Talk:Puberty blocker

I took the liberty to add "United States Department of Health and Human Services"'s stance since Trump's second administration on puberty blockers for gender disphoria. I tried to make it as neutral and fact based as possible. Hunig Brocc (talk) 08:44, 15 January 2026 (UTC)

Under "Medical Uses," in the "Gender Dysphoria" section, the third paragraph begins with the phrase Studies examining the effects of puberty blockers for gender non-conforming and transgender adolescents have indicated that these treatments are reasonably safe, are reversible, and can improve psychological well-being in these individuals. This statement is technically correct, but I feel like it is not WP:NPOV.

A number of recent systematic reviews have concluded that evidence in favor of puberty blockers is very limited and generally low-quality. Indicatively, see: Taylor et al. (2024), Jerez et al. (2024) (scroll to conclusion), and Chew et al. (2018). Of course, this isn't to say that there is no proof of benefit, or that any WP:MEDRS recomends puberty blockers be removed from gender-affirming care protocols, but I feel like the text we offer is nevertheless a bit outdated. The consensus on this matter has shifted in ways since 2024, and newer sources warrant a few changes. I would propose the following:

• Changing the given phrase to Studies examining the effects of puberty blockers for gender non-conforming and transgender adolescents have found that the evidence surrounding these treatments is very limited, though generally suggets the latter are reasonably safe, are reversible, and can improve psychological well-being in these individuals. Of course, we can make adjustments to this, such as adding and warrants more research after is very limited, but this is the gist of what I recommend.
• Expand the second paragraph so as to mention the recent concerns regarding the evidence quality of puberty blockers by experts.
• Consider cutting down on the number of specific studies that get mentioned. Given this is a section on how puberty blockers are used, not their research status (which is what it used to be in previous versions of the article), I feel like it would be better to simply summarize the available evidence, rather than mentioning every new systematic review that comes out, while not including some of the more recent ones. The mention of the Australian govt report also feels like a violation NPOV when other reports with opposing conclusions do not get a mention (and it is probably apparent that mentioning every report and the criticisms thereof is undue).

I'd like to listen to any potential opposing opinions here, so I won't add the NPOV dispute template or proceed to any edits by myself. Amateur Truther (talk) 12:06, 2 October 2025 (UTC)

I intend to reply to this, I'm just sprinting at work. Snokalok (talk) 04:24, 3 October 2025 (UTC)

It has been almost a week and no one has raised any objections, so I went ahead and made some changes to the sentence I mainly had a problem with, as a first step. Amateur Truther (talk) 21:17, 7 October 2025 (UTC)

RIGHT! Sorry, there's an arbcom case on trans healthcare right now so that completely stole my attention. Anyway, right, so in regards to your first set of changes, my primary objection is that the level of evidence available is not unusual within the realm of medicine. That is to say, most medications don't have randomized controlled trials, many physically can't (if one side starts visible going through puberty and the other doesn't, it's not double blind) and if we only emphasize the lack thereof for blockers and not for, every single medicine on this site ever, we're providing an unbalanced perspective. Snokalok (talk) 22:17, 7 October 2025 (UTC)

To elaborate if I have a moment to do so, this is a link I often like to drop in this conversation as it comes up. Basically, only 5.6% of medical treatments have been found to have high quality evidence backing them. [https://pubmed.ncbi.nlm.nih.gov/35447356/] This makes perfect sense for a medical professional, as when using it as an internal measure of how thorough the studies on a treatment are, you can call everything but a select subset low quality and still understand their merit. But with puberty blockers, that's bled over into pop science, so that now when many readers see "The evidence is of predominantly low quality", they read that as "there is no real evidence" even though in reality it's the only standard of evidence reached by all but the slimmest minority of treatments. Snokalok (talk) 22:31, 7 October 2025 (UTC)

I object to changing the existing wording, as the proposed new wording is redundant and adds nothing to the article. The article already says numerous times that research on puberty blockers is limited (as is research on virtually all medical treatments). The most recent systematic review, Tornese et al. 2025, states that "This systematic review provides a comprehensive overview of current evidence on the use of GnRHa in TGD adolescents, confirming its efficacy in suppressing puberty and improving mental health outcomes... available moderate to high-quality evidence supports its clinical use as part of gender-affirming care." So I would also argue that over-emphasis on the "limited" nature of the research is unwarranted. It's much more useful to discuss which specific areas have limited research, which the article already does. Nosferattus (talk) 00:33, 8 October 2025 (UTC)

agree User:Bluethricecreamman (Talk·Contribs) 13:59, 8 October 2025 (UTC)

You raise a fair point. To be clear, I was already aware that low-quality evidence is not rare in medicine, and that said is largely due to the intricacies of RCTs, as well as the role they play in the GRADE approach. After all, Gender-Affirming Care as a whole falls under this (being well-accepted care despite lacking RCTs). That being said, my main conflict here is whether or not the evidence quality of puberty blockers is really comparable to that of other commonly-used, "low-quality" evidence treatments. As far as I'm aware, GnRHa research is limited not just by a lack of controlled trials, but also due to small samples, short study windows, high attrition, and confounding factors. Is most of pediatrics on this level?

