[Children's brains with gender dysphoria. Effects of hormones and puberty blockers on a developing brain. An ethical approach].

In recent years, there has been a significant increase in minors with gender dysphoria (GD) seeking transition treatments, including puberty blockers and cross-sex hormones. The developing child's brain exhibits structural and functional differences in children with GD compared to cisgender children, particularly in areas where sex differences exist. Brain development during childhood and adolescence is strongly influenced by sex hormones. During puberty, a significant reorganisation of the brain occurs, with changes in grey and white matter affecting cognition, emotional regulation, and socialisation. The administration of puberty blockers interferes with this process, which may have consequences on IQ, working memory,and decision-making. Treatments with puberty blockers and cross-sex hormones have both benefits and risks. Among the benefits, reducing the distress of minors by preventing the irreversible bodily changes of puberty is often cited. However, the risks include decreased bone density, potential impacts on fertility,and alterations in brain development. Recent studies indicate that puberty suppression may affect cognitive functionality and executive functions. The rise in GD diagnoses has raised concerns within the medical community. It has been observed that many minors with GD have a history of adverse childhood experiences, higher rates of anxiety and depression, and, in some cases, diagnoses within the autism spectrum. Additionally, some studies suggest that the surge in gender dysphoria diagnoses among adolescents may be influenced by social factors and exposure to digital networks. In response to the growing controversy over the effects of these treatments, some countries have restricted or banned the use of puberty blockers in minors, citing a lack of solid scientific evidence regarding their long-term safety and effectiveness. From an ethical perspective, concerns have been raised about medical practices not based on scientific evidence, the application of the principle of the child's best interests, and questions regarding minors' capacity to provide informed consent. The importance of a multidisciplinary approach to the diagnosis and treatment of GD is emphasised, considering alternatives that do not involve irreversible medical interventions until the minor reaches sufficient maturity to make fully informed decisions.