Why We Watch and Wait

A better approach to helping teens with Gender Dysphora by Jason Watson

Imagine a teen arrives at the mental health unit where you work. Once they are settled, you sit down to talk about what is bothering them. Some stay quiet, others mention a specific issue, and a few even know what they need to do next. Usually, they only have a vague idea of what is wrong, so together you start figuring it out—step by step. That is how therapy often begins.

But things are different with teens who feel uncomfortable with their gender, a condition called Gender Dysphoria. Since cases spiked in the late 2010s, the approach has shifted. Now, when these teens say their struggles come from Gender Dysphoria, staff often accept it without much question. Instead of exploring other possibilities, therapy centers on agreeing with their belief and moving toward gender-related solutions. This “affirm-first” style clashes with how we usually help people in mental health care.

Normally, we follow a clear process: build trust, assess what is going on, make a plan, try it out, and check if it works. We call this the Nursing Process—Assess, Plan, Implement, Evaluate. A key part of assessing is “Watchful Waiting,” where we observe and learn about the teen’s struggles without jumping into big treatments. Yet, with Gender Dysphoria, this step is often skipped or barely touched.

What Is Watchful Waiting?

Watchful Waiting means keeping a close eye on someone’s health without rushing into major treatments unless they are urgently needed for safety. It is used when starting treatment might cause more harm than good. For teens with Gender Dysphoria, it is not about pushing them to accept or reject their gender feelings. Instead, it is a neutral way to explore what is really going on—over time—while offering proven help for any other mental health challenges, like depression or anxiety, which often show up alongside Gender Dysphoria. It is a slow, steady way to understand the whole picture, backed by professionals who value careful assessment over quick fixes.

Why Watchful Waiting Helps

1. Gives Time to Understand the Full Story
   Teens with Gender Dysphoria often deal with other issues—think depression, anxiety, autism, trauma, or low self-esteem. Watchful Waiting lets us spot and treat these first. Some even argue Gender Dysphoria acts like the “new anorexia,” influenced by trends among friends or online.

2. Avoids Rushing into Permanent Changes
   Starting gender treatments—like hormones—can lead to lifelong effects. These include weaker bones, mood swings, weight gain, heart risks, infertility, and even changes in brain function. Waiting helps avoid regrets from choices that cannot be undone.

3. Lowers the Chance of Mistakes
   In places like the UK’s Tavistock clinic, rushed assessments led to wrong diagnoses. A neutral, careful approach prevents that.

4. Reduces Peer Pressure
   Studies show some teens feel pushed toward identifying as transgender by friends or social media. Waiting gives them space to think for themselves.

5. Supports Natural Growth
   Most kids who question their gender eventually feel okay with their birth sex if given time and neutral support—no pushing either way.

6. Brings Families Together
   Parents are a teen’s biggest allies. Waiting opens up honest talks and builds trust over time.

7. Builds Confidence
   Rushing into gender changes and then regretting it can hurt mentally. Exploring all options first helps teens feel surer of who they are.

Real Risks, Real Regrets

Gender treatments—like puberty blockers or hormones—carry serious side effects: infertility, heart problems, even brain tumors in rare cases. Stories like Keira Bell’s, who sued a clinic for rushing her into treatment she later regretted, show why slowing down matters. Her case sparked the 2024 Cass Review, which calls for change.

A Safer Way Forward

Today’s quick-to-affirm approach skips the careful steps mental health care relies on. Watchful Waiting puts assessment first, keeping teens safe while they figure things out. With growing evidence and reviews like Cass pushing back, it is a practical, thoughtful way to help.

Jason Watson is a New Zealand Registered Nurse who has dedicated 18 years of his 40-year career to working in Child and Adolescent Mental Health settings.

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