Additionally, I understand that there is going to be far more bias here than with any other type of medication, but the fact that some European health bodies have recently cautioned against GnRHa for trans patients makes me sceptical of the notion that the latter is supported by evidence as robust as standard medical care. I'm open to discussion, so feel free to prove me wrong I guess. Amateur Truther (talk) 13:06, 8 October 2025 (UTC)

Most of pediatric medicine is entirely off-label, puberty blockers occupy a bit of a privileged position in comparison. As for Euro health bodies, you can read the article yourself. The UK has the Cass Review which cited right wing youtube channels to say that being trans might be caused by pornography, one of the Cass Review’s advisors is the trans healthcare czar of Finland with more or less complete and total say, and in Finland conversion therapy is the default means of treatment. other euro countries that may have once cautioned have largely since gone back on that (Norway, Germany, France, Denmark). Snokalok (talk) 15:52, 8 October 2025 (UTC)

Puberty blockers are on-label for precocious puberty, not gender dysphoria. Their use for the latter is still off-label.

one of the Cass Review’s advisors is the trans healthcare czar of Finland with more or less complete and total say

I actually did not know that. Fair point.

other euro countries that may have once cautioned have largely since gone back on that (Norway, Germany, France, Denmark).

Norway (according to this very article) is still considering the NHIB’s recommendations, which are against the use of puberty blockers, so they do not really count towards the countries you mention. You also do not mention Sweden. As for the UK, I concur that the Cass review is largely pseudoscience, though the fact UK health bodies accepted its claims on puberty blocker evidence is noteworthy to me. Whether that means the UK's health bodies are unreliable, or that Cass' claim about evidence-quality carries enough weight compared to other medical interventions, your choice. Either way, I will just end this part of the discussion by saying I concede that more European health bodies support puberty blockers than oppose.

That being said, I cannot find (at least, with the time I am allowed due to time constraints) evidence on the notion that puberty blockers are on the same level as most pediatric medicine evidence-wise. It is true that most medicine is not backed by RCTs, but I already outlined what other issues PB research is found to be limited by. I would appreciate if you could provide some sources, and not ones focused on just the RCT comparison. Amateur Truther (talk) 18:10, 8 October 2025 (UTC)

Your request is much too vague to be addressed in any reasonable manner. How is anyone supposed to compare the evidence-base of all pediatric medicine? And evidence for what specifically? The evidence varies a lot depending on what area you are looking at. The evidence for efficacy (i.e. blocking puberty) is robust and non-controversial (at least a dozen moderate to high quality studies). The evidence for mental health outcomes is weaker, especially for long-term effects, but there are at least 7 studies that have been ranked moderate or high quality in systematic reviews showing positive mental health outcomes (and none showing negative outcomes). Areas that are even weaker include long-term bone health, long-term cognitive function, reproductive health, etc. In fact that list is theoretically infinite. Has anyone studied the long term effect of puberty blockers on bowel health? No. But importantly, there are no studies showing strong evidence for serious negative effects (unless you include short-term reversible effects on bone mineral density). The constant refrain that puberty blockers lack evidence to support their use is effectively just sealioning. For people that oppose gender affirming care, no amount of evidence will ever be sufficient. Nosferattus (talk) 18:59, 8 October 2025 (UTC)

I do not oppose gender-affirming care. I am actually in favor of puberty blockers being prescribed under proper medical supervision, and my original text acknowledged there is evidence of benefit; I just think the current version of the article may be doing a disservice to the research. I am not asking for a comparison of all pediatric medicine, I am asking for reliable sources stating that the evidence-quality for puberty blockers' efficacy in improving mental health is equivelant to the quality of other standard pediatric procedures. This is Snokalok's argument, and thus what we are currently discussing. The areas of care involved in this are the ones mentioned in the sentence I editted (before that edit was reverted).

I am also aware of Tornese et al., I was the one who added it to this article. Tornese et al is admittedly an outlier here in saying the evidence in favor of psychological improvement is more robust than previously thought. That being said, Tornese at el was published less than a year after systematic reviews with opposite conclusions (1, 2). I will be fair and balanced in saying I am not opposed to Tornese et al being used to justify the current version of the article due to its more recent nature (something the study itself highlights). In fact, this was something I had not considered previously (and perhaps should have).

