The subject of the therapeutic approach to gender dysphoria, previously discussed in a book by one of our members (“Transexualidad. Valoración pluridisciplinar del fenómeno y su regulación legal”,), has been analyzed by Paul W. Hruz MD Ph.D. of  “Washington University School of Medicine”, in St. Louis, MO, USA. in an article published in The Linacre Quarterly,  read HERE.

As the author says, people who experience a gender identity that is discordant with their biological sex are increasingly presenting to physicians for help to relieve the associated psychological distress. In contrast to previous efforts to identify and primarily address the underlying psychiatric contributors to gender dysphoria, other interventions based on the simple social affirmation of this tendency encourage the use of gonadotropin-releasing hormone agonists to suppress puberty, along with the administration of cross-sex steroid hormones to induce secondary sexual characteristics of the non-biological sex, advocated by an emerging cohort of transgender medicine specialists. For patients with persistent gender dysphoria, they propose surgery that seeks to alter the appearance of the breasts and genital organs.

Puberty blockade objective ethical difficulties

The ethical difficulties of this process of puberty blockade, cross-sex hormone therapy and reassignment surgery arise fundamentally from the lack of solid evidence on the benefits of the procedure, and the appearance of associated risks related to both the undesirable side effects of these treatments and the irreversibility of the surgical procedures performed, in many cases.

 “…lack of high-quality scientific data…short study duration”

The paper hits the nail on the head when it draws attention to the lack of high-quality scientific data supporting the safety and effectiveness of these procedures. The transgender literature suffers from limitations in many cases related to the general absence of well-designed prospective randomized trials, small and non-representative sample sizes, participant recruitment bias, short study duration (an important aspect given the late appearance of the worst consequences of these interventions, which may take several years), high subject dropout rates and reliance on “expert” opinion. Existing data, which the author presents, reveal significant morbidity associated with the aforementioned interventions and raise serious concern: failure to achieve the primary goal of suicide prevention.


In addition to substantial moral questions, adherence to the principles of evidence-based medicine requires a high degree of caution in accepting the approach of gender transition medical interventions as the preferred option. Continued analysis of the problem and the search for new scientific evidence obtained from rigorous research could result in new alternative approaches to those mentioned above, which would help alleviate the suffering of people with gender dysphoria.


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