Randomized-controlled trials are methodologically inappropriate in adolescent transgender healthcare

Background Despite multiple rigorous observational studies documenting the association between positive mental health outcomes and access to puberty blockers, hormone therapy, transition-related surgeries among adolescents, some jurisdictions have banned or are attempting ban gender-affirming medical interventions for minors due an absence of randomized-controlled trials (RCTs) proving their benefits.Methods This article critically reviews whether RCTs methodologically appropriate studying adolescent care outcomes.Results The scientific value is severely impeded when impact on trans adolescent. Gender-affirming physiologically evident effects highly desired by participants, giving rise concerns over adherence, drop-out, response bias, generalizability. Complementary well-designed can instead be used ground reliable recommendations clinical practice policymaking in healthcare, without need RCTs.Conclusion lack impacts adolescents does not entail that based insufficient evidence. Given methodological limitations RCTs, complementary offer more evidence than should considered sufficient quality guide policymaking.