The medical treatment of gender affirmation in adolescents — defined as the period from the onset of puberty until the age of 18 — has become one of the most debated areas of medicine today. An article published in The Lancet, one of the medical journals with the greatest impact factor in the world, analyses how the scientific evidence is being interpreted and warns about the risks of its biased use.
The authors, the psychologists David M. Doyle and Annelou L. C. de Vries, review the 13 systematic reviews carried out since 2017 — seven of them from 2023 onwards — on the effects of puberty suppression and affirming hormone therapy on the psychosocial, cognitive and physical well-being of transgender, gender-diverse or non-binary adolescents.
Systematic reviews are considered, according to the principles of evidence-based medicine, the highest-quality source of empirical knowledge. That is why their influence is enormous: they shape health and government policies, guide clinical practice and feed wider social debates.
What worries the authors is not only what those reviews say, but how they are being used. They argue that some of these analyses are being employed in a biased way to restrict or eliminate treatment options and care pathways, ignoring the methodological limitations that the studies themselves acknowledge and the variable quality of the available data.
Against such use, they defend that the development of clinical guidelines must rest on the three facets that define evidence-based medicine: empirical evidence, clinical expertise and the values and preferences of patients, all of it assessed by experts in the field.
The article is not an original study, but a perspective piece signed by two specialists well known in the field of gender identity. Its value lies in bringing order to a debate in which the same reviews are often cited in opposite directions, and in reminding us that evidence, clinical practice and respect for the person must walk together.
Source: Doyle DM, de Vries ALC. Systematic reviews and the needs of the adolescent transgender health care field. The Lancet 2026;408(10557):861-866. DOI: 10.1016/S0140-6736(26)00788-9.
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