Transgender and gender-expansive (TGE) youth often experience gender dysphoria, defined as distress related to a mismatch between one's gender identity and physical development. The authors conducted a systematic review of literature on interventions for gender dysphoria and related health problems in TGE youth (age 25 or younger) to inform health care practice, policy, and research.

Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth

A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research

Alex R. Dopp, Allison Peipert, John Buss, Robinson De Jesús-Romero, Keytin Palmer, Lorenzo Lorenzo-Luaces

ResearchPublished Nov 26, 2024

Cover: Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth
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Includes Annex I; Annex II

Transgender and gender-expansive (TGE) youth often experience gender dysphoria, defined as distress related to a mismatch between one's gender identity and physical development. This report summarizes the rapidly evolving state of evidence on interventions for gender dysphoria and related health problems in TGE youth. The authors conducted a systematic review of studies that assessed interventions for gender dysphoria in TGE youth (age 25 or younger), published from 1990 to 2023, and summarized the amount, clinical significance, and certainty of evidence available.

The authors reviewed and summarized the available evidence for beneficial and harmful outcomes associated with intervention categories currently recommended as the standards of care (i.e., gender-affirming psychosocial, hormonal, surgical, and reproductive health interventions) for addressing gender dysphoria and related health problems, as well as proposed alternatives to the standards of care (gender identity and expression change efforts and treatment for co-occurring mental disorders to reduce gender dysphoria).

Across intervention categories and outcomes, limitations in the available evidence made it difficult to estimate with certainty the strength (and sometimes direction) of associations between intervention and outcome. Yet practitioners and policymakers can incorporate the best available science when making decisions about health care for TGE youth using evidence-informed approaches to account for these conditions of uncertainty. The authors also discuss implications for researchers seeking to improve this body of evidence so that it provides greater certainty about intervention effects and has greater practice and policy relevance.

Key Findings

  • This systematic review summarized and synthesized 118 peer-reviewed publications across 105 studies reporting outcomes from interventions for gender dysphoria and related health problems in TGE youth, up to and including age 25 (although outcomes were sometimes measured at older ages). In total, the authors reviewed research on seven categories of interventions (five considered part of the standards of care and two proposed alternatives).
  • Overall, the review findings were consistent with the results of previous reviews that summarized the research evidence for specific interventions related to gender dysphoria in TGE youth, including consistency in the identification of benefits and potential harms across intervention categories and the assessment of high risk of statistical bias in this body of evidence. All outcomes were rated as having very low or low certainty of evidence.
  • The team found evidence for five intervention categories that are from the standards of care (psychosocial interventions, puberty-suppressing hormones, hormone replacement therapy, gender-affirming surgeries, and reproductive health interventions). No relevant evidence for outcomes in youth was found for voice therapy or support for detransition. The team also found evidence for two categories of alternative interventions (treatment of co-occurring disorders and gender identity and expression change efforts [GIECE], the latter sometimes called conversion therapy or reparative therapy).

Recommendations

  • Evidence-informed approaches exist to help practitioners and policymakers incorporate the best available science into their decisions about health care for TGE youth while accounting for the conditions of uncertainty found in the available evidence.
  • The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision framework can be used to balance the limited certainty of the evidence with other key considerations when developing or updating standards of care for youth with gender dysphoria to incorporate the best available science.
  • Policymakers can use evidence-based policymaking approaches to incorporate the evidence summarized in this review into solutions that address major risks of harm to TGE youth, whether from the provision or restriction of interventions.

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RAND Style Manual

Dopp, Alex R., Allison Peipert, John Buss, Robinson De Jesús-Romero, Keytin Palmer, and Lorenzo Lorenzo-Luaces, Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research, RAND Corporation, RR-A3223-1, 2024. As of April 30, 2025: https://www.rand.org/pubs/research_reports/RRA3223-1.html

Chicago Manual of Style

Dopp, Alex R., Allison Peipert, John Buss, Robinson De Jesús-Romero, Keytin Palmer, and Lorenzo Lorenzo-Luaces, Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-Expansive Youth: A Systematic Review of Benefits and Risks to Inform Practice, Policy, and Research. Santa Monica, CA: RAND Corporation, 2024. https://www.rand.org/pubs/research_reports/RRA3223-1.html.
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This work was supported by Indiana University Bloomington and the Medical College of Wisconsin and conducted by the Access and Delivery Program in RAND Health Care and the Social and Behavioral Policy Program in RAND Social and Economic Well-Being.

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