ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This retrospective cohort study compared Youth Self-Report (YSR) scores at their hormone readiness assessment, before the start of gender-affirming sex hormone treatment, between 40 transgender adolescents, who had received puberty suppression from Tanner stage 2-3, and 398 transgender adolescents who had not received puberty suppression. In multivariate analyses adjusting for gender, and using a sensitivity analysis restricted to 13–15-year-olds, the group with puberty suppression showed lower scores for total problems, internalizing problems, depression problems, anxiety problems and stress problems.

Current guidelines recommend puberty suppression with GnRH analogues as an initial treatment for eligible transgender and gender diverse adolescents to prevent the development of unwanted secondary sex characteristics, and thereby improve wellbeing. In many studies of GnRH analogue treatment, only a minority started treatment in early puberty, when irreversible changes such as voice breaking and breast development can still be prevented. The current study included a relatively large number of adolescents who had started GnRH analogue treatment in early puberty (Tanner stage 2 or 3). This treated group had better psychological outcomes compared to adolescents who did not receive puberty suppression.

Although the cross-sectional design does not allow causal inference, and groups may have differed in factors that caused earlier presentation for GnRH analogue treatment in the treated group, the positive impact of GnRH analogue treatment is supported by another recent study. Fisher et al., in a longitudinal study of 36 adolescents, also found improved YSR total, internalizing and depression and anxiety scores after the start of GnRH analogue treatment (1). These findings are in line with previous findings of less internalizing problems in adolescents treated with GnRH analogue treatment (2, 3), although not confirmed in all studies (4).

References: 1. Fisher AD, Ristori J, Romani A, Cassioli E, Mazzoli F, Cocchetti C, Pierdominici M, Marconi M, Ricca V, Maggi M, Vignozzi L, Castellini G. Back to the Future: Is GnRHa Treatment in Transgender and Gender Diverse Adolescents Only an Extended Evaluation Phase? J Clin Endocrinol Metab. 2024 May 17;109(6):1565-1579. doi: 10.1210/clinem/dgad729. PMID: 38099569.2. van der Miesen AIR, Steensma TD, de Vries ALC, Bos H, Popma A. Psychological Functioning in Transgender Adolescents Before and After Gender-Affirmative Care Compared With Cisgender General Population Peers. J Adolesc Health. 2020 Jun;66(6):699-704. doi: 10.1016/j.jadohealth.2019.12.018. Epub 2020 Apr 6. PMID: 32273193.3. de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011 Aug;8(8):2276-83. doi: 10.1111/j.1743-6109.2010.01943.x. Epub 2010 Jul 14. PMID: 20646177.4. Carmichael P, Butler G, Masic U, Cole TJ, De Stavola BL, Davidson S, et al. 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. PLoS One. 2021;16(2):e0243894