7

Thesis Statement and Annotated Bibliography

Destiny Johnson

Chamberlain University College of Nursing

PHIL 347: Critical Reasoning

Todd Buck

December 1, 2024

Thesis Statement and Annotated Bibliography

Thesis Statement

The prospect of administering puberty blockers, hormone treatment, and surgery for sex reassignment for young minors presents a problem of ethics of gender-related discomfort and possible risks in a future perspective. While puberty blocking substances might have reversible effects, the irreversible effects from hormone treatment and/or surgeries involves risks, such as regret, medical repercussions, and trauma. Due to the lack of sufficient data about long-term effects, these therapies should be done with extreme care considering the importance of mental health and informed consent to deliver secure, ethical, and personalized care.

Annotated Bibliography

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. 
Pediatrics, 
145(2), e20191725. https://doi.org/10.1542/peds.2019-1725

The authors used data from a cross-sectional survey of 20, 619 transgender adults aged 18 to 36 years to test their hypothesis that there is an association between suppressing puberty during adolescence and mental health outcomes during adulthood. They used self-reported data on the history of use of puberty blockers during adolescence. Their hypothesis was not supported in transgender adults by finding a significant association between receiving pubertal suppression treatments during adolescence and lifetime suicidal ideation. The use of puberty suppressants for transgender adolescents desiring this treatments is linked to favorable mental health outcomes.

This source supports my thesis that puberty blocking substances might have reversible effects as they do not cause permanent changes, but hormone treatment and gender reassignment surgeries may have irreversible consequences, significantly, leading to lasting mental health impacts on minors, especially when they are adults. Although it reveals potential psychological benefits associated with these therapies, it raises concerns about long-term consequences.

Biggs, M. (2022). The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence. 
Journal of Sex & Marital Therapy, 
49(4), 348–368. https://doi.org/10.1080/0092623X.2022.2121238

The authors use data from Dutch Protocol for Juvenile Transsexuals comprising 70 adolescents who had been introduced to puberty suppression, followed by cross-sex hormones and surgery to review the history of this intervention and supporting evidence. They found positive outcomes immediately after the surgery except for the death of one patient. Puberty blockers may temporarily alleviate juvenile transsexuals’ distress, but may lock them into further medical interventions in the long-term. The therapies may result in lethal physical effects, such as accrual bone mass and unknown effects on the patient’s emotional and cognitive development.

This source strongly supports my thesis that the use of puberty suppression treatments and gender reassignment surgeries my present long-term implications on the client due to the irreversible effects associated. The irreversible therapeutic effects may require clinicians to do careful assessments based on individual cases.

de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. 
Pediatrics, 
134(4), 696–704.
https://doi.org/10.1542/peds.2013-2958

The researchers used data from a longitudinal study of 55 young transgender adults with a history of receiving puberty suppression during teen years to evaluate the effectiveness of these interventions. They evaluated the outcomes of the adolescents before starting puberty suppression, when they received the cross-sex hormones and at least after one year of undergoing gender reassignment surgery. They found significant alleviation of gender dysphoria and steady improvement in psychological functioning. The well-being of this group was similar or better than their counterparts from the general population. They found a positive correlation between postsurgical subjective well-being and enhancements in psychological well-being.

This source supports the thesis that the puberty suppression and gender reassignment therapies may relieve gender dysphoria and improve psychological functioning in the short-term, but careful considerations should be made when administrating these therapies in the contexts of safety, ethics and personalized care. It supports cautious care by suggesting a clinical protocol comprising a multidisciplinary team of physicians, mental health professionals, and surgeons, including puberty suppression, followed by gender reassignment and cross-sex hormones, in supporting gender dysphoric youths seeking such interventions to develop into well-functioning young adults.

van Leerdam, T. R., Zajac, J. D., & Cheung, A. S. (2023). The Effect of Gender-Affirming Hormones on Gender Dysphoria, Quality of Life, and Psychological Functioning in Transgender Individuals: A Systematic Review. 
Transgender Health, 
8(1), 6–21. https://doi.org/10.1089/trgh.2020.0094

