New Guidelines for the Treatment of Transgender Youth

Wed 23rd Apr, 2025

The treatment of adolescents who do not identify with the gender assigned to them at birth has been practiced in Germany for several years. However, until recently, there was no unified guideline based on the latest knowledge for the treatment of transgender minors by psychologists, psychiatrists, and hormone specialists. This has changed with the publication of a comprehensive medical guideline in early March by 26 medical and therapeutic professional societies along with two patient advocacy organizations.

This extensive document outlines numerous recommendations for the respectful care and appropriate treatment of transgender children and adolescents. According to experts, this guideline represents a significant advancement that will enhance the medical and psychotherapeutic support for transgender youth while also providing greater transparency for these young individuals and their families.

The guidelines offer well-founded recommendations covering all relevant treatment steps, from diagnostics and psychosocial support options to gender-affirming measures. The emphasis is placed on the importance of allowing adolescents to make their own decisions regarding gender-affirming hormone treatment, with parental consent being necessary. Professionals are encouraged to support these individuals in making informed choices.

It has been noted that many youths experience distrust or assumptions about their identities during treatment. Some providers, lacking adequate knowledge, may doubt a young person's transgender identity if they do not express a desire to begin hormone therapy. Therefore, it is crucial that youths have a supportive environment to navigate their decision-making process.

Experts are advised to assess each case individually and make careful considerations. While it is vital to protect young people from premature decisions, it is also important to recognize that prolonged delays in treatment can have detrimental effects.

For a medical treatment to commence, experts indicate that patients should experience significant distress related to their assigned gender or be at risk of increased distress without treatment. A gender-affirming hormone treatment should only be initiated if the individual has identified as transgender for several years, which helps ensure that this is not merely a temporary phase of identity exploration. Parents or guardians must be involved in the decision-making process.

The guidelines specify that a minimum number of therapy sessions is not required before beginning hormone therapy. Instead, psychotherapy should be accessible to anyone in need, without making it a prerequisite for hormone treatment, as forced therapy may not be effective.

Nonetheless, comprehensive psychiatric assessments are deemed necessary before a young person can receive puberty blockers or hormone therapy. This includes multiple discussions with a child and adolescent psychiatrist or psychologist. Notably, hormone therapy should never start before puberty, although no specific minimum age is established.

Puberty blockers are medications designed to temporarily halt the physical changes associated with puberty, thereby preventing the development of features that conflict with a person's identified gender. This approach affords young individuals the time to consider whether they wish to pursue gender-affirming hormone therapy while allowing for the possibility to resume puberty if desired.

In contrast to puberty blockers, hormone therapy actively induces bodily changes, with trans women receiving estrogen and trans men receiving testosterone. These hormonal treatments result in irreversible changes, underscoring the necessity for a high level of cognitive and emotional maturity among minors when making such decisions.

The number of youths undergoing medical treatment for transgender issues remains relatively low in Germany, with estimates suggesting only a few hundred new cases each year initiating puberty blockers or hormone therapy. In recent years, there has been a significant rise in gender-affirming surgeries among adults, largely attributed to increased societal acceptance and reduced stigmatization, along with improved availability of treatment options.


More Quick Read Articles »