I'm no expert, but below are some premises I've gleaned from my independent research.
- Schizophrenia usually does not manifest until a person's 20s. The onset is often gradual, during which time the person will have symptoms that can fly under the radar for years before rising to a level warranting a diagnosis.
- I have read mixed reports about the prevalence of gender dysphoria-like delusions among schizophrenics, but it appears that it does happen.
- Gender-affirming medical care, like hormone therapy and surgery, is sometimes provided to teenagers, the rationale being that earlier affirming care improves mental health outcomes.
I presume that gender-affirming medical professionals are aware of and on the lookout for other potential causes of gender dysphoria, including confounding mental health issues. But if schizophrenia usually cannot be diagnosed until adulthood, doesn't this mean there's a risk of a young person presenting with gender dysphoria, ultimately receiving irreversible gender-affirming care, later being diagnosed and treated for schizophrenia, then finding that the gender dysphoria was actually a delusion caused by the schizophrenia, and finally regretting their transition? This is, in fact, exactly what is described here.
So, how big of a risk is this? Is it a big enough risk to justify delaying medical transition until the patient is older? Might it justify the use of antipsychotic drugs as a test to weed out those who are likely to regret their transition later?
(I realize this question might sound like I'm fishing for a justification for medical discrimination against trans people since two of the questions in the above paragraph look an awful lot like gatekeeping, and the exploratory antipsychotics idea sounds particularly unethical to me. I assure you that's not where this is coming from. I am a trans ally and this question arose out of my various interactions with gender-critical types who often argue some variation of "transgender people are mentally ill and gender dysphoria is nothing more than a delusion.)