Current best practice (20th April 2022) seems to be that advocated by the State of Florida in the United States of America.

The following is reproduced from their factsheet:

Systematic reviews on hormonal treatment for young people show a trend of low-quality evidence, small sample sizes, and medium to high risk of bias. A paper published in the International Review of Psychiatry states that 80% of those seeking clinical care will lose their desire to identify with the nonbirth sex. One review concludes that “hormonal treatments for transgender adolescents can achieve their intended physical effects, but evidence regarding their psychosocial and cognitive impact is generally lacking.”

According to the Merck Manual, “gender dysphoria is characterized by a strong, persistent crossgender identification associated with anxiety, depression, irritability, and often a wish to live as a gender different from the one associated with the sex assigned at birth.”

Due to the lack of conclusive evidence, and the potential for long-term, irreversible effects, the Department’s guidelines are as follows:

• Social gender transition should not be a treatment option for children or adolescents.

• Anyone under 18 should not be prescribed puberty blockers or hormone therapy.

• Gender reassignment surgery should not be a treatment option for children or adolescents.

• Based on the currently available evidence, “encouraging mastectomy, ovariectomy,
uterine extirpation, penile disablement, tracheal shave, the prescription of hormones
which are out of line with the genetic make-up of the child, or puberty blockers, are all
clinical practices which run an unacceptably high risk of doing harm.”

• Children and adolescents should be provided social support by peers and family and seek counseling from a licensed provider.

These guidelines do not apply to procedures or treatments for children or adolescents born with a genetically or biochemically verifiable disorder of sex development (DSD). These disorders include, but are not limited to, 46, XX DSD; 46, XY DSD; sex chromosome DSDs; XX or XY sex reversal; and ovotesticular disorder.

The Department’s guidelines are consistent with the federal Centers for Medicare and Medicaid Services age requirement for surgical and non-surgical treatment. These guidelines are also in line with the guidance, reviews, and recommendations from Sweden, Finland, the United Kingdom, and France.

Agency for Health Care Administration

Following on from the above State policy, the Agency for Healthcare Administration which determines whether a treatment can be provided on Medicaid, released a report which provides more objectivity:

On April 20, 2022, the Florida Department of Health issued guidance related to the treatment of gender dysphoria in children and adolescents. In accordance with Chapter 59G-1035, Florida Administrative Code, the Secretary of the Agency for Health Care Administration requested that Florida Medicaid program review whether treatments are consistent with widely accepted professional medical standards. This report was completed on June 2, 2022 and found that several services for the treatment of gender dysphoria – i.e., sex reassignment surgery, cross-sex hormones, and puberty blockers – are not consistent with widely accepted professional medical standards and are experimental and investigational with the potential for harmful long term affects.What You Should Know
The Agency’s report summarizes the scientific research about the effectiveness of treatment for gender dysphoria for children. Research found:

  • Scientific studies supporting hormone replacement therapy, puberty blockers, and sex reassignment surgery for treating gender dysphoria are weak to very weak.
  • The evidence showing benefits from hormone replacement therapies for gender dysphoria is very weak.
  • Scientific studies do not show that the use of puberty blockers improves mental health.
  • There is a lack of long term, follow-up studies after sex reassignment surgery.
  • There are no randomized control trials on the effectiveness of “gender affirming” treatment.

In clinical research, randomized controlled trials are the gold standard for demonstrating the effectiveness and safety of a new treatment. Read more about randomized control trials at the National Institutes of Health.

Read the Report
Florida Medicaid Generally Accepted Professional Medical Standards Determination on the Treatment of Gender Dysphoria

Attachment A:Transmittal Letter

Attachment B:Rule Chapter 59G-1.035, Florida Administrative Code

Attachment C:Romina Brignardello-Petersen, DDS, MSc, PhD and Wojtek Wiercioch, MSc, PhD: Effects of Gender Affirming Therapies in People with Gender Dysphoria: Evaluation of the Best Available Evidence. 16 May 2022

Attachment D:James Cantor, PhD: Science of Gender Dysphoria and Transsexualism. 17 May 2022

Attachment E:Quentin Van Meter, MD: Concerns about Affirmation of an Incongruent Gender in a Child or Adolescent. 17 May 2022

Attachment F:Patrick Lappert, MD: Surgical Procedures and Gender Dysphoria. 17 May 2022

Attachment G:G. Kevin Donovan, MD: Medical Experimentation without Informed Consent: An Ethicist’s View of Transgender Treatment for Children. 16 May 2022