I am not knowledgeable enough in medicine to determine whether this approach is appropriately balanced, so if this is the argument you are making, and @Snokalok agrees, I guess I will just concede here. Amateur Truther (talk) 19:28, 8 October 2025 (UTC)

I don't think those reviews necessarily contradict Tornese et al. says in its conclusions, "This review demonstrates that hormone blockers positively impact mental health outcomes in transgender adolescents, reducing depression, anxiety, and suicidal ideation." is more reserved, saying "Limited and/or inconsistent evidence was found in relation to... psychological and psychosocial health.", but its research cut-off was 2 years earlier than Tornese (April 2022 vs February 2024). Nosferattus (talk) 20:29, 8 October 2025 (UTC)

Also, for a bit of comic relief: . Nosferattus (talk) 20:38, 8 October 2025 (UTC)

Right let’s do this:

I don’t disagree with discussing the specific limitations in the body, but I do think that it would be unbalanced and kinda medpop in spirit to write about this med treatment in the lead with this much more critical lens compared to other treatments with similar standards of evidence. It reads like Wikipedia is swayed by moral panics and popular hysterics. As for level of evidence, the best I can think of is that review showing that only 5.6% of treatments have high quality evidence. While that’s not pediatric specific, I don’t think that makes a tremendous difference because it does still show the sheer scale of modern medicine that has problems exactly like research on puberty blockers, and that we can’t really in all good fairness write our lead about them with such extra attention to such things that we wouldn’t apply to any other treatment. Snokalok (talk) 14:18, 9 October 2025 (UTC)

Honestly, the main thing that has swayed me here is reconsidering Tornese et al. I understand your point as well, obviously (albeit I still have some reservations regarding how comparable different treatments are). Either way, I think I've effectively switched to thinking we should wait to see what newer systematic reviews will have to say on the subject. In a year from now, we can assess if the article needs changes, and have an RfC if the discussion goes nowhere. Amateur Truther (talk) 17:01, 10 October 2025 (UTC)

Sorry to jump in to a neverending edit war.

Basically, there's probably some AI text here; I have not checked every edit because A) there are so many of them and B) a large swath of them have been revdelled, but this seems to be one (and probably the other changes around that time by that editor). There is most likely more. So, uh, take that into account when discussing undue weight and accurate reflections of sources and so on. Gnomingstuff (talk) 22:46, 9 October 2025 (UTC)

Well, I was sceptical when I first saw this banner added, but I think this looks like AI since it has attracted a failed verification and clarification needed template, and doesn't seem to be a necessary insertion. I'll take it out. Sirfurboy🏄 (talk) 06:42, 10 October 2025 (UTC)

It's the kind of thing where if you've looked at thousands of AI edits the code smells jump out at you right away, but if you haven't, then you might not know it needs extra verification for AI issues. Since all of these edits were made around the same time the new text is probably all AI. (This was a student editor so unfortunately they're probably not around anymore to confirm.)

The hallucinations aren't the only problem though, especially on a controversial topic like this. Other issues just in these few edits:

• Editorializing and introducing opinions: text like ...underscore the importance of careful, individualized medical counseling... is not only the exact verbiage AI spits out all the time about pretty much anything it's told to, but is a statement of opinion that (to put it mildly) some people don't share.
• Weasel words: Not just an AI tell obviously, but ...there is concern that prolonged suppression of puberty may influence sexual function... is classic weasel wording -- who specifically is concerned? how prevalent is that view? etc?

Gnomingstuff (talk) 16:08, 10 October 2025 (UTC)

Much of the precocious puberty section was written by a student, so I'm not too surprised. Nosferattus (talk) 02:04, 11 October 2025 (UTC)

I see those are the same paragraphs I was trying to copyedit, so if other people also want to commiserate on how bad it is, I'm certainly not going to complain... In fact, might look at bit harder at Mallai98's additions. Alpha3031 (t • c) 15:42, 11 October 2025 (UTC)

I got attribution from wikiblame after wondering where that source was from, since I hadn't started looking too much at the other edits by going through the history yet, but, man "added citation". Alpha3031 (t • c) 16:08, 11 October 2025 (UTC)

Hi @Alpha3031 do you think you've sorted out the LLM content now and therefore the tag at the top of the article can be removed? LunaHasArrived (talk) 13:26, 20 October 2025 (UTC)

I have unfortunately been distracted by other things and had mostly been looking at things from a copyediting angle and not an AI cleanup angle. However, I think Special:Diff/1237669223 at the top of the "short term" subsection would be the largest contiguous block still remaining, so replacing with an inline tag (or if anyone else is able to just check and rewrite that) would be fine, though Gnomingstuff mentioned possibly more which I wouldn't be sure I could identify (most of my identification work is for entire articles that are generated). Alpha3031 (t • c) 10:00, 21 October 2025 (UTC)

@Gnomingstuff would you object to the tag being moved to the Puberty blockers#Effects section? Katzrockso (talk) 00:38, 13 November 2025 (UTC)

The Chinese guideline for treatment of gender dysphoria can be found here . Puberty blocker guidance can be found on pages 8-9. Katzrockso (talk) 20:56, 8 November 2025 (UTC)

The only more recent guideline I found was this one from Peking University Third Hospital from 2022 as well . Pages 26-28 are about puberty blockers and seems to mostly just elaborate on the 'expert consensus' I linked above.

