Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: preliminary results

Achille, Christal; Taggart, Tenille C.; Eaton, Nicholas R.; Osipoff, Jennifer N.; Tafuri, Kimberly; Lane, A.; Wilson, Thomas A.

doi:10.1186/s13633-020-00078-2

Cited by 113 publications

(108 citation statements)

References 12 publications

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“…1 ). After screening and full-text review for the specific research question on the psychological effects of gender-affirming hormone therapy, 20 studies reported in 22 publications were included ( Table 1 ): 1 RCT [ 27 ], 2 before-after trials [ 28 , 29 ], 12 prospective cohorts reported in 13 publications [ 30-42 ], 1 retrospective cohort reported in 2 publications [ 43 , 44 ], and 4 cross-sectional studies [ 45-48 ]. De Vries (2014) [ 35 ] reported on a subset of the participants in de Vries (2011) [ 34 ] who continued in care.…”

Section: Resultsmentioning

confidence: 99%

Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review

Baker

Wilson

Sharma

et al. 2021

Journal of the Endocrine Society

152

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We sought to systematically review the effect of gender-affirming hormone therapy on psychological outcomes among transgender people. We searched PubMed, Embase, and PsycINFO through June 10, 2020 for studies evaluating quality of life (QOL), depression, anxiety, and death by suicide in the context of gender-affirming hormone therapy among transgender people of any age. We excluded case studies and studies reporting on less than 3 months of follow-up. We included 20 studies reported in 22 publications. Fifteen were trials or prospective cohorts, one was a retrospective cohort, and 4 were cross-sectional. Seven assessed QOL, 12 assessed depression, 8 assessed anxiety, and 1 assessed death by suicide. Three studies included trans-feminine people only; 7 included trans-masculine people only, and 10 included both. Three studies focused on adolescents. Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety. Associations were similar across gender identity and age. Certainty in this conclusion is limited by high risk of bias in study designs, small sample sizes, and confounding with other interventions. We could not draw any conclusions about death by suicide. Future studies should investigate the psychological benefits of hormone therapy among larger and more diverse groups of transgender people using study designs that more effectively isolate the effects of hormone treatment.

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Section: Resultsmentioning

confidence: 99%

Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review

Baker

Wilson

Sharma

et al. 2021

Journal of the Endocrine Society

152

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“…In a prospective, longitudinal investigation, de Vries et al (2011) reported improvements in general functioning as well as decreases in depressive symptoms and emotional and behavioral problems. The findings of these two studies are further supported by a recent longitudinal investigation that found youth aged 9–25 years who engaged in gender‐affirming endocrine treatment (i.e., puberty suppression or cross‐sex hormones) demonstrated improved mental health over time (Achille et al, 2020). The chance to have more time to consider medical transition was helpful to the young person in one of the case study reports (Cohen‐Kettenis et al, 2011).…”

Section: Discussionmentioning

confidence: 57%

Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature

Rew

Young

Monge

et al. 2020

Child Adoles Ment Health

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Background: Increasingly, early adolescents who are transgender or gender diverse (TGD) are seeking genderaffirming healthcare services. Pediatric healthcare providers supported by professional guidelines are treating many of these children with gonadotropin-releasing hormone agonists (GnRHa), which reversibly block pubertal development, giving the child and their family more time in which to explore the possibility of medical transition. Methods: We conducted a critical review of the literature to answer a series of questions about criteria for using puberty-blocking medications, the specific drugs used, the risks and adverse consequences and/or the positive outcomes associated with their use. We searched four databases: LGBT Life, PsycINFO, PubMed, and Web of Science. From an initial sample of 211 articles, we systematically reviewed 9 research studies that met inclusion/exclusion criteria. Results: Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged 'excellent', five studies met the majority of quality criteria resulting in 'good' ratings, whereas three studies were judged fair and had serious risks of bias. Conclusion: Given the potentially life-saving benefits of these medications for TGD youth, it is critical that rigorous longitudinal and mixed methods research be conducted that includes stakeholders and members of the gender diverse community with representative samples. Key Practitioner Message What is known? • Increasing numbers of early adolescents who are transgender or gender diverse (TGD) and seeking professional help. • Pubertal development may lead to (a) greater anxiety about sexual identity and (b) suicidal thoughts among TGD. • Professional organizations, such as the Endocrine Society and the World Professional Association for Transgender Health (WPATH), have recommended the use of puberty-blocking hormones to arrest pubertal development, thus allowing early adolescents and their families more time to consider the possible outcomes of gender reassignment. What is new? • This article is a report of a critical and systematic review of literature about the use of puberty-blocking hormones among TGD, the positive, and the negative outcomes associated with their use. • The findings of this systematic review can guide healthcare professionals in their discussions with TGD youth and their families as they consider the risks and benefits of puberty suppression. What is significant for clinical practice? • A summary of current research on the us...

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“…Three longitudinal studies from the Netherlands and the USA have examined psychological function over time in cohorts of young people treated with GnRHa and then cross-sex hormones [ 17 , 18 , 24 ], although the two US cohorts were of limited size. Our study adopted the same psychological outcome measures as the Dutch cohort, to facilitate comparison [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK

et al. 2021

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Background In adolescents with severe and persistent gender dysphoria (GD), gonadotropin releasing hormone analogues (GnRHa) are used from early/middle puberty with the aim of delaying irreversible and unwanted pubertal body changes. Evidence of outcomes of pubertal suppression in GD is limited. Methods We undertook an uncontrolled prospective observational study of GnRHa as monotherapy in 44 12–15 year olds with persistent and severe GD. Prespecified analyses were limited to key outcomes: bone mineral content (BMC) and bone mineral density (BMD); Child Behaviour CheckList (CBCL) total t-score; Youth Self-Report (YSR) total t-score; CBCL and YSR self-harm indices; at 12, 24 and 36 months. Semistructured interviews were conducted on GnRHa. Results 44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months. All had normal karyotype and endocrinology consistent with birth-registered sex. All achieved suppression of gonadotropins by 6 months. At the end of the study one ceased GnRHa and 43 (98%) elected to start cross-sex hormones. There was no change from baseline in spine BMD at 12 months nor in hip BMD at 24 and 36 months, but at 24 months lumbar spine BMC and BMD were higher than at baseline (BMC +6.0 (95% CI: 4.0, 7.9); BMD +0.05 (0.03, 0.07)). There were no changes from baseline to 12 or 24 months in CBCL or YSR total t-scores or for CBCL or YSR self-harm indices, nor for CBCL total t-score or self-harm index at 36 months. Most participants reported positive or a mixture of positive and negative life changes on GnRHa. Anticipated adverse events were common. Conclusions Overall patient experience of changes on GnRHa treatment was positive. We identified no changes in psychological function. Changes in BMD were consistent with suppression of growth. Larger and longer-term prospective studies using a range of designs are needed to more fully quantify the benefits and harms of pubertal suppression in GD.

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Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: preliminary results

Cited by 113 publications

References 12 publications

Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review

Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review

Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature

Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK

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