Evaluating the benefits and risks of puberty blockers and gender-affirming hormones for transgender adolescents

The use of puberty blockers and gender-affirming hormones by transgender adolescents is the subject of an ongoing public debate. In this paper, we address one central ethical aspect of the debate – the question of what sort of benefits these treatments provide and how to evaluate the significance of these benefits in relation to risks. We argue that the intended benefit of these treatments is best understood as appearance congruence, namely, to create or maintain alignment of physical appearance with one's gender identity. The common focus on the mental health benefits associated with these treatments may obscure a range of experiential benefits sought by young people, such as positive gender experiences and being treated by others as one's identified gender. We also address concern about the risk that young people may revert to their assigned gender (de-transition) and experience regret. We distinguish between de-transition and regret, highlighting that regret appears to occur in a minority of instances of de-transition or discontinuation of hormone treatment.