I just want to add something to all the other great comments and to LangCleg's succinct summary and answer her question
How much worse can it get?
The HRA states that the GIDS study is not using puberty blockers as a pause but as a method to lock in transition in children they have already deemed to be persistent as a means of ensuring passability in adulthood. [my emphasis]
I read all of the the available studies on persistence and desistance that attempted to figure out which of the children would desist and which would persist into adulthood. The hypothesis was, that the most dysphoric would persist and the least dysphoric desist. So, "the worse your GD, the more likely you are to persist" was the theory.
However, the data showed that severity of GD was not a good indicator of persistence.
And that was fine, because these children were treated in line with the watchful waiting approach. No medical interventions until long after puberty set in, which they found was the mechanism that separated those who would persist into adulthood from those who would reconcile with their bodies and desist.
So, I'd love to know how GIDS is determining which children are going to persist. Especially since we have tentative first results that show if you block puberty, you prevent desistance, and an astonishing 98% to 100% go on to cross-sex hormones. IOW, GIDS is creating a self-fulfilling prophecy.
We also have no data on the ROGD cohort in girls, who present atypically for gender dysphoria. That is, they only start identifying as trans when they are post-pubescent (for girls that's around 14 years of age).
We don't know what their desistance rate would be without medical interventions. No data exists. But we are giving them irreversible, life-limiting treatments anyway.