It's worth noting that I believe only a small number of Chinese hospitals (I read somewhere 3, but can't confirm right now) provide transgender health care. Katzrockso (talk) 21:09, 8 November 2025 (UTC)

Interestingly, the guideline paper apparently has a doi according to the Wangfang Data entry, doi:10.3969/j.issn.1005-3220.2022.z1.001 it just doesn't appear to work. Some other DOIs in the same journal appear to resolve fine, wonder if it's a matter of being a special issue, since 002 from the same issue seems to be broken as well. Conveniently, one of the citing works (Zhu et al., 2025) seems to have the "3 hospitals offer puberty blockers" fact, though... it uses the wrong DOI in the citation (to the guideline paper Lu et al., 2022, no citation needed for the "3 hospitals") lol.

Zhu, Wenxin; Xu, Ni; Zhang, Yunbo; Pan, Bailin; Liu, Ye; Yu, Xin (August 5, 2025). "Review: Mental Health and Health Care Needs in Transgender and Gender Diverse Youth in China". JAACAP Open. doi:10.1016/j.jaacop.2025.07.002. ISSN 2949-7329. Seven medical centers are qualified to provide gender-affirming hormone therapy or surgeries, and among these, 3 centers can offer puberty suppression treatment for transgender children and adolescents. Alpha3031 (t • c) 08:58, 11 November 2025 (UTC)

Thanks for this other great source, I did not find that in my search! I interpreted the 2022 paper as "According to the consensus on multidisciplinary diagnosis and treatment of gender incongruence, therapy for puberty suppression is recommended for transgender adolescents" when I read the section on puberty blockers and this 2025 review has the same interpretation.

The authors of the first review all have the affiliation "Tongji Hospital Affiliated to Tongji University" and the authors of the second review all have the affiliation of Peking University, some being associated with the Peking University Third Hospital and some with the Peking University Institute of Mental Health (the Sixth Hospital). Katzrockso (talk) 09:42, 11 November 2025 (UTC)

Is this sentence in the lead actually true: Several European health authorities have also issued more restrictive or cautious guidance on their use in minors. Other than the UK, which is already discussed in the lead, it looks like Sweden has definitely made their guidelines on puberty blockers more restrictive. The article vaguely suggests that Finland has as well, but I haven't been able to verify this. The article states that "Finland revised its guidelines to prioritise psychotherapy over medical transition", but it doesn't say anything about puberty blockers or what the specific changes were (nor does the cited Economist article). A medical organization in Norway recommended that their guidelines be tightened, but they weren't. Danish guidelines seem to still be fairly liberal and I couldn't find much information about what they were like before the current guidelines. In France, 2022 guidelines from the Académie Nationale de Médecine urged caution, but according to the cited Politico article, this didn't change anything, and the most recent French guidelines from 2024 don't seem restrictive. If this sentence in the lead is actually true, I think it needs more evidence in the article body, as right now there isn't much. Nosferattus (talk) 19:40, 22 February 2026 (UTC)

It seems like it would be more precise and avoid SYNTH concerns to just name the specific countries that have made their guidelines more restrictive (Sweden, UK) rather than try to cast some trend without good secondary sourcing. Katzrockso (talk) 21:41, 22 February 2026 (UTC)

But which ones have actually become more restrictive on puberty blockers? Besides the UK and Sweden, it seems like possibly Finland, but I'll need to do some more digging on that one. Nosferattus (talk) 22:23, 22 February 2026 (UTC)

The only concrete differences I could find with the new Finnish guidelines are that they lay out specific eligibility criteria (nothing unexpected) and recommended treatment of psychiatric comorbidities prior to medical intervention. The biggest change is really just in prioritizing psychotherapy over medical transition, but there aren't really any new restrictions on puberty blockers. I think I'll go ahead and change the sentence to just mention specific restrictions as you suggest (to avoid SYNTH concerns). If anyone can find any others, feel free to add them. Nosferattus (talk) 23:58, 22 February 2026 (UTC)

We should rely on whether reliable secondary sources are describing guidelines as more or less restrictive, rather than analyzing the changes in guidelines ourselves. I see a bunch of unreliable SEGM articles and SEGM member pieces claiming that Finland's guidelines are "sanity" in comparison to the USA, but I didn't see any reliable sources analyzing Finland's guidelines and whether or not they have changed. Perhaps they were already more 'restrictive', but often looking at just the guidelines without looking at how they are applied in practice can be misleading anyways.

