3 (2023): 240–250.

Jedrzejewski, Breanna Y., Mary C. Marsiglio, Jess Guerriero, Amy Penkin, and Jens U. Berli. “Regret after Gender Affirming Surgery–A Multidisciplinary Approach to a Multifaceted Patient Experience.” Plastic and Reconstructive Surgery (2023): 10–1097.

Olsavsky, Anna L., Connor Grannis, Josh Bricker, Gayathri Chelvakumar, Justin A. Indyk, Scott F. Leibowitz, Whitney I. Mattson, Eric E. Nelson, Charis J. Stanek, and Leena Nahata. “Associations among gender-affirming hormonal interventions, social support, and transgender adolescents’ mental health.” Journal of Adolescent Health (2023).

Pflugeisen, Chaya Mangel, Aytch A. Denaro, and Anna Boomgaarden. “The Impact of Parent Support on Patient Empowerment in Trans and Gender Diverse Youth.” LGBTQ+ Family: An Interdisciplinary Journal (2023): 1–10.

Pullen Sansfaçon, Annie, Denise Medico, Damien Riggs, Anna Carlile, and Frank Suerich-Gulick. “Growing up trans in Canada, Switzerland, England, and Australia: Access to and impacts of gender-affirming medical care.” Journal of LGBT Youth 20, no. 1 (2023): 55–73.

van der Loos, Maria ATC, Daniel T. Klink, Sabine E. Hannema, Sjoerdje Bruinsma, Thomas D. Steensma, Baudewijntje PC Kreukels, Peggy T. Cohen-Kettenis, Annelou LC de Vries, Martin den Heijer, and Chantal M. Wiepjes. “Children and adolescents in the Amsterdam Cohort of Gender Dysphoria: trends in diagnostic-and treatment trajectories during the first 20 years of the Dutch Protocol.” The Journal of Sexual Medicine 20, no. 3 (2023): 398–409.

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Julia Serano

writes about gender, sexuality, social justice, & science. author of Whipping Girl, Excluded, 99 Erics, & her latest: SEXED UP! more at