Teenager HRT
The WPATH (World Professional Association for Transgender Health) is the worldwide authority on all things regarding transgender/non-binary/metagender people, with hundreds of citations of well-researched studies. Specifically applicable to you would be Chapter 6 on adolescents, and Chapter 12 on hormone replacement therapy.
The WPATH doesn’t recommend puberty blockers for youth older than 15 (although you can be on them for longer), but does recommend starting HRT at age 14 (at the earliest) if the teenager is medically eligible and mentally prepared. In general, teenagers who express that they are trans, especially if they have known that truth about themselves for a few years, have the cognitive ability and reasoning skills necessary for making long-term decisions regarding their bodies. Teenagers may know from birth that they are not their assigned gender, or it may be a developmental process that has grown with them.
Many studies have shown that MOST youth do not regret having puberty blockers or starting HRT. While there are permanent changes with both testosterone HRT and estrogen HRT, if a teen decides to stop they will no longer progress in body changes corresponding to their HRT. Several Dutch studies have found that the rate of a person starting HRT in their teens and deciding not to continue is about 2-3.5%, which is a lower regret rate than the rate of breast augmentation performed on cisgender teenage girls (~25%) and also low compared to the regret rate of cisgender men who have penile implants (25-30%), as a few examples.
Overwhelmingly, youth who start HRT in their teens have massively reduced suicide rates and less depression and anxiety. A massive Trevor Project study found that gender-diverse teens on HRT with at least one supportive guardian in their lives had 40% lower odds of experiencing a suicidal crisis or attempt. Another study published in PLOS One found that among almost 13,000 teen participants who started HRT at age 14-15, the odds of severe psychological distress were decreased 222% and the odds of past-year suicidal ideation were decreased 135%. Among those who started HRT during later, at age 16-17, the odds of severe psychological distress and past-year suicide ideation were decreased by 153% and 62%, respectively, indicating that an earlier start produces greater benefits in terms of mental health.
I understand the fear and uncertainty of allowing a teenager to make a big step! But it’s super important for families and caregivers to know that there are great, reputable, long-term studies about HRT and the body of evidence is growing every year. Supportive guardians are key for the long-term health and safety of a trans teen by showing understanding, awareness, and the knowledge of bodily autonomy. And letting trans teens start HRT absolutely saves lives.
- WPATH Guidelines: https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644
- PLOS One study: Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults
- Summary of that PLOS One study if this is easier to read: New Study Shows Transgender People Who Access Gender-Affirming Hormones During Adolescence Are Significantly Less Likely To Experience Psychological Distress Or Suicidal Ideation - Fenway Health
- The Trevor Project about LGBTQIA+ su1 rates https://www.thetrevorproject.org/resources/article/facts-about-lgbtq-youth-suicide/
- Article about the WPATH lowering recommendations for HRT to start at age 14 in the most recent edition Guidelines lower minimum age for gender transition treatment and surgery | AP News
- Great study from the American Academy of Pediatrics about comprehensive care for trans and gender-diverse youth Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents | Pediatrics | American Academy of Pediatrics