Medico-legal and bioethical controversies of the use of puberty blockers in adolescents with gender dysphoria: a comparative perspective between Italy and Spain

Background: the administration of puberty blockers to adolescents with gender dysphoria has ignited significant bioethical controversy, especially in light of recent legislative changes in the United States, Australia and several European states, especially the UK, which in March 2024 permanently banned the administration of puberty blockers to children. Italy and Spain, with their distinct legal, cultural, and medical approaches to treating gender dysphoria in minors, serve as focal points for examining these complex issues. Aims: this article aims to explore the bioethical and medico-legal implications of using puberty blockers in adole scents with gender dysphoria, focusing on the regulatory frameworks in Italy and Spain. It seeks to contribute to theinternational dialogue on best practices for supporting adolescents with gender dysphoria by comparing these two countries’ approaches. Discussion: in recent years in many European states there has been an important evolution in the position on hormone blockade therapy for minors with gender dysphoria, having gone from open policies on puberty blockade treatment to decidedly more restrictive positions. In Italy, the debate on the legitimacy of authorising treatment has been lively for several years, and in the last year has become even more intense due to the decisions taken by countries such as Finland, Sweden, Norway and the United Kingdom. In Spain, a landmark law on trans rights was passed in 2023, but it did not directly regulate hormone-blocking treatment in adolescents with gender dysphoria, which only made an already intense debate even more heated. Conclusion: it is essential to recognise the complexity of gender identity in adolescents and adopt an inclusive ap proach that considers medical, legal, ethical and social implications. The dynamic nature of the debate on the use of puberty blockers requires ongoing international dialogue. Policy analysis from Italy and Spain can inform best prac tice globally, promoting inclusive guidelines that prioritise adolescent welfare by addressing the complex bioethical, medico-legal and scientific issues related to the use of puberty blockers.