Here is an overview article I found that is published in an academic journal that might be useful. It also states And during the writing of this article, the centralized gender clinic in Denmark has also restricted the use of puberty blockers, cross-sex hormones, and genderreassignment surgery in minors. This article, however, was written by a number of SEGM authors and some authors are/were members of anti-transgender groups, such as the International Association of Therapists for Desisters and Detransitioners , so we might need to check the claims more closely. Katzrockso (talk) 01:04, 24 February 2026 (UTC)

Any authors connected to SEGM are likely to be unreliable. I can confirm that Denmark tightened their restrictions on hormone therapy, but I haven't yet been able to find evidence of them tightening restrictions on puberty blockers. Specifically says (translated from Danish), "Several countries, including Denmark, have initiated a more cautious approach to hormone therapy until more evidence is available for its beneficial effect." Snokalok may be able to provide more specific info. Nosferattus (talk) 04:42, 24 February 2026 (UTC)

The paper cited for And during the writing of this article, the centralized gender clinic in Denmark has also restricted the use of puberty blockers, cross-sex hormones, and genderreassignment surgery in minors is (in Danish). The only guidelines in that paper mentioning puberty blockers specifically are: The structure of the Danish treatment offer is similar to that of most European countries, with a thorough assessment and psychiatric evaluation before starting hormone therapy. Hormone therapy is provided at V&R, and in some cases partly by the patient's own doctor, and follows international guidelines [18]. Treatment can be initiated with puberty-inhibiting gonadotropin-releasing hormone (GnRH) analogue alone or as a combination of puberty-inhibiting hormone and sex hormone, depending on age (Table 2). Treatment with GnRH analogue can be started from Tanner stage II/III, thereby delaying puberty, with the aim of providing time for exploration of gender identity without further development of secondary sex characteristics (Table 2). (Table 2 does not mention any ages or limitations. It's just a table of effects and risks.) Although these guidelines might technically be more strict than the previous Danish guidelines (which I don't know about), they are not restrictive in any practical sense regarding puberty blockers, unlike Sweden, the UK, and the US. Indeed, they explicitly claim to be aligned with the guidelines of the Endocrine Society ([18]), which supports the use of puberty blockers. So I don't think it would be accurate to frame Denmark as cracking down on puberty-blockers, even if they have restricted hormone therapy and surgery. Nosferattus (talk) 01:15, 26 February 2026 (UTC)

Thanks for checking on this. This is precisely why anything affiliated with SEGM needs to be check more carefully, very often their claims (despite being published by presumably reliable sources) are factually inaccurate.

On Denmark, one can compare what the actual report you link states vs what the SEGM people say and see their descriptions have absolutely no connection. This is probably where this misconception comes from. Katzrockso (talk) 01:45, 26 February 2026 (UTC)

Back in September 14, 2025 the Guyatt review was removed , with the following summary: The author has short-of rescinding the paper https://hei.healthsci.mcmaster.ca/systematic-reviews-related-to-gender-affirming-care/called out that it should not be misused by anti-trans groups after the anti-trans organization's link was uncovered. Even though Guyatt apologized for accepting funds from SEGM, the study was not retracted nor changed and should not have been removed. I have added it back. PositivelyUncertain (talk) 19:50, 3 April 2026 (UTC)

@Nosferattus - I have reverted you here . This is a MEDRS article and we cannot overstate the quality of the research and, because med articles require special considerations, in edit conflicts it is better to understate effectiveness than an overstate it. Furthermore, in the discussion above the Torense review is being given undue preference in comparison to the other reviews. PositivelyUncertain (talk) 20:50, 3 April 2026 (UTC)

We are not overstating the research. The research on safety, reversibility, and psychological health are sufficiently established at this point. There are lots of areas with uncertainty regarding long-term effects, but that's true of most drugs, and we already highlight those specific areas in the article. Nosferattus (talk) 21:03, 3 April 2026 (UTC)

There are lots of areas with uncertainty regarding long-term effects, but that's true of most drugs - And when there's uncertainty, science/medicine considers whether the known benefit outweighs the uncertainty and/or potential harms. As it stands, reviews from top institutions say that the lack of high quality studies means the benefits — and which subset of dysphoric youth benefit the most — is unknown and therefore they cannot assess risk vs benefit. Saying this is a safe and effective treatment without caveat is bad medical information. PositivelyUncertain (talk) 21:23, 3 April 2026 (UTC)

Could you please provide sources or just be more specific with your claims that top institutions can not assess the risk vs benefit of puberty blockers. These German guidelines explicitly ask clinicians to do an individual risk-benefit assessment as part of the recommendation for puberty suppression which seems at odds with the claim that assessing risk v benefit can not be done. LunaHasArrived (talk) 22:49, 3 April 2026 (UTC)

To add to this, most American health associations seem to heavily support puberty blockers. We mention this in the article's lead too.

