Feature
18 May 2026
On 5 May 2026, the MOH released two circulars: “Counselling Guidelines for Youths with Sexuality Issues” (43/2026) and “Treatment Guidelines for Children and Adolescents with Gender Dysphoria” (44/2026).
In this article, we focus on the latter. After outlining the general guidelines, we make a few observations on the key features of the MOH approach for GD among children and young people, briefly contrasting MOH’s cautious approach to transitioning for children and adolescents who present with GD to the approach typified by the Gender Affirmative Model. We shall conclude this article with a short theological musing on the severing of gender from sex and our unique status before God as Creaturely creators.
General Guidelines spelled out by MOH
Circular 44 acknowledges the “associated permanent and wide-ranging effects of treatment for children and adolescents who are still developing their sense of identity and undergoing major physical and psychological changes”. In view of that, the circular states the principles below in the treatment of Gender Dysphoria (GD) pertaining to children and adolescents:
- It should be managed by a multidisciplinary team.
- Hormonal and Surgical treatment should be the last resort after psychological treatment.
- Those who are 18 and below should not be offered hormonal and surgical treatment, even if they are diagnosed with GD.
- Hormonal and surgical treatment for those over 18 diagnosed with GD should only be offered when there is “clear evidence of harm reduction… and agreement from the MDT.”
- For those who are green-lighted, treatment should consist only of gender-affirming hormonal therapy and not puberty-blockers.
The circular further notes that registered medical practitioners who infringe on these guidelines “may be referred to the Singapore Medical Council for further investigation and possible disciplinary action.” MOH will be issuing licences to monitor more closely those who treat children and adolescents diagnosed with GD. It concludes that “healthcare professionals should err on the side of informed consent and harm minimization.”
Key features of the MOH approach
1. Multidisciplinary approach
The approach that MOH has articulated for children emphasizes an assessment period of over six months to a year, by a team comprising at the minimal:
- Medical Doctors: Psychiatrists, endocrinologists, reproductive medicine specialists, Paediatricians and so on
- Allied Health Professionals: Clinical Psychologists, Medical Social workers
A Treatment Review Panel (TRP) comprising the same specialists as above is similarly required for adolescents who present with GD before they qualify for Gender Affirming Hormone Therapy (GAHT) or Gender Affirming Surgery (GAS). In particular, the child or adolescents’ medical and developmental history ought to be thoroughly investigated.
In contrast, in the Gender Affirmation Model (GAM) approach, “no assumption is made that every child exhibiting a gender nonconforming presentation is in need of mental health treatment.” (Diane Ehrensaft, 2017) “[T]he role of the mental health professional is a facilitator in helping a child discover and live in their authentic gender with adequate social supports… mental health professionals are their translators—striving to understand what they are telling us about their gender in words, actions, feelings, thoughts, and relationships.” (Colt Keo-Meier and Diane Ehrensaft, 2018)
2. External Factors
With regard to environmental factors such as family, peer relationships and school, the MOH model seeks to uncover possible stressors that impact the child or adolescent’s view of his or her gender identity. In other words, the child or adolescent’s social, economic and environmental contexts are investigated for reasons that might have contributed to him or her repudiating his or her birth sex.
In contrast, one of the basic premises of GAM is that “any pathology that is present is more often caused by cultural reactions to gender diversity (e.g., transphobia, homophobia, sexism) than by internal psychological disturbances within the child.” ( Keo-Meier and Ehrensaft, 2018) Because no gender variation is deemed to be disordered, “interventions may be targeted at the surrounding environment, rather than the child’s individual psyche.” (Ehrensaft, 2017) In the GAM it is the culture (parents, school, religious institutions) that needs help because of its unwillingness to accept the child’s gender identity/ presentation.
3. Puberty-blockers and Gender Affirming Hormonal Therapy
Those who argue for puberty-blockers for children do so because they recognise that puberty itself is already a tumultuous time, hence the process of maturing into the sex which one rejects becomes particularly harrowing for children with GD. Furthermore, allowing the body to mature into its natural sex “strongly favours cis embodiment by raising the psychological and medical toll of transitioning…. Youth who take puberty blockers have their options wide open, their bodies unaltered by either testosterone or oestrogen.” (Florence Ashley, 2019)
In contrast, the 2025 MOH guideline for children states that “[t]reatment with gonadotropin releasing hormone analogues (GnRHa) should not be carried out or be made available for children with GD.” This is reiterated in the Guideline for Adolescents with Gender Dysphoria that “PS (pubertal suppression) is not recommended.” The rationale for this ban is that the effects of puberty-blockers on children are inconclusive in terms of alleviating GD, and there is a paucity of research on the safety of GnRHa for children. For MOH, a cautious approach creates an environment where the outcome of gender exploration is not predetermined and averts any danger of irreversible consequences. One concurs with the need for caution; after all, the treatment of GD with puberty-blockers “recasts a normal physiological process as a disease and can trigger a cascade of increasingly invasive medical interventions.” (Sarah C. J. Jorgensen, Nicole Athéa, Céline Masson, 2024)
The same cautious approach is advocated in the use of Gender Affirming Hormonal Therapy (GAHT). GAHT is allowed only for those who have reached 21, demonstrate ability to give informed consent, and have been through fertility counselling with their parents, except when evidence can be provided of harm reduction, with agreement from the TRP, for someone over 18 and below 21.
