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Review Article
Rapid review of gender-affirming healthcare for children and adolescents: Evidence synthesis (2021–2025) and recommendations for South Africa
Submitted: 23 December 2025 | Published: 28 August 2026
About the author(s)
Ingrid Lynch, Department of Critical Studies in Sexualities and Reproduction, Rhodes University, Makhanda, South AfricaKL Dunkle, Centre for Sexualities, AIDS and Gender, University of Pretoria, Pretoria, South Africa; and, Hubert Department of Global Health, Emory University, Atlanta, United States
Chris McLachlan, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa; and, Department of Psychology, University of South Africa, Pretoria, South Africa
Pierre Brouard, Centre for Sexualities, AIDS and Gender, University of Pretoria, Pretoria, South Africa
Landa Mabenge, Division of Public Health Medicine, School of Public Health, University of Cape Town, Cape Town, South Africa
Sakhile Msweli, KwaZulu-Natal Department of Health, Empangeni, South Africa
Liberty Matthyse, Gender DynamiX, Cape Town, South Africa
Marion Stevens, Department of Political Science, Stellenbosch University, Stellenbosch, South Africa
Robin Dyers, Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa; and, WHO-FIC Collaborating Centre, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; and, Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
Jenna-Lee de Beer-Procter, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
Kevin Adams, Division of Plastic, Reconstructive and Maxillo-Facial Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
W.D. Francois Venter, Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Elma de Vries, School of Medicine, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
Abstract
Background: Since the publication of the Southern African HIV Clinicians Society Gender-Affirming Healthcare (GAHC) Guideline in 2021, global evidence on care for transgender and gender-diverse (TGD) youth has expanded. An updated, locally grounded, evidence-informed assessment of health outcomes can support South African stakeholders, particularly as both adolescents and TGD persons are populations of relevance to HIV prevention, sexual health, and integrated healthcare programmes in South Africa.
Objectives: To synthesise global empirical evidence (2021–2025) across psychosocial, endocrine, surgical, policy, and non-medical gender-affirming interventions for TGD youth under 18, with attention to South Africa’s social, legal, and health-system, and HIV-service delivery context.
Method: A rapid review was conducted across 12 databases, supplemented by targeted searches for recent systematic reviews. Eligible sources comprised peer-reviewed empirical studies (N ≥ 5) reporting psychosocial or physical health outcomes of relevant interventions for TGD youth under 18 (or their families), and systematic or grey-literature reviews with reproducible methods. Findings were synthesised narratively by intervention domain.
Results: The review included 200 primary studies, 29 academic systematic reviews, and four grey-literature reviews. Affirming psychosocial interventions were associated with reduced distress, anxiety and suicidality, and improved functioning and belonging. Puberty blockers and hormone therapy produced expected physiological outcomes under specialist care, with generally mild adverse events and stable or improved mental health. Restrictive policies were linked to poorer mental health, while protective policies improved outcomes. Most studies were small, observational, and Global North-focused.
Conclusion: Evidence supports the safety and effectiveness of GAHC for TGD youth. Strengthening affirming care, timely clinical access, and protective policies in South Africa may improve healthcare engagement and support the delivery of integrated adolescent, sexual health, and HIV-related services for TGD youth.
Keywords
Sustainable Development Goal
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