i think it's extremely difficult. quality of life impact really begins at puberty for people that experience gender dysphoria, so that's probably a good time for it to be diagnosed. in practice, i think it's a bit more complicated.

I don't completely know where I stand on the issue but I tend to lean on the side of caution. In a perfect world, a non-biased and skilled psychologist should be able to accurately diagnose and treat gender dysphoria in an adolescent. In reality, I don't think it's that simple.

I also don't know if it's as simple as "slap some hormone blockers on the patient while we figure things out" because I'm not sure if hormone blockers have been shown to have no detrimental impact (tbf i also haven't really looked).