Gender diversity dimensions in world pediatric practice: a narrative review

This narrative review explores gender identity development in children and adolescents, with a focus on pediatric care. It aims to synthesize current evidence on gender diversity and gender dysphoria, identify global disparities in healthcare access, and examine the role of pediatricians in supporting transgender and gender-diverse (TGD) youth. A comprehensive literature review was conducted using peer-reviewed PubMed articles, consensus guidelines, official booklets, and online policy documents. Additional searches focused on legislative and healthcare frameworks supporting TGD youth across various regions and cultural contexts. Inclusion emphasized sources published between 2016 and 2024. Gender identity typically consolidates in early childhood, though fluidity may persist through adolescence. The review highlights the importance of distinguishing gender nonconformity from gender dysphoria to inform appropriate clinical interventions. Gender-affirming care-ranging from social transition to medical therapies-has been shown to improve psychological outcomes when provided within multidisciplinary, supportive environments. Despite medical advances, global disparities in access to care persist due to legal, economic, and regional barriers. TGD youth remain at elevated risk for mental health challenges, largely due to stigma and discrimination; however, affirmation and inclusion significantly reduce these risks.

Pediatricians play a crucial role in identifying gender-related concerns, providing affirming care, and addressing structural inequities. This review calls for enhanced pediatric education, culturally competent practice, and policy advocacy. Future research should prioritize longitudinal, diverse, and ethically grounded approaches to optimize health outcomes for gender-diverse youth globally.

• TGD youth face high mental health risks; gender-affirming care improves outcomes but access is hindered by global disparities. • Pediatric and primary care providers are central in supporting youth and families.

• Pediatric gender research lacks longitudinal data, inclusive tools, and attention to ethics (autonomy, dignity, privacy). • Voices of TGD youth-especially those facing multiple marginalization-are often excluded.