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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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Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in adolescent girls having both reproductive and metabolic implications. Patients with PCOS typically present to their pediatrician for evaluation of menstrual irregularity and/or signs of hyperandrogenism, such as hirsutism and acne. The diagnosis of PCOS is made by clinical symptoms and laboratory evaluation. Because of the long-term health consequences that can accompany the disorder, pediatricians should consider PCOS in their initial evaluation of menstrual irregularity. Lifestyle modification is the cornerstone of treatment for girls with PCOS, however hormonal medication such as oral contraceptive pills and insulin sensitizing agents are useful and effective adjuncts to therapy. The goals of treatment for girls with PCOS are to improve clinical manifestations of the disorder, health-related quality of life, and long-term health outcomes.