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I'm going to break down "Deficiencies in Scientific Evidence for Medical Management of Gender Dysphoria", since people still seem largely confused about the evidence on this topic. Thread 
To get this straight to begin with, sex is not a spectrum. It's binary and defined by gonads. People who suffer under DSD (aka intersex), doesn't prove that, (and off note they really hate being used in this conversation at all)
The cause of gender dysphoria. As pretty much everything it's not fully understood yet. But regarding "female" and "male" brain. Studies analyzing brain differences, mostly show great heterogeneity and overlap. We still relay on self reporting to determine "gender identity"
While there might be many contributors, twin studies show only 40% concordance making purely genetic/ prenatal causes unlikely. The role of social contributors remains unclear
Majority (85%) of children with GD (by the old definition) desist. That doesn't hold up for adolescents necessarily
The quality of evidence for the current recommendation from WPATH (of GnHR (puberty blockers) and affirmative care) is low to very low. While systemically lacking RCT, for pretty much any intervention
Not randomized/controlled studies with small sample sizes could show an improvement in dysphoria and general well-being. However a meta analysis of direct comparison of before and after transition, show INCREASED SUICIDALITY
This is not exactly a critical appraisal. I just pointed out the most important points and the paper is not a study or meta analysis, but just an article. But I think it's important people know these bits of information. (This is the paper https://sci-hub.tw/10.1177/0024363919873762 )
