Adolescent neurocognitive development and decision-making abilities regarding gender-affirming care

Orma Ravindranath; Maria I Perica; Ashley C Parr; Amar Ojha; Shane D McKeon; Gerald Montano; Naomi Ullendorff; Beatriz Luna; E Kale Edmiston

doi:10.1016/j.dcn.2024.101351

Adolescent neurocognitive development and decision-making abilities regarding gender-affirming care

Dev Cogn Neurosci. 2024 Feb 12:101351. doi: 10.1016/j.dcn.2024.101351. Online ahead of print.

Authors

Orma Ravindranath¹, Maria I Perica², Ashley C Parr³, Amar Ojha⁴, Shane D McKeon⁵, Gerald Montano⁶, Naomi Ullendorff⁶, Beatriz Luna⁷, E Kale Edmiston⁸

Affiliations

¹ Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: orr4@pitt.edu.
² Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
³ Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
⁵ Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
⁶ Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
⁷ Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
⁸ Department of Psychiatry, University of Massachusetts Chan School of Medicine, USA.

PMID: 38383174
DOI: 10.1016/j.dcn.2024.101351

Abstract

Recently, politicians and legislative bodies have cited neurodevelopmental literature to argue that brain immaturity undermines decision-making regarding gender-affirming care (GAC) in youth. Here, we review this literature as it applies to adolescents' ability to make decisions regarding GAC. The research shows that while adolescence is a time of peak risk-taking behavior that may lead to impulsive decisions, neurocognitive systems supporting adult-level decisions are available given deliberative processes that minimize influence of short-term rewards and peers. Since GAC decisions occur over an extended period and with support from adult caregivers and clinicians, adolescents can engage adult-level decision-making in this context. We also weigh the benefits of providing GAC access during adolescence and consider the significant costs of blocking or delaying GAC. Transgender and non-binary (TNB) adolescents face significant mental health challenges, many of which are mitigated by GAC access. Further, initiating the GAC process during adolescence, which we define as beginning at pubertal onset, leads to better long-term mental health outcomes than waiting until adulthood. Taken together, existing research indicates that many adolescents can make informed decisions regarding gender-affirming care, and that this care is critical for the well-being of TNB youth. We highlight relevant considerations for policy makers, researchers, and clinicians.

Keywords: Adolescence; Cognition; Decision-making; Gender-affirming care; Policy; Transgender.

Publication types

Review