Formulation, Implementation and Outcome Monitoring of New Treatment Guidelines for Children and Adolescents with Gender Dysphoria

73 Ms He Ting Ru asked the Coordinating Minister for Social Policies and Minister for Health in relation to the recent Ministry of Health circular on treatment guidelines for children and adolescents with gender dysphoria (a) what clinical evidence and external organisations were relied upon in formulating the guidelines; (b) how did the Ministry assess the credibility, independence, and consensus standing of these sources; and (c) whether the Ministry will publish the full list of references underlying the guidelines.

74 Ms Eileen Chong Pei Shan asked the Coordinating Minister for Social Policies and Minister for Health given that the Ministry does not track the number of persons with gender dysphoria or the gender-related medical interventions provided locally (a) how does the Ministry intend to monitor and evaluate the clinical and mental health outcomes of new treatment guidelines for children and adolescents with gender dysphoria; and (b) whether the full guidelines are publicly accessible to affected patients and families.

75 Ms Eileen Chong Pei Shan asked the Coordinating Minister for Social Policies and Minister for Health (a) whether Treatment Review Panels under the new treatment guidelines for children and adolescents with gender dysphoria have been implemented; (b) if so, how many panels were operational on the date the guidelines took effect; (c) what is the median waiting time for a patient to be assessed by a panel; and (d) what interim arrangements are in place to ensure care continuity.

Mr Ong Ye Kung: I will address Questions 73 to 75 together. My response will also address Written Question No 20 raised by Mr Victor Lye in today's Order Paper. [Please refer to "Impact of Gender Dysphoria Treatment Guidelines on Existing Patient Treatment Plans and Transitional Arrangements for Affected Children and Adolescents", Official Report, 5 August 2026, Vol 96, Issue 34, Written Answers to Questions section.]

Gender Dysphoria (GD) is a psychiatric condition that requires careful and holistic management, particularly for young people who are still undergoing major physiological and psychological changes. Someone diagnosed with GD will require empathy, acceptance and support from their family and the wider community. The person will also need appropriate and effective clinical care.

However, the management of GD in children and adolescents is an area of significant international debate, as the evidence base continues to evolve. Some advocate earlier access to gender-affirming interventions, including puberty blockers, citing the absence of hard evidence-based thresholds on when such treatments should be withheld, and arguing that children can be firm in their resolve to change gender at a young age. Others urge greater caution against such treatments, citing their permanent and potentially irreversible effects on children and adolescents who may not continue to have GD later in adulthood.

The risks are significant both ways. For individuals with GD who remain undiagnosed or who are diagnosed but have treatment withheld, the consequences are severe. Appropriate treatment must therefore be accessible to them. On the other hand, for individuals without GD but given irreversible treatment, the consequences are also very severe. This requires some exercise of precaution.

The purpose of the Treatment Guidelines for Children and Adolescents with Gender Dysphoria (Treatment Guidelines) is to address and minimise these risks. As the new Treatment Guidelines come into force, we need to ensure that existing patients undergo a supportive and empathetic transition process.

In developing the Guidelines, the focus of our clinicians in the Ministry of Health (MOH) is to do what is clinically appropriate, given what we know about the condition and the evidence available. For a complex condition like GD, the diagnosis needs to be robust, and treatment decisions must be based on the best available clinical evidence and the patient's best interests.

Hence, the Treatment Guidelines require a consistent standard of care. Given the clinical complexity of GD and the potentially severe consequences of inappropriate treatment, it should not be managed solely at the primary care level. Some less complex medical conditions, including complications associated with common chronic diseases, already require the primary care physician to refer the patient for specialist assessment and multidisciplinary care. The Treatment Guidelines therefore require GD to be assessed and managed by a multidisciplinary care team. They emphasise psychological support as the first line of treatment. They also provide for a Treatment Review Panel, which includes an independent medical specialist, to review individual cases where clinically appropriate and evidence-based medical intervention should be considered in the patient's best interests.

MOH is working with the public healthcare institutions and private providers managing existing cases to develop treatment pathways in line with the Guidelines. We will need some time to set up Panels, and schedule existing patients for review. While this is being done, existing treatment should continue under the care of the managing clinician to avoid the potential harm of an abrupt interruption. When ready, the Panels will assess patients on an individual basis, and a careful decision will be made on whether to continue or adjust their treatment plan.

In the longer term, this approach gives us greater assurance that each patient receives an appropriate diagnosis and treatment pathway. It enables us to better support young people with GD, while avoiding putting those without on a painful and irreversible path.

In developing the Treatment Guidelines, MOH established multidisciplinary workgroups to review available published evidence and international reviews on the management of GD in children and adolescents. The workgroups considered published studies, international evidence reviews and policy positions from overseas jurisdictions. They assessed the evidence on its merits, taking into account the quality of the available evidence and findings of independent reviews. The Treatment Guidelines were based on expert consensus, clinical considerations and the available evidence, and were subsequently endorsed by the Academy of Medicine, Singapore, before they were issued.

The Treatment Guidelines are aligned with the clinical policy position published by the National Health Service England in March 2024 which drew on the evidence review conducted by the National Institute for Health and Care Excellence in 2020. The position has been further reinforced by a growing number of independent reviews – in New Zealand, Sweden, Norway, Denmark and Finland.

Today, MOH could not have complete information on the total number of patients with GD, as some individuals may seek care in the private sector, and it is not a notifiable condition. Given our emphasis on continuity of care, MOH is not yet aware of patients who were unable to continue with their existing treatment.

As the Treatment Guidelines are clinical guidelines intended for registered medical practitioners involved in the care of children and adolescents with GD, they were, like other clinical guidelines, disseminated to all registered medical practitioners as professional guidance and were not intended for a wider audience. Nonetheless, MOH has publicly set out the key principles underpinning the Treatment Guidelines in its response to a Parliamentary Question in May 2026. [Please refer to "Supporting Youths with Gender Dysphoria", Official Report, 6 May 2026, Vol 96, Issue 30, Written Answers to Questions for Oral Answer not Answered by End of Question Time section.]