Body Dissatisfaction and Mental Health Outcomes of Youth on Gender-Affirming Hormone Therapy

Abstract

OBJECTIVES: Our first aim was to examine baseline differences in body dissatisfaction, depression, and anxiety symptoms by gender, age, and Tanner (ie, pubertal) stage. Our second aim was to test for changes in youth symptoms over the first year of receiving gender-affirming hormone therapy. Our third aim was to examine potential differences in change over time by demographic and treatment characteristics. Youth experiences of suicidal ideation, suicide attempt, and nonsuicidal self-injury (NSSI) are also reported.

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

“…We reported a range of adverse events previously described to be associated with pubertal 10 and 18 years and were followed until eligible to commence cross-sex hormones, 5 (3.6%) ceased treatment and did not later commence cross-sex hormones. [19] 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.…”

“…Follow-up of the Kuper et al cohort found non-significant changes in depression and anxiety scores in those (n=25) who had only pubertal suppression treatment, although improvements were seen in the whole sample combining these with those receiving cross-sex hormones. [17] A second US cohort reported that in 23 young people who had received pubertal suppression (using GnRHa or anti-androgens in birth-registered males and either GnRHa or medroxyprogesterone in birth-registered females), there was a reduction in depression scores in birth-registered males but not females.…”

“…Our finding that 1 participant ceased pubertal suppression and did not commence cross-sex hormones is somewhat similar to the experience of one US cohort and a second Dutch cohort; Kuper et al described that 2 of approximately 57 young people aged 10-15 years who commenced pubertal suppression treatment stopped this treatment without commencing cross-sex hormones. [17] Brik et al reported that in a cohort of 137 young people who began GnRHa between 10 and 18 years and were followed until eligible to commence cross-sex hormones, 5 (3.6%) ceased treatment and did not later commence cross-sex hormones. [19]…”

“…[4] Longer-term follow-up data on pubertal suppression in GD are limited to individuals from four cohorts. [14][15][16][17][18][19] In 2011 a study was begun to evaluate the proximal outcomes of mid-pubertal suppression using GnRHa in young people with persistent GD (see http://gids.nhs.uk/our-early-intervention-study).…”

Challenges in Timing Puberty Suppression for Gender-Nonconforming Adolescents

“…So far, researchers of the limited follow-up studies after puberty suppression show that the rate of adolescents that stop the reversible blockers is low (1.4%, 1.9%, and 3.5%). 4,12,13 However, systematic studies on the rate of adolescents who discontinue their transitions after they have started affirming hormones or surgeries with lasting effects are lacking at present. Given these uncertainties, providing early medical treatment to transgender adolescents remains a challenging area to work in.…”