The researchers used data from a systematic review comprising observational studies (longitudinal and cross-sectional studies) published in English and in a peer-reviewed journal to assess the efficacy of gender-affirming hormone therapy (GAHT) in enhancing gender and body-related dysphoria, along with Quality of Life (QoL) and psychological well-being. They found that GAHT may body-related and subjective gender dysphoria, QoL and psychological well-being. However, they found most evidence, predominantly from cohort studies and cross-sectional studies to show low to moderate quality in body-related and subjective gender dysphoria improvements. The researchers reveal gaps in the quality measurement or assessment of gender dysphoria, as the primary goal of GAHT. They propose evaluation of the secondary outcomes, including QoL and mental health, as arguably the most critical outcomes of such treatments, providing accuracy of the efficacy of GAHT.

This source supports my thesis by highlighting gaps in evaluating the outcomes of gender-affirming therapies, including mental health and QoL due to low to moderate quality evidence existing to support gender dysphoria improvements. It makes it challenging to draw clear inferences and fails to mirror the external social factors, which have substantial impacts on dysphoria.

Ludvigsson, J. F., Adolfsson, J., Höistad, M., Rydelius, P. A., Kriström, B., & Landén, M. (2023). A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. 
Acta Paediatrica (Oslo, Norway: 1992), 
112(11), 2279–2292. https://doi.org/10.1111/apa.16791

The researchers employed data from a systematic review comprising studies published in English focused on hormone therapy in children with gender dysphoria to evaluate the effects on psychosocial and mental health, body composition, cognition, and metabolic markers of hormone treatment in such children They found that in the few longitudinal studies included, the outcomes were hindered by small numbers and high attrition rates. As a result, it was difficult to evaluate the long-term effects of hormone therapy on the child’s psychosocial health. They also found that gonadotropin-releasing hormone analogues (GnRHa) treatment leads to delayed bone maturity and gaining bone density, which, however, they found to partially recover during cross-sex hormone treatment (CSHT) when studied when patients reached 22 years.

This source supports my thesis by emphasizing the cautious approach to the use of puberty suppression and gender-reaffirming treatments by revealing that the long-term effects of hormone therapy on somatic and psychosocial are largely unknown based on existing literature. The only evidence revealed are the effects of GnRHa, including delayed bone maturity and bone mineral density gain, hence, the need to ensure the safety of such treatments before administering them.

Overall, the existing evidence on the use of puberty suppressants and gender-reassignment surgeries appears to be limited on the long-term impacts of such treatments on patients’ psychosocial well-being, mental health and QoL The reviewed studies suggest the need for cautious, individualized approach to the administration of such therapies, stressing informed consent, mental evaluation and the need for more robust longitudinal studies.

References

Biggs, M. (2022). The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence. 
Journal of Sex & Marital Therapy, 
49(4), 348–368. https://doi.org/10.1080/0092623X.2022.2121238

de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. 
Pediatrics, 
134(4), 696–704.
https://doi.org/10.1542/peds.2013-2958

Ludvigsson, J. F., Adolfsson, J., Höistad, M., Rydelius, P. A., Kriström, B., & Landén, M. (2023). A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. 
Acta Paediatrica (Oslo, Norway: 1992), 
112(11), 2279–2292. https://doi.org/10.1111/apa.16791

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. 
Pediatrics, 
145(2), e20191725. https://doi.org/10.1542/peds.2019-1725

van Leerdam, T. R., Zajac, J. D., & Cheung, A. S. (2023). The Effect of Gender-Affirming Hormones on Gender Dysphoria, Quality of Life, and Psychological Functioning in Transgender Individuals: A Systematic Review. 
Transgender Health, 
8(1), 6–21. https://doi.org/10.1089/trgh.2020.0094

