ESPE Yearbook of Paediatric Endocrinology

Brief summary: Concerns exist that transgender adolescents opting for gender affirming treatments may subsequently regret their decision. This large study from Amsterdam provides information that in early adulthood, 98% of their cohort continued to access these treatments.

The Amsterdam Cohort of Gender Dysphoria is one of the largest ongoing studies on the long-term outcomes of gender affirming hormone treatments (GAH). The authors presented outcomes at a mean age of 20.2 years on 720 transadolescents (69% birth-registered female) starting GnRHa at 14.1 yr in the transgirls and 16.0 yrs in the transboys. All subsequently moved on to GAH. The authors report a very high proportion continuing to access GAH as adults. The continued GAH use was not associated with age at first clinic visit, nor was age at start of GnRHa treatment, age at start of GAH treatment, nor puberty stage at start of GnRHa treatment, nor whether gonadectomy had been performed.

Butler et al. reported the status of access to treatment and transgender identification in 1089 young adults at the time of discharge from child and adolescent services in England (1). 92% continued to identify as transgender or gender variant, 87% seeking ongoing care through National Health Service adult gender identity clinics. 2.9% ceased identifying as transgender after an initial consultation prior to any endocrine intervention and 5.3% had stopped treatment either with GnRHa or GAH, a higher proportion in those starting interventions under 16 years of age compared with those over 16 years. Using a different approach, Roberts et al. examined medical records from the US Military Healthcare System and found that at a mean age of 19.2 years, the 4 year GAH continuation rate in 627 trans males and 325 trans females was 70%, but with a higher continuation rate in those initially starting treatment under 18 years (74%) compared with adult starts (64%), a finding in contrast to that of the UK study (2). An additional retrospective report from the US Military Healthcare System of 434 transadolescents, mean age 15.4 years, found no increased use of GAH in those initially starting with GnRHa interventions (3).

References: 1. Butler G, Adu-Gyamfi K, Clarkson K, El Khairi R, Kleczewski S, Roberts A, Segal TY, Yogamanoharan K, Alvi S, Amin N, Carruthers P, Dover S, Eastman J, Mushtaq T, Masic U, Carmichael P. Discharge outcome analysis of 1089 transgender young people referred to paediatric endocrine clinics in England 2008–2021. Arch Dis Child. 2022 Jul 18:archdischild-2022-324302. doi:10.1136/archdischild-2022-324302. Epub ahead of print. PMID: 35851291. 2. Roberts CM, Klein DA, Adirim TA, Schvey NA, Hisle-Gorman E. Continuation of Gender-affirming Hormones Among Transgender Adolescents and Adults. J Clin Endocrinol Metab. 2022 Aug 18;107(9):e3937–e3943. doi: 10.1210/clinem/dgac251. PMID: 35452119. 3. Nos AL, Klein DA, Adirim TA, Schvey NA, Hisle-Gorman E, Susi A, Roberts CM. Association of gonadotropin-releasing hormone analogue use with subsequent use of gender-affirming hormones among transgender adolescents. JAMA Netw Open. 2022 Nov 1;5(11):e2239758. doi: 10.1001/jamanetworkopen.2022.39758. PMID: 36318207; PMCID: PMC9627413.