Systematic reviews and the needs of the adolescent transgender health care field.

Abstract

Gender-affirming medical treatment for adolescents (defined as the start of puberty to age 18 years) has become an increasingly contested area of medicine in recent years. 13 reviews have been conducted since 2017 (with seven since 2023) to summarise studies on the potential effects of pubertal suppression and gender-affirming hormone therapy on psychosocial, cognitive, and physical outcomes in adolescents who are transgender, gender diverse, or non-binary. As systematic reviews are seen as the highest quality of sources of empirical knowledge according to the principles of evidence-based medicine, these reviews have far-reaching influence on government and health-care policies and practice, and prompt broader societal debates. In this Viewpoint, we review the conclusions of these systematic reviews regarding the efficacy and safety of pubertal suppression and gender-affirming hormone therapy for adolescents, and examine how these reviews are being misused to influence treatment options and care pathways. We affirm that the development of clinical guidelines should be underpinned by all three facets of evidence-based medicine (ie, empirical evidence, clinical expertise, and patient values), as evaluated by experts in the field.