What's the "state of the art alternative" to address gender dysphoria in adolescents? Certainly the alternative to puberty blockers or hormones most often advocated is doing nothing.

The author makes some perfectly reasonable points about flaws in the study like the large and uneven number of dropouts from the study, likelihood of confounding factors in the nonrandom selection process and oddities in its construction to the extent I'm not sure the study itself can be used as firm evidence of anything, but his insistence that the treatment group not getting worse like the control group can't be evidence for it being beneficial isn't justified either.

Shouldn't the control group get placebo treatment? Simply by knowing they have been "treated" could already make them feel better. When the effect you are looking for is a psychological effect, it is even more serious a research design problem.

what is the state of the art alternative, for this?