The authors of “Prohibition of Gender-Affirming Care as a Form of Child Maltreatment: Reframing the Discussion”1 state that GAC “does not cause harm” and “decreases many negative health outcomes, including rates of depression.” No relevant citations are provided for this claim. Although youth GAC has the support of the professional medical community in the United States,2–4 that does not mean there is no risk of harm. Infertility, lack of development of genital tissue, problems with sexual functioning, psychosocial/cognitive delay, decrease in bone mineral density accrual, and the known side effect profiles of estrogen and testosterone (eg, thrombotic events, cardiovascular disease, etc) are all potential risks associated with the hormonal agents used in youth GAC.5 Furthermore, systematic reviews6–9 have found the quality of evidence in this field is low, meaning the literature does not actually show, with any reasonable degree of certainty, that youth GAC decreases rates of negative mental health outcomes. This runs contrary to the authors’ claim that use of hormonal interventions in this population is “supported by a wealth of research on their safety and effectiveness.” Later in the paper, the authors reiterate that “GAC…entirely mitigates the increased risk of depression and suicidal ideation.” The citation for this claim is Tordoff et al 2022,10 which is the only clinical research study involving youth GAC in the reference list. This was an observational study of hormonal treatment in which there was no significant change in mental health outcomes over time. Some participants did not start hormones and had high rates of depression/suicidal ideation at the end of the study period; however, this was a tiny number (n = 7), and any resulting statistical comparison cannot support the assertion that depression and suicidal ideation were “entirely mitigated” in this study.10