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

Abstract

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...

Commentary: The Signal and the Noise—questioning the benefits of puberty blockers for youth with gender dysphoria—a commentary on Rew et al. (2021)

“…Contrast Rew et al.’s (2021) conclusions with another recently completed systematic review of puberty blockers for GD youth, commissioned by England’s NHS and conducted by The National Institute for Health and Care Excellence (NICE) (2020). The NICE review concluded that studies investigating the benefits or adverse effects of GnRH analogs (puberty blockers) were of “very low certainty using modified GRADE.” They noted that any outcome differences that were found could have represented changes of “questionable clinical value,” or, as the studies themselves were “not reliable,” could have been “due to confounding, bias or chance.” They suggest that if controlled studies are not possible, then reliable comparative studies are required.…”

Consenso sobre incongruencia/disforia de género

“…Si bien el objetivo principal de este consenso no comprende el manejo de los individuos con incongruencia/disforia de género menores de edad, se destinó un apartado especial en tres temas esenciales en este grupo etario: 1) Criterios para uso de bloqueadores de la pubertad, los cuales fueron obtenidos de la revisión de literatura realizada por Rew et al (13) en 2021, 2) Criterios para el inicio de la terapia hormonal cruzada reportados y obtenidos de Edwards-Leeper et al (14) y 3) El algoritmo de manejo para abordaje del recién nacido con genitales atípicos-asignación de sexo certero (figura 1), el cual fue tomado del libro "Disforia de género" en su capítulo "Cómo abordar la inconformidad/ incongruencia de género relacionado con la salud sexual en niños, niñas y adolescentes", escrito por Chahín (15).…”

Parental consent and the treatment of transgender youth: the impact ofRe Imogen

“…Access to timely gender-affirming care is associated with improved mental health outcomes and overall wellbeing. 17,18 The erosion of the concept of Gillick competency diminishes the personal autonomy and agency of trans youth and directly affects their ability to access this care.…”