In general, it is quite difficult to navigate proper phrasing in this topic, simply because the consensus view among most major WP:MEDORG's is different from what is suggested by systematic reviews, and the subset of medical institutions that do adhere to evidence quality warnings strictly (e.g. the British NHS) have faced criticism for bias. Amateur Truther (talk) 23:00, 3 April 2026 (UTC)

Sorry I wasn't clear. I mean top evidence based research institutions (York and McMaster) say it's the benefit is unknown and thus medical professionals cannot make evidence-based decisions (risk vs benefit) about patient care. PositivelyUncertain (talk) 23:00, 3 April 2026 (UTC)

I do not think you are addressing their point. How do you define an 'evidence based institution'? Are the American Medical Association or Yale evidence based institutions? Is the aforementioned German AWMF an evidence based institution? For the record, I am not stating this as a point against the limited language caveat, I just do not get your argument here. Amateur Truther (talk) 23:05, 3 April 2026 (UTC)

York , which did the reviews for the Cass Review, and MacMaster , which did the Guyatt review, are leaders in systematic reviews and evidence-based science. They're both known for it specifically. PositivelyUncertain (talk) 23:15, 3 April 2026 (UTC)

Well medorgs are releasing statements saying that they can make risk-benefit assesments so it seems unlikely that they cannot possibly do that. LunaHasArrived (talk) 23:12, 3 April 2026 (UTC)

And perhaps they can, but our article should still state the evidence is limited. PositivelyUncertain (talk) 23:16, 3 April 2026 (UTC)

In re "Saying this is a safe and effective treatment without caveat is bad medical information": Saying that anything is an effective treatment, without saying what it's effective for, is bad medical information. Antibiotics are an effective treatment for bacterial pneumonia. (They are also an effective treatment for certain kinds of headaches experienced by the medical staff, when "that patient" comes in with a common cold and a chip on her shoulder.) But they are lousy for treating a heart attack. Editors should not write "antibiotics are an effective treatment"; they should write "antibiotics are an effective treatment for bacterial infections".

The question here should be: What's the "for" statement with PBs? "PBs are effective at temporarily pausing pubertal development"? I suspect we have plenty of evidence for that. "PBs are effective at reducing lifetime self-harm incidence"? It sounds like there is some concern in the medical community that this is not actually true. WhatamIdoing (talk) 23:32, 3 April 2026 (UTC)

Here's our article states Studies examining the effects of puberty blockers for gender non-conforming and transgender adolescents have indicated that these treatments are reasonably safe, are reversible, and can improve psychological well-being in these individuals. Treatment of transgender adolescents with puberty blockers, especially when followed by gender-affirming hormone therapy, has been shown to reduce depression, anxiety, and suicidality. The second sentence is solely sourced to Tornese

So the "effective for" in our article goes beyond what is generally agreed upon (delaying puberty) and into areas that, according to the Taylor et al and Guyatt reviews, have a weak evidence base. PositivelyUncertain (talk) 01:02, 4 April 2026 (UTC)

Well that's why we say "that studies indicate that puberty blockers can improve psychological wellbeing". Instead of saying simply "that puberty blockers improve psychological wellbeing". We do already use language to caveat the point here. LunaHasArrived (talk) 07:40, 4 April 2026 (UTC)

Is there any substantive difference in saying that "that studies indicate" instead of saying "that studies find"? I don't think so. But even if, would any average reader understand this to mean that the research-based is currently limited/weak? PositivelyUncertain (talk) 16:41, 4 April 2026 (UTC)

Hello. As the person who intially inserted the "limited" language, I would like to make some points here.

in the discussion above the Torense review is being given undue preference in comparison to the other reviews

Tornese was given more weight because it has the latest study inclusion window out of the published systematic reviews. That being said, I agree it is undue preference to use it specifically in order to dismiss other reviews. Tornese cites 7 primary studies it considers as moderate- to high-quality evidence in favor of puberty blockers improving mental health. At the same time, only two of those studies were outside the inclusion window of Taylor et al. (2024), a highly critical review, and only one of the two is about mental health in the sense it is meant here (the other is about IQ and educational achievement). This raises questions about the degree to which Tornese really "supersedes" the other reviews, especially given they were published on year apart.

