{"id":3438,"date":"2025-03-22T09:12:41","date_gmt":"2025-03-22T08:12:41","guid":{"rendered":"https:\/\/trajectoiresjeunestrans.fr\/non-categorise\/germany-austria-and-switzerland-commit-to-supporting-gender-affirmation-for-trans-minors\/"},"modified":"2026-01-25T15:46:43","modified_gmt":"2026-01-25T14:46:43","slug":"germany-austria-and-switzerland-commit-to-supporting-gender-affirmation-for-trans-minors","status":"publish","type":"post","link":"https:\/\/trajectoiresjeunestrans.fr\/en\/news\/germany-austria-and-switzerland-commit-to-supporting-gender-affirmation-for-trans-minors\/","title":{"rendered":"Germany, Austria and Switzerland commit to supporting gender affirmation for trans minors"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text css=””]After several years of work, the Association of Scientific Medical Societies (AWMF), an organisation bringing together numerous German-speaking professional societies, has published a scientific consensus text on gender-affirming care specific to trans adolescents, spanning 425 pages. This consensus involved very broad participation: 26 professional medical and psychotherapeutic organisations, as well as two organisations of people with lived experiences, contributed to building the consensus, which applies to Germany, Austria and Switzerland. <\/p>\n

From the outset, the professional societies highlight the delicate ethical context of producing definitive scientific evidence on care for trans adolescent populations, due to the absence of proven effectiveness of non-affirming approaches: \u201cAs there is no proven effective alternative treatment for persistent gender incongruence with gender dysphoric distress that works without body-altering medical interventions<\/strong>, the feasibility of controlled clinical trials is also severely limited for ethical reasons. This means that the available evidence is mainly based on clinical observational studies.\u201d<\/p>\n

In the absence of randomised controlled trials, the clinical experience of professionals is even more necessary in developing guidelines. This approach, based on the experience of professionals working with trans youth and directly observing the effects of gender-affirming care prescribed to them, is fundamentally different from the approach followed by the Cass report (previously discussed on our site<\/a><\/span>) \u2013 \u201cSome national health authorities’ guidelines, such as the Cass Review for NHS England and Wales (Cass, 2024), recommend a comparatively more restrictive approach to adolescents’ access to body-altering interventions on the grounds that the evidence base is uncertain. The involvement of clinical experts in the preparation of these recommendations is not assured or at least not transparent or questionable<\/strong>.\u201d <\/p>\n

On this matter, the AWMF supports its position by citing the statement of the German Federal Medical Association (2020):
\u201cEvidence-based medicine is the conscientious, explicit and judicious use of current best external scientific evidence to inform decisions in the medical care of individual patients. The practice of evidence-based medicine is the integration of individual clinical expertise with the best available external evidence from systematic research. Evidence-based medicine is based on three pillars: individual clinical experience, the values and wishes of the patient and the current state of research<\/strong>.\u201d <\/p>\n

Regarding ethical debates on gender-affirming care, the AWMF societies recognise that it is necessary to consider \u201cOn the one hand, the irreversible consequences of a treatment decision in favour of hormone treatment\u201d, but also, \u201cOn the other hand, postponing such treatment due to the equally irreversible progression of the development of male or female physical characteristics can lead to an aggravation of gender dysphoric distress and thus to the worsening and chronification of gender dysphoria<\/strong>.\u201d The AWMF emphasises, echoing the German Ethics Council\u2019s requirement, that a \u201ccareful consideration of the benefits and risks of both the contemplated treatment and the decision not to undergo such treatment <\/strong> when making medical treatment decisions in adolescence.\u201d In this ethical balancing, “The principles of “non-maleficence”, “beneficence”, “autonomy” and “justice” should be observed equally and in a balanced manner. This means that experimental or outdated methods should not be used uncritically, but treatments should be used in a well-considered manner and with a careful risk-benefit assessment. A risk-benefit assessment of non-treatment<\/strong> should also be carried out.” with the latter potentially “can be associated with an increased risk of impaired long-term mental health<\/strong>.” <\/p>\n

Referring to the construction of the expert consensus, the authors of the text recognise the possibility of dissent, especially on basic ethical and therapeutic positions, which are systematically documented. Most evidence-based recommendations, however, show strong consensus (> 95 % approval). <\/p>\n

How are guideline recommendations justified when evidence is uncertain? The AWMF professional societies directly address this question and justify their methodology as follows: \u201cGuideline recommendations recognised by the medical community for which there is only uncertain or very uncertain evidence are widespread in medicine. This is particularly true for paediatric medicine. According to a recent meta-analysis, 82% of all treatment recommendations in medical guidelines for off-label prescriptions in paediatric medicine are based on uncertain to very uncertain evidence<\/strong> (Meng et al., 2022). If one considers that in paediatric medicine up to 65% of all medications prescribed in the inpatient sector and up to 31% of all medications prescribed in the outpatient sector are only available in off-label use<\/strong> (Kimland & Odlind, 2012), one can estimate the scale of established guideline recommendations for children and adolescents that are based on uncertain to very uncertain evidence only. In such cases, until research gaps are closed by further studies, consensus-based guideline recommendations\u2014aligned with recognized best clinical practice\u2014are generally justified in pediatric medicine if, alongside positive clinical experience, the following conditions are fully or partially met (Meng et al., 2022):\u201d <\/p>\n