Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review

Abstract

BackgroundTreatment to suppress or lessen effects of puberty are outlined in clinical guidelines for adolescents experiencing gender dysphoria/incongruence. Robust evidence concerning risks and benefits is lacking and there is a need to aggregate evidence as new studies are published.AimTo identify and synthesise studies assessing the outcomes of puberty suppression in adolescents experiencing gender dysphoria/incongruence.MethodsA systematic review and narrative synthesis. Database searches (Medline, Embase, CINAHL, PsycINFO, Web of Science