Besides Tornese, the other big argument that had made me back down in the old conversation was the formulation that most of medicine is backed by "low quality research" as the latter is defined in the GRADE approach, yet Wikipedia does not mention that fact each time. While the claim about evidence in medicine is correct, I honestly do not know to what extent it is true that we do not mention low-quality evidence. I have edited many medical articles and, from my anecdotal experience, this does not seem to be the case, and I am unsure how we would prove either scenario without the argument ultimately being anecdotal and potentially misrepresentative of medical WP. Plus, even if we could prove that WP does not mention evidence quality on most occasions, I am not sure to what extent that is applicable here.

In short, after extra consideration, I believe I am a lot more in favor of an evidence-quality caveat than I was when the last conversation ended, though I do not know how that should be best formulated to adhere to standards. Amateur Truther (talk) 21:28, 3 April 2026 (UTC)

I posted this discussion on WikiProject Medicine and I'm hoping editors more knowledgable about medical subjects will weigh in. As for the reason we mention evidence quality here, it's because MEDRS think it's important. It's definitely atypical for a standards of care guideline to recommend pharmaceutical interventions for youth that may have irreversible side effects without a strong evidence base of benefit.

One item that stuck out to me re Tornese is the journal. Frontiers Media does not have a stellar reputation but that doesn't necessarily apply to all of its sub-journals. But another issue is Tornese is, when compared to Guyatt, a lower-quality study. It does not include a meta-analysis and not nearly as in-depth as the Guyatt. Another thing is it includes studies (and lots of them) where patients used both puberty blockers AND hormone therapy (GaHT) yet somehow they are making claims about the effects of PBs. That also increases my concerns about the journal because this should have been corrected in peer review.

As for the other three two sources attached to that statement, there all from before 2020 and WP:AGEMATTERS especially on this topic. PositivelyUncertain (talk) 22:23, 3 April 2026 (UTC)

WP:MEDDATE prefers sources from "the last five years or so", but there is no strict cutoff. Informally, Wikipedia:WikiProject Medicine editors try hard to avoid sources that are 10+ years old, iff it's a subject that changes (e.g., not for anatomy, because an arm's been called an arm for centuries, and no new "research" is going to change that). WhatamIdoing (talk) 23:20, 3 April 2026 (UTC)

Tornese is the most up-to-date systematic review, so if you're going to weigh sources by age, it should get the most weight. As to your other point, puberty blockers are normally used prior to hormone therapy, so it absolutely makes sense to look at studies that include both. The fact that York ignored those studies was a major source of criticism. Tornese looked both at studies of only puberty blockers and studies that included hormone therapy. They concluded that "Mental health improved significantly, including reduced depression, anxiety, and suicidality—especially when GnRHa was followed by gender-affirming hormone therapy (GAHT)." Note that it says especially, meaning that even without hormone therapy, puberty blockers significantly improved mental health outcomes. Nosferattus (talk) 03:05, 4 April 2026 (UTC)

@PositivelyUncertain Unless there is a consensus that Frontiers in Endocrinology is a predatory journal (which I doubt), I don't think there is much substance in trying to argue in favor of Tornese being superior or inferior compared to other systematic views. (To be clear, @Nosferattus, I am not sure whether saying Tornese takes precedence is really your argument here, though I feel what I say below concerns your position too.)

WP:MEDDATE is not applicable in this context considering Taylor and Jerez (which disagree with Tornese) were published only one year before Tornese (in 2024), and that the latest systematic review on GnRHa is actually Miroshnychenko et al. (2025), which also disagrees with Tornese. The fact that Tornese contains primary studies wherein both GnRHa and HRT were used does not matter to us given Wikipedians should never interpret the content of primary sources for themselves (WP:RS). Unless there has been some major, consensus-driven pushback against this type of research in this field, Tornese is free to have its own conclusion as a secondary sources -- it is not up to us to say whether the primaries it analyzed support or oppose that conclusion, and potentially reject Tornese on that basis.

The only notable fact we can draw from Tornese is that it opposes the notion of limited evidence regarding mental health outcomes, and that this opposition is a minority view among systematic reviews. Amateur Truther (talk) 12:01, 4 April 2026 (UTC)

My main point regarding to Tornese wasn't that we should disregard it (its conclusions belong). Currently Tornese is the rationale for why we aren't saying research is limited. I'm arguing that Tornese cannot be used to ignore the other systematic reviews that disagree with Tornese. Perhaps I should have made that clearer.

it is not up to us to say whether the primaries it analyzed support or oppose that conclusion I disagree with that. We are able to assess reliable sources and when there is a glaring methodological problem, it should be noted in discussion on the talk page. PositivelyUncertain (talk) 16:20, 4 April 2026 (UTC)

Assess them how? Something like the Cass Review, for example, is regarded as non-MEDRS by a lot of Wikipedians because many subject-matter experts have published critiques of it. I do not see how we would make a similar determination for Tornese without RS-based criticism to cite. Doing it without sources to lean on, based on our personal rationale, is just anti-WP:NPOV.

