Objective: Adolescence is one of the most neglected developmental phases, yet there are few phases in the life course when gender socialisation is as intense. So far, no framework or theory exists that theoretically conceptualises gender norms, gender attitudes and mental health outcomes. To address this gap, we aim to develop a conceptual framework that illustrates the interplay of key constructs in the gendered pathways of health, using the Delphi technique. Methods: We carried out a Delphi study enrolling an international panel of 21 experts from different disciplines, with 43% of the respondents completing all three survey rounds. We asked the experts to identify core constructs (first round), suggest operationalisations of the constructs (second round), and to hypothesise about their relationships (third round). Items were included, excluded or adapted according to experts’ feedback. A 70% threshold was used for consensus. Results: The panelists consented on the following core constructs: gender norms (social environment), sex assigned at birth, gender attitudes, gender roles, competencies, and gender identity to the mental health of adolescents. They further consented on gender approaches, namely the intersectional, multidimensional and multilevel approach as well as the power relations lens. The operationalisation of the constructs in round two led to the inclusion of variables forming an intersectional lens and four social environment levels: the household, community, political and digital level. In round three, the experts formed 14 hypotheses about the relationships between the core constructs. Conclusion: The derived conceptual framework links the interplay of six key constructs, four gender approaches and four social environment levels to adolescent mental health. Future research should validate and apply the hypothesised relationships between the constructs to disentangle the gendered pathways to (mental) health in adolescence.

The authors have declared no competing interest.

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval was obtained from the ethics board at Bielefeld University, Germany, in May 2023 (application number: 2023-111 of 2023/05/22).

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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All relevant data are within the manuscript and its Supporting Information files. We have removed personal and sensitive data due to the small sample size and the anonymous nature of the Delphi study. These data are available on reasonable request from the corresponding author.