Reflection on the severing of Sex and Gender
Today we are taught that Sex and Gender are different – that sex refers to one’s biology and gender to the meanings associated with each sex. (Favale, 2022) In fact, the nomenclature Gender Dysphoria amounts to an acknowledgement that the dysphoria pertains not to the body but the meaning the person associates with the body.
If that is so, it is indeed prudent of MOH to approach medical treatment such as puberty blockers, hormones and surgery to change the body, with extreme caution.
What are Christians to make of this severing of sex and gender? It may be helpful for us to know that “gender” comes from the Old French gendre, which in turn is derived from the Latin genus. We see that taxonomy is inextricably woven into the word “gender” – it suggests that for us to make sense of one another as fellow human beings, classification around male and female is inescapable.
The word “gender” was first used by professor of psychiatry Robert Stoller in 1968 to refer to psychological characteristics pertaining to transsexuality. (Cynthia R. Nielsen & Michael Barnes Norton, 2017) Subsequently, it is argued, the word was “repurposed” and made a part of popular usage by feminists to underscore the socio-cultural factors that perpetuate social difference between men and women. (Jennifer Hornsby,1995; Nielsen & Norton, 2017; Tina Beattie, 2017)
Abigail Favale observes that “[o]nce gender entered the theoretical scene, it quickly became the dominant force…. In gender-world, the power of the body to constitute identity is diminished.”
Carl Trueman concurs with Favale on the depreciation of the body once the connection between sex and gender became tenuous:
[I]f sex and gender are inextricably connected, then a mismatch between what one is biologically and who one is psychologically must inevitably be regarded as a dysfunction of the mind. Once the two are detached from each other… then the problem becomes one of the body, to be treated with medication and surgery. Technology makes the whole claim plausible.
Creaturely creator
The last sentence in the preceding paragraph hints at the philosophy behind approaches that eschew caution. It is a faith in the human ability to shape ourselves according to our wish, to surmount through advances in medicine what traditionally has been insurmountable – the givenness of our sexed bodies. Indeed, this faith fuels another burgeoning industry – that of Transhumanism. We can be our own creators, as it were.
Most of us would probably be familiar with LEGO® blocks. Currently in its 96th year of existence, its slogans include gems such as “What Will You Make?”, “Believe What You Will Believe” and “Rebuild the World”, inviting and referencing the LEGO® builder’s exercise of creativity. Yet no matter how creative the child or adult is, the material from which the LEGO® block is made, the shape it already comes in, are inbuilt boundaries of malleability.
No material in the universe is infinitely malleable. This is because everything created, living or non-living, has a set of innate characteristics that limits its possibilities.
This is what theologians such as Aquinas call essence. The essence of a thing is that set of properties it possesses which persists through changes and which, “were it to lose any of them, it would no longer exist.” (Howard-Snyder, 2001) Importantly, the sex which we are born into is one of those that would qualify as essential and unchangeable. Puberty-blockers cannot cause a body to change into the opposite sex; they merely prevent sexual maturity. Likewise, gender affirming hormones cannot cause the growth of internal organs that typify a male or a female; they can only cause the atrophy of the sexual organs that one is born with.When we lose sight of our creatureliness we are likely to take an anti-essentialist stance towards ourselves. Or we believe that “what constitutes a thing’s essence is up to us: we “construct” the sorts of things that there are.” (Howard-Snyder, 2001)
Conclusion
We conclude with the observation that countries that have recently adopted a more conservative approach include Sweden, Finland, Norway, Denmark, France, Italy and the United Kingdom. That these countries began with models of treatment that were relatively permissive but have since backpedalled, ought to give us pause. For that reason, one would applaud MOH for the decidedly conservative direction of its circular on the treatment of Children and Adolescents with Gender Dysphoria.
Dr Khaw Siew Ping is a research associate at Trinity Theological College. She has been a teacher, home-maker, and church worker involved in a variety of ministries from preaching, administration, to drama and worship ministry. Siew Ping has been a member of St. John’s – St. Margaret’s Church for more than three decades.