Nevertheless, I understand your point and I agree that Tornese alone is not enough to avoid clarifying the research limitations. Amateur Truther (talk) 19:29, 4 April 2026 (UTC)

Assess them how? Something like the Cass Review, for example, is regarded as non-MEDRS by a lot of Wikipedians because many subject-matter experts have published critiques of it - I agree that the Cass Review isn't MEDRS and is only reliable for what is stated in the Cass Review. What is MEDRS is the seven systematic reviews conducted by University of York and published in the BMJ that Cass relies on to make her conclusions (which includes Taylor 2024).

I do not see how we would make a similar determination for Tornese without RS-based criticism to cite. Doing it without sources to lean on, based on our personal rationale, is just anti-WP:NPOV. Hmmm this is an interesting thought. In my mind, we can use non-RSs to determine DUE weight. And that's all I was trying to do in my assessment here. I'm not trying to remove it. I'm not arguing to add my opinion that the study is overstating its conclusions (cause obviously that's just my interpretation). Tornese is obviously a MEDRS secondary source and should be in this article. Does that make sense or do you still believe that to be anti-NPOV.

PS - Im genuinely curious because I really do care about NPOV. I'm also a relatively new user and still learning the ropes and am very open to feedback. PositivelyUncertain (talk) 21:29, 4 April 2026 (UTC)

I mean, if you agree that it is MEDRS and that we should not try to paint it as lesser within the article, I do not see the point in conducting a talk page assessment really. From there, our interpretations are our own thing, and the article is separate. Amateur Truther (talk) 21:34, 4 April 2026 (UTC)

AGEMATTERS does not mean a source that comes out in 2025 is better source than 2024. Its about medical research/information changing over time. PositivelyUncertain (talk) 16:23, 4 April 2026 (UTC)

@AmateurTruther: At the risk of splitting hairs, Miroshnychenko et al. is not the most up-to-date. Miroshnychenko's research cut-off is September 2023. Tornese's is February 2024. Regardless, your point is taken. Nosferattus (talk) 18:08, 4 April 2026 (UTC)

@PositivelyUncertain: I agree. And over time the research on puberty blockers is becoming less and less limited. For example, just last year Finegan et al. became the first study to examine long-term effects of puberty blockers on sexual function in transgender individuals and it found no negative effects. The issue isn't whether the research is limited or not, as it will always be limited. The issue is how much to emphasize that it is limited and this is a very politicized point. I'm wondering if there is any way to reach a compromise between unduly overemphasizing it (as your wording does) and the current wording which avoids it entirely. Could we add something like, While research on long-term effects remains limited, especially regarding bone health, cognitive function, and fertility, available evidence supports the use of puberty blockers as part of gender-affirming care. Nosferattus (talk) 18:09, 4 April 2026 (UTC)

I support this wording. Not conveying limitations at all (like in the current version) is disingenuous, but the topic clearly warrants better communication to the reader, and insinuating that GnRHa is discredited for trans care would violate RS as well. This avoids both. Amateur Truther (talk) 19:19, 4 April 2026 (UTC)

This is a great suggestion! Thank you for proposing this language. My only suggestion (and preference) would be to say "available evidence generally supports". But if you and/or AT disagree with adding generally, I won't object to including the language as is. As I said - I really really appreciate this suggestion. PositivelyUncertain (talk) 20:36, 4 April 2026 (UTC)

I think "generally" may be a bit innaccurate? GnRHa is included in GAC due to its perceived mental health contribution, and on that front, the primary studies are basically ubiquitous on finding benefit. The real issue here is not "some primary studies disagree," it is "the primary studies are limited." Then again, I guess 'generally' may include the fact that GnRHa has physical side-effects. I guess I have no strong preference here. Amateur Truther (talk) 21:34, 4 April 2026 (UTC)

I was proposing that as a sentence to add to the paragraph, not to replace the current content. I still think the statement that puberty blockers are "reasonably safe, are reversible, and can improve psychological well-being in these individuals" is important to have in the first paragraph of that section and is supported by the cited sources. Nosferattus (talk) 22:44, 4 April 2026 (UTC)

I restored the wording about being "reasonably safe" while keeping the new content about the long-term research being limited. Hopefully this is a decent compromise that makes everyone equally unhappy. Nosferattus (talk) 03:24, 5 April 2026 (UTC)

This looks good to me! PositivelyUncertain (talk) 03:42, 5 April 2026 (UTC)