Gender Dysphoria in Minors: A Critical Look at Early Medicalization and Proposals for Ethical Support

Authors

  • Regina Cárdenas Santos Ramon Llull University image/svg+xml , Institut Borja de Bioètica
  • josé María Pardo Sáenz University of Navarra image/svg+xml

DOI:

https://doi.org/10.14422/rib.i29.y2025.001

Keywords:

gender dysphoria, childhood, bioethics, medicalization, evolving autonomy, clinical support

Abstract

This article offers a critical analysis of the early medicalization of gender dysphoria in minors from a clinical and bioethical perspective. Beginning with an examination of the Dutch protocol, it explores the tensions between the affirmative model endorsed by WPATH and the recommendations of the British Cass Review. By examining the scientific and ethical foundations underpinning both approaches, the article underscores the inherent complexity of providing care to minors navigating identity-seeking processes.

It also offers a bioethical reflection in which the vulnerability of minors is positioned as a guiding principle for deliberation. The article advocates for non-invasive, long-term clinical support and, ultimately, proposes a comprehensive model of care that prioritizes psychosocial assessment, psychological support, family involvement, and therapeutic prudence.

Downloads

Download data is not yet available.

References

A. N. de Médecine. (2022). Medicine and gender transidentity in children and adolescents.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Arnoldussen, M., Steensma, T. D., Popma, A., van der Miesen, A. I., Twisk, J. W. y de Vries, A. L. (2020). Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals? European child & adolescent psychiatry, 29(6), 803-811. https://doi.org/10.1007/s00787-019-01394-6

Budge, S. L., Sinnard, M. T. y Hoyt, W. T. (2021). Longitudinal effects of psychotherapy with transgender and nonbinary clients: A randomized controlled pilot trial. Psychotherapy, 58(1), 1. https://doi.org/10.1037/pst0000310

Cass, H. (2022). Independent review of gender identity services for children and young people: Interim report.

Chew, D., Anderson, J., Williams, K., May, T. y Pang, K. (2018). Hormonal treatment in young people with gender dysphoria: a systematic review. Pediatrics, 141(4). https://doi.org/10.1542/peds.2017-3742

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., De Vries, A. L., Deutsch, M. B., ... y Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International journal of transgender health, 23(sup1), S1-S259. https://doi.org/10.1080/26895269.2022.2100644

Crone, E. A. y Dahl, R. E. (2012). Understanding adolescence as a period of social–affective engagement and goal flexibility. Nature reviews neuroscience, 13(9), 636-650. https://doi.org/10.1038/nrn3313

De Vries, A. L., Steensma, T. D., Doreleijers, T. A. y Cohen‐Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow‐up study. The journal of sexual medicine, 8(8), 2276-2283. https://doi.org/10.1111/j.1743-6109.2010.01943.x

Gorga, M. (2021). La autonomía progresiva y el neurodesarrollo de niñas, niños y adolescentes desde una perspectiva neuroética. Revista Redbioética/UNESCO, 65.

Grootens-Wiegers, P., Hein, I. M., van den Broek, J. M. y de Vries, M. C. (2017). Medical decision-making in children and adolescents: developmental and neuroscientific aspects. BMC pediatrics, 17(1), 120. https://doi.org/10.1186/s12887-017-0869-x

Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., ... y T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869-3903. https://doi.org/10.1210/jc.2017-01658

Horton, C. (2024). Experiences of puberty and puberty blockers: Insights from trans children, trans adolescents, and their parents. Journal of Adolescent Research, 39(1), 77-103. https://doi.org/10.1177/07435584221100591

Jarvis, S. W., Fraser, L. K., Langton, T., Hewitt, C. E. y Doran, T. (2025). Epidemiology of gender dysphoria and gender incongruence in children and young people attending primary care practices in England: retrospective cohort study. Archives of disease in childhood. https://doi.org/10.1136/archdischild-2024-327992

Karvonen, M., Karukivi, M., Kronström, K. y Kaltiala, R. (2022). The nature of co-morbid psychopathology in adolescents with gender dysphoria. Psychiatry research, 317, 114896. https://doi.org/10.1016/j.psychres.2022.114896

Katz, A. L., Webb, S. A., Committee on Bioethics, Macauley, R. C., Mercurio, M. R., Moon, M. R., ... y Statter, M. B. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2), e20161485. https://doi.org/10.1542/peds.2016-1485

Konrad, K., Firk, C. y Uhlhaas, P. J. (2013). Brain development during adolescence: neuroscientific insights into this developmental period. Deutsches Ärzteblatt International, 110(25), 425. https://doi.org/10.3238/arztebl.2013.0425