7

Thesis Statement and Annotated Bibliography

Destiny Johnson

Chamberlain University College of Nursing

PHIL 347: Critical Reasoning

Todd Buck

December 1, 2024

Thesis Statement and Annotated Bibliography

Thesis Statement

The prospect of administering puberty blockers, hormone treatment, and surgery for sex reassignment for young minors presents a problem of ethics of gender-related discomfort and possible risks in a future perspective. While puberty blocking substances might have reversible effects, the irreversible effects from hormone treatment and/or surgeries involves risks, such as regret, medical repercussions, and trauma. Due to the lack of sufficient data about long-term effects, these therapies should be done with extreme care considering the importance of mental health and informed consent to deliver secure, ethical, and personalized care.

Annotated Bibliography

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. 
Pediatrics, 
145(2), e20191725. https://doi.org/10.1542/peds.2019-1725

The authors used data from a cross-sectional survey of 20, 619 transgender adults aged 18 to 36 years to test their hypothesis that there is an association between suppressing puberty during adolescence and mental health outcomes during adulthood. They used self-reported data on the history of use of puberty blockers during adolescence. Their hypothesis was not supported in transgender adults by finding a significant association between receiving pubertal suppression treatments during adolescence and lifetime suicidal ideation. The use of puberty suppressants for transgender adolescents desiring this treatments is linked to favorable mental health outcomes.

This source supports my thesis that puberty blocking substances might have reversible effects as they do not cause permanent changes, but hormone treatment and gender reassignment surgeries may have irreversible consequences, significantly, leading to lasting mental health impacts on minors, especially when they are adults. Although it reveals potential psychological benefits associated with these therapies, it raises concerns about long-term consequences.

Biggs, M. (2022). The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence. 
Journal of Sex & Marital Therapy, 
49(4), 348–368. https://doi.org/10.1080/0092623X.2022.2121238

The authors use data from Dutch Protocol for Juvenile Transsexuals comprising 70 adolescents who had been introduced to puberty suppression, followed by cross-sex hormones and surgery to review the history of this intervention and supporting evidence. They found positive outcomes immediately after the surgery except for the death of one patient. Puberty blockers may temporarily alleviate juvenile transsexuals’ distress, but may lock them into further medical interventions in the long-term. The therapies may result in lethal physical effects, such as accrual bone mass and unknown effects on the patient’s emotional and cognitive development.

This source strongly supports my thesis that the use of puberty suppression treatments and gender reassignment surgeries my present long-term implications on the client due to the irreversible effects associated. The irreversible therapeutic effects may require clinicians to do careful assessments based on individual cases.

de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. 
Pediatrics, 
134(4), 696–704.
https://doi.org/10.1542/peds.2013-2958

The researchers used data from a longitudinal study of 55 young transgender adults with a history of receiving puberty suppression during teen years to evaluate the effectiveness of these interventions. They evaluated the outcomes of the adolescents before starting puberty suppression, when they received the cross-sex hormones and at least after one year of undergoing gender reassignment surgery. They found significant alleviation of gender dysphoria and steady improvement in psychological functioning. The well-being of this group was similar or better than their counterparts from the general population. They found a positive correlation between postsurgical subjective well-being and enhancements in psychological well-being.

This source supports the thesis that the puberty suppression and gender reassignment therapies may relieve gender dysphoria and improve psychological functioning in the short-term, but careful considerations should be made when administrating these therapies in the contexts of safety, ethics and personalized care. It supports cautious care by suggesting a clinical protocol comprising a multidisciplinary team of physicians, mental health professionals, and surgeons, including puberty suppression, followed by gender reassignment and cross-sex hormones, in supporting gender dysphoric youths seeking such interventions to develop into well-functioning young adults.

van Leerdam, T. R., Zajac, J. D., & Cheung, A. S. (2023). The Effect of Gender-Affirming Hormones on Gender Dysphoria, Quality of Life, and Psychological Functioning in Transgender Individuals: A Systematic Review. 
Transgender Health, 
8(1), 6–21. https://doi.org/10.1089/trgh.2020.0094

