The paper it's discussing is linked from the article but as you don't have access, here it is: https://journals.plos.org/plosone/article?id=10.1371/journal.pone

The paper it's discussing is linked from the article but as you don't have access, here it is: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243894 https://journals.plos.org/plosone/article?id=10.1371/journal... The rapid response to the article refers to the qualitative interviews given regarding the patient experience, later on in the study timeline, whereas the psychological outcomes are measured by standardised scales that can be analysed quantitatively, and which were first issued prior to treatment. It is the latter that are being used to examine differences from baseline over time, for psychological effect. A key paragraph in the discussion regarding this: "Young people experienced little change in psychological functioning across the study. We found no differences between baseline and later outcomes for overall psychological distress as rated by parents and young people, nor for self-harm. Outcomes that were not formally tested also showed little change." This does not support the oft-made claim (outside of this study) that this intervention reduces depressive thoughts and suicidal ideation, and saves children from committing suicide. (For example, a commenter I replied to above claimed it's typical to see a 60-70% improvement on these measures, though this assertion was uncited.) The study you linked is interesting, but as the authors state in the limitations section: "First, causation cannot be inferred due to the study's cross-sectional design. It is possible that those who historically have higher rates of depression and suicidal thoughts and behaviors are also less able to seek or obtain [gender-affirming hormone therapy]." "To better understand directionality, prospective longitudinal designs are needed." That is, the study lacks sufficient power to support the hypothesis that this medical intervention improves mental health outcomes.