Kozlowska, K., Ambler, G. R., Dechêne, S., Almaraz Almaraz, M. C., Eliacheff, C., Entwistle, K., ... y Scher, S. (2025). Evolving national guidelines for the treatment of children and adolescents with gender dysphoria: International perspectives. Human Systems, 5(2), 89-152. https://doi.org/10.1177/26344041241269298

Lang, A. y Paquette, E. T. (2018, October). Involving minors in medical decision making: understanding ethical issues in assent and refusal of care by minors. Seminars in Neurology 38(5), 533-538. https://doi.org/10.1055/s-0038-1668078

Levine, S. B. y Abbruzzese, E. (2023). Current concerns about gender-affirming therapy in adolescents. Current Sexual Health Reports, 15(2), 113-123. https://doi.org/10.1007/s11930-023-00358-x

Ley 4/2023, de 28 de febrero, para la igualdad real y efectiva de las personas trans y para la garantía de los derechos de las personas LGTBI. Boletín Oficial del Estado, n.º 36, de 1 de marzo de 2023.

Ludvigsson, J. F., Adolfsson, J., Höistad, M., Rydelius, P. A., Kriström, B. y Landén, M. (2023). A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. Acta Paediatrica, 112(11), 2279-2292. https://doi.org/10.1111/apa.16791

Paz-Otero, M., Becerra-Fernández, A., Pérez-López, G. y Ly-Pen, D. (2021). A 2020 review of mental health comorbidity in gender dysphoric and gender non-conforming people. Journal of Psychiatry Treatment and Research, 3(1), 44-55. https://doi.org/10.36959/784/425

Ponty, M. M. (1985). Fenomenología de la percepción. Planeta.

Rafferty, J., Yogman, M., Baum, R., Gambon, TB, Lavin, A., Mattson, G., ... y Comité sobre Aspectos Psicosociales de la Salud Infantil y Familiar. (2018). Garantizar la atención y el apoyo integrales para niños, niñas y adolescentes transgénero y de género diverso. Pediatría, 142(4). https://doi.org/10.1542/peds.2018-2162

Riaño Galán, I., del Río Pastoriza, I., Guindulain, M. C., Fraile, S. G. y de Montalvo Jääskeläinem, F. (2018). Statement by the Spanish Paediatric Association in relation to gender diversity in childhood and adolescence: Ethical and legal view from a multidisciplinary perspective. Anales de Pediatría, 89(2), 123-e1. https://doi.org/10.1016/j.anpedi.2018.02.012

Salter, E. K., Hester, D. M., Vinarcsik, L., Matheny Antommaria, A. H., Bester, J., Blustein, J., ... y Ross, L. F. (2023). Pediatric decision making: consensus recommendations. Pediatrics, 152(3), e2023061832. https://doi.org/10.1542/peds.2023-061832

Sawyer, K. y Rosenberg, A. R. (2020). How should adolescent health decision-making authority be shared? AMA Journal of Ethics, 22(5), 372-379. https://doi.org/10.1001/amajethics.2020.372

Socialstyrelsen, S. (2022, October). Uppdaterade rekommendationer för hormonbehandling vid könsdysfori hos unga.[Updated recommendations for hormone therapy for gender dysphoria in young people.].

Suess, A., Espineira, K. y Walters, P. C. (2014). Depathologization. Transgender Studies Quarterly, 1, 73-77. https://doi.org/10.1215/23289252-2399650

Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J. y Ahrens, K. (2022). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA network, 5(2), e220978-e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978

Winnicott, D. (1998). Los procesos de maduración y el ambiente facilitador: estudios para una teoría del desarrollo emocional. Paidós

Zepf, F. D., Koenig, L., Kaiser, A., Ligges, C., Ligges, M., Roessner, V., ... y Holtmann, M. (2024). Beyond NICE: updated systematic review on the current evidence of using puberty blocking pharmacological agents and cross-sex-hormones in minors with gender dysphoria. Zeitschrift fur Kinder-und Jugendpsychiatrie und Psychotherapie. https://doi.org/10.1024/1422-4917/a000972

Disforia de género en menores

Downloads

Published

2025-12-16

How to Cite

Gender Dysphoria in Minors: A Critical Look at Early Medicalization and Proposals for Ethical Support. (2025). Revista Iberoamericana De Bioética, 29, 01-15. https://doi.org/10.14422/rib.i29.y2025.001