The researchers used data from a systematic review comprising observational studies (longitudinal and cross-sectional studies) published in English and in a peer-reviewed journal to assess the efficacy of gender-affirming hormone therapy (GAHT) in enhancing gender and body-related dysphoria, along with Quality of Life (QoL) and psychological well-being. They found that GAHT may body-related and subjective gender dysphoria, QoL and psychological well-being. However, they found most evidence, predominantly from cohort studies and cross-sectional studies to show low to moderate quality in body-related and subjective gender dysphoria improvements. The researchers reveal gaps in the quality measurement or assessment of gender dysphoria, as the primary goal of GAHT. They propose evaluation of the secondary outcomes, including QoL and mental health, as arguably the most critical outcomes of such treatments, providing accuracy of the efficacy of GAHT.

This source supports my thesis by highlighting gaps in evaluating the outcomes of gender-affirming therapies, including mental health and QoL due to low to moderate quality evidence existing to support gender dysphoria improvements. It makes it challenging to draw clear inferences and fails to mirror the external social factors, which have substantial impacts on dysphoria.

Ludvigsson, J. F., Adolfsson, J., Höistad, M., Rydelius, P. A., Kriström, B., & Landén, M. (2023). A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. 
Acta Paediatrica (Oslo, Norway: 1992), 
112(11), 2279–2292. https://doi.org/10.1111/apa.16791

The researchers employed data from a systematic review comprising studies published in English focused on hormone therapy in children with gender dysphoria to evaluate the effects on psychosocial and mental health, body composition, cognition, and metabolic markers of hormone treatment in such children They found that in the few longitudinal studies included, the outcomes were hindered by small numbers and high attrition rates. As a result, it was difficult to evaluate the long-term effects of hormone therapy on the child’s psychosocial health. They also found that gonadotropin-releasing hormone analogues (GnRHa) treatment leads to delayed bone maturity and gaining bone density, which, however, they found to partially recover during cross-sex hormone treatment (CSHT) when studied when patients reached 22 years.

This source supports my thesis by emphasizing the cautious approach to the use of puberty suppression and gender-reaffirming treatments by revealing that the long-term effects of hormone therapy on somatic and psychosocial are largely unknown based on existing literature. The only evidence revealed are the effects of GnRHa, including delayed bone maturity and bone mineral density gain, hence, the need to ensure the safety of such treatments before administering them.

Overall, the existing evidence on the use of puberty suppressants and gender-reassignment surgeries appears to be limited on the long-term impacts of such treatments on patients’ psychosocial well-being, mental health and QoL The reviewed studies suggest the need for cautious, individualized approach to the administration of such therapies, stressing informed consent, mental evaluation and the need for more robust longitudinal studies.

References

Biggs, M. (2022). The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence. 
Journal of Sex & Marital Therapy, 
49(4), 348–368. https://doi.org/10.1080/0092623X.2022.2121238

de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. 
Pediatrics, 
134(4), 696–704.
https://doi.org/10.1542/peds.2013-2958

Ludvigsson, J. F., Adolfsson, J., Höistad, M., Rydelius, P. A., Kriström, B., & Landén, M. (2023). A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. 
Acta Paediatrica (Oslo, Norway: 1992), 
112(11), 2279–2292. https://doi.org/10.1111/apa.16791

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. 
Pediatrics, 
145(2), e20191725. https://doi.org/10.1542/peds.2019-1725

van Leerdam, T. R., Zajac, J. D., & Cheung, A. S. (2023). The Effect of Gender-Affirming Hormones on Gender Dysphoria, Quality of Life, and Psychological Functioning in Transgender Individuals: A Systematic Review. 
Transgender Health, 
8(1), 6–21. https://doi.org/10.1089/trgh.2020.0094

7

Thesis Statement and Annotated Bibliography

Destiny Johnson

Chamberlain University College of Nursing

PHIL 347: Critical Reasoning

Todd Buck

December 1, 2024

Thesis Statement and Annotated Bibliography

Thesis Statement

The prospect of administering puberty blockers, hormone treatment, and surgery for sex reassignment for young minors presents a problem of ethics of gender-related discomfort and possible risks in a future perspective. While puberty blocking substances might have reversible effects, the irreversible effects from hormone treatment and/or surgeries involves risks, such as regret, medical repercussions, and trauma. Due to the lack of sufficient data about long-term effects, these therapies should be done with extreme care considering the importance of mental health and informed consent to deliver secure, ethical, and personalized care.

Annotated Bibliography

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. 
Pediatrics, 
145(2), e20191725. https://doi.org/10.1542/peds.2019-1725

The authors used data from a cross-sectional survey of 20, 619 transgender adults aged 18 to 36 years to test their hypothesis that there is an association between suppressing puberty during adolescence and mental health outcomes during adulthood. They used self-reported data on the history of use of puberty blockers during adolescence. Their hypothesis was not supported in transgender adults by finding a significant association between receiving pubertal suppression treatments during adolescence and lifetime suicidal ideation. The use of puberty suppressants for transgender adolescents desiring this treatments is linked to favorable mental health outcomes.

This source supports my thesis that puberty blocking substances might have reversible effects as they do not cause permanent changes, but hormone treatment and gender reassignment surgeries may have irreversible consequences, significantly, leading to lasting mental health impacts on minors, especially when they are adults. Although it reveals potential psychological benefits associated with these therapies, it raises concerns about long-term consequences.

Biggs, M. (2022). The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence. 
Journal of Sex & Marital Therapy, 
49(4), 348–368. https://doi.org/10.1080/0092623X.2022.2121238

The authors use data from Dutch Protocol for Juvenile Transsexuals comprising 70 adolescents who had been introduced to puberty suppression, followed by cross-sex hormones and surgery to review the history of this intervention and supporting evidence. They found positive outcomes immediately after the surgery except for the death of one patient. Puberty blockers may temporarily alleviate juvenile transsexuals’ distress, but may lock them into further medical interventions in the long-term. The therapies may result in lethal physical effects, such as accrual bone mass and unknown effects on the patient’s emotional and cognitive development.

This source strongly supports my thesis that the use of puberty suppression treatments and gender reassignment surgeries my present long-term implications on the client due to the irreversible effects associated. The irreversible therapeutic effects may require clinicians to do careful assessments based on individual cases.

de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. 
Pediatrics, 
134(4), 696–704.
https://doi.org/10.1542/peds.2013-2958

The researchers used data from a longitudinal study of 55 young transgender adults with a history of receiving puberty suppression during teen years to evaluate the effectiveness of these interventions. They evaluated the outcomes of the adolescents before starting puberty suppression, when they received the cross-sex hormones and at least after one year of undergoing gender reassignment surgery. They found significant alleviation of gender dysphoria and steady improvement in psychological functioning. The well-being of this group was similar or better than their counterparts from the general population. They found a positive correlation between postsurgical subjective well-being and enhancements in psychological well-being.

This source supports the thesis that the puberty suppression and gender reassignment therapies may relieve gender dysphoria and improve psychological functioning in the short-term, but careful considerations should be made when administrating these therapies in the contexts of safety, ethics and personalized care. It supports cautious care by suggesting a clinical protocol comprising a multidisciplinary team of physicians, mental health professionals, and surgeons, including puberty suppression, followed by gender reassignment and cross-sex hormones, in supporting gender dysphoric youths seeking such interventions to develop into well-functioning young adults.

van Leerdam, T. R., Zajac, J. D., & Cheung, A. S. (2023). The Effect of Gender-Affirming Hormones on Gender Dysphoria, Quality of Life, and Psychological Functioning in Transgender Individuals: A Systematic Review. 
Transgender Health, 
8(1), 6–21. https://doi.org/10.1089/trgh.2020.0094

The researchers used data from a systematic review comprising observational studies (longitudinal and cross-sectional studies) published in English and in a peer-reviewed journal to assess the efficacy of gender-affirming hormone therapy (GAHT) in enhancing gender and body-related dysphoria, along with Quality of Life (QoL) and psychological well-being. They found that GAHT may body-related and subjective gender dysphoria, QoL and psychological well-being. However, they found most evidence, predominantly from cohort studies and cross-sectional studies to show low to moderate quality in body-related and subjective gender dysphoria improvements. The researchers reveal gaps in the quality measurement or assessment of gender dysphoria, as the primary goal of GAHT. They propose evaluation of the secondary outcomes, including QoL and mental health, as arguably the most critical outcomes of such treatments, providing accuracy of the efficacy of GAHT.

This source supports my thesis by highlighting gaps in evaluating the outcomes of gender-affirming therapies, including mental health and QoL due to low to moderate quality evidence existing to support gender dysphoria improvements. It makes it challenging to draw clear inferences and fails to mirror the external social factors, which have substantial impacts on dysphoria.

Ludvigsson, J. F., Adolfsson, J., Höistad, M., Rydelius, P. A., Kriström, B., & Landén, M. (2023). A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. 
Acta Paediatrica (Oslo, Norway: 1992), 
112(11), 2279–2292. https://doi.org/10.1111/apa.16791

The researchers employed data from a systematic review comprising studies published in English focused on hormone therapy in children with gender dysphoria to evaluate the effects on psychosocial and mental health, body composition, cognition, and metabolic markers of hormone treatment in such children They found that in the few longitudinal studies included, the outcomes were hindered by small numbers and high attrition rates. As a result, it was difficult to evaluate the long-term effects of hormone therapy on the child’s psychosocial health. They also found that gonadotropin-releasing hormone analogues (GnRHa) treatment leads to delayed bone maturity and gaining bone density, which, however, they found to partially recover during cross-sex hormone treatment (CSHT) when studied when patients reached 22 years.

This source supports my thesis by emphasizing the cautious approach to the use of puberty suppression and gender-reaffirming treatments by revealing that the long-term effects of hormone therapy on somatic and psychosocial are largely unknown based on existing literature. The only evidence revealed are the effects of GnRHa, including delayed bone maturity and bone mineral density gain, hence, the need to ensure the safety of such treatments before administering them.

Overall, the existing evidence on the use of puberty suppressants and gender-reassignment surgeries appears to be limited on the long-term impacts of such treatments on patients’ psychosocial well-being, mental health and QoL The reviewed studies suggest the need for cautious, individualized approach to the administration of such therapies, stressing informed consent, mental evaluation and the need for more robust longitudinal studies.

References

Biggs, M. (2022). The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence. 
Journal of Sex & Marital Therapy, 
49(4), 348–368. https://doi.org/10.1080/0092623X.2022.2121238

de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. 
Pediatrics, 
134(4), 696–704.
https://doi.org/10.1542/peds.2013-2958

Ludvigsson, J. F., Adolfsson, J., Höistad, M., Rydelius, P. A., Kriström, B., & Landén, M. (2023). A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. 
Acta Paediatrica (Oslo, Norway: 1992), 
112(11), 2279–2292. https://doi.org/10.1111/apa.16791

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. 
Pediatrics, 
145(2), e20191725. https://doi.org/10.1542/peds.2019-1725

van Leerdam, T. R., Zajac, J. D., & Cheung, A. S. (2023). The Effect of Gender-Affirming Hormones on Gender Dysphoria, Quality of Life, and Psychological Functioning in Transgender Individuals: A Systematic Review. 
Transgender Health, 
8(1), 6–21. https://doi.org/10.1089/trgh.2020.0094