A framework note from the HAS (2026) sets the objectives and the method for developing future recommendations on transidentity among minors. It aims to structure quality support and specify the care pathway (medical or social transition) for children and adolescents questioning gender, while supporting those around them. This work follows the adult component of 2025 and mobilizes professionals, users and associations.
These new national recommendations must structure the health care pathway for minors with gender issues or transgender issues, as well as the support of those around them. This project follows the section dedicated to adults published in 2025 and responds to a marked increase in requests for care, with the average age of medical referral now being around thirteen years, in a context of strong heterogeneity of practices on French territory. The objective is thus to propose harmonized, secure and ethical professional benchmarks, the final publication of which is scheduled for the end of 2027.
Complexity of clinical pictures
For mental health professionals, this note reaffirms the principle of depsychiatrization of transidentity, while emphasizing the central role of psychiatry and child psychiatry in multidisciplinary evaluation. Future work should guide practitioners in the face of the complexity of the clinical pictures encountered, characterized by a high frequency of neurodevelopmental disorders, notably the autism spectrum. (“An American expert consensus recommendation as well as a French systematic review concerning gender dysphoria in children and adolescents indicate that the incidence of autism spectrum disorders (ASD) is 7.8% among children and adolescents diagnosed with gender dysphoria, or ten times the rate in the general population (0.6 to 1%)”). and psychiatric comorbidities such as anxiety, depression or addictive behaviors. The initial assessment must pay particular attention to psychological distress, suicidal risk as well as vulnerability linked to domestic violence or harassment. A meta-analysis published in 2020 (23), based on ten studies (conducted in particular in the United States, United Kingdom, Australia and Japan) revealed, among transgender children, adolescents and young adults (aged 3 to 25), very high rates of self-aggressive behavior (28.2%), suicidal ideation (28%) and suicide attempts (14.8%).note the HAS.
Therapeutically, the recommendations will specify the conditions of access, the calendar and the graduation of interventions, which includes social transition, ongoing psychological support and possible recourse to medical treatments such as puberty blockers and cross hormones. HAS insists on the need to document the benefit-risk balance of these molecules, to consider the fluidity of pathways, including detransition, and to preserve the reversibility of choices as much as possible. The ethical and legal dimension also constitutes a pivot of the note. The experts will indeed have to clarify the methods for obtaining informed consent from the minor, according to their degree of maturity, and from their holders of parental authority, by determining in particular whether these interventions relate to usual or non-usual acts. The management of disagreements within the family and the necessary coordination with the school environment will also be the subject of guidelines. To base these recommendations, the HAS will rely on a rigorous analysis of recent international scientific literature and on a working group.
To find out more:
• Transidentity: support for minors and their entourage, and care offered – Framework note, GOOD PRACTICE RECOMMENDATION – Posted online on May 5, 2026.
