Moving the goal post and using ethics as a rhetorical refuge doesn't change the evidence: About the debate on the best care for minors with gender issues.

In their recent article, Oosthoek et al. propose a paradigm shift in the evaluation and justification of gender-affirming medical treatment (GAMT) for minors with gender dysphoria or gender incongruence. Rather than relying on traditional clinical outcome measures such as mental health, global functioning, or quality of life, they argue for a patient-defined standard centered around "embodiment goals" and autonomy. While we acknowledge the importance of incorporating patient perspectives and values, we raise significant theoretical and clinical concerns about the implications of this approach. Central to our critique is the tension between the authors' framework and established principles of medical ethics, especially beneficence and non-maleficence. We argue that abandoning the expectation of demonstrable clinical improvement undermines the professional ethos of health care and poses risks to vulnerable adolescents. Moreover, we caution against using ethics as a rhetorical refuge to justify treatments for which evidence of benefit remains weak or inconsistent. Instead of redefining effectiveness post hoc, we advocate for a robust evidence-based framework that prioritizes well-being and supports careful, honest shared decision-making. Non-medical interventions, including psychosocial support and treatment of comorbidities, should remain the first-line approach until stronger evidence for GAMT emerges. We call for improved research that evaluates both medical and non-medical interventions using established clinical outcome measures.