Gender affirming care, what is the evidence of benefit to minors?

The honest answer: the retrieved evidence contains almost nothing on minors, and nothing at all on the outcome that matters most, whether gender-affirming care improves their mental health or survival.

The question asks about benefit to minors. The records that actually match are thin. One scoping review of 20 brain-imaging studies in gender-diverse adolescents found functional connectivity differences and noted that long-term effects of hormone therapy are underrepresented, with a call for multicenter work [5]. That is a description of brain scans, not a measure of benefit. A study of transgender veterans found lower suicidal ideation and depression in those who had both hormones and surgery [6], but those are adults, and a cross-sectional look at who chose treatment cannot tell you the treatment caused the improvement. The rest of the retrieval is about adults: surgical orgasm rates [1], testicular tissue changes [2], and cardiovascular risk on hormones [3][4]. None of it answers the question for a child.

What the evidence does show is real risk on the hormone side. In a Dutch registry cohort, transgender women on hormones had about 1.8 times the expected rate of blood clots, and transgender men had about 4.25 times the expected heart attacks compared with women [4]. Those are adults, and the numbers are small in absolute terms, but they are the kind of hard outcome that a pediatric decision should be weighed against.

The retrieval did not surface a single randomized trial of puberty blockers or hormones in minors measuring depression, suicide, or bone density. That absence is a fact about this search, not proof none exist. But you asked what the evidence of benefit is, and on this record the answer is that the benefit to minors is asserted far more than it is demonstrated.

My call: the evidence here does not establish clinical benefit of gender-affirming care for minors, and the safety data in children is largely missing. Confidence: low, because the retrieval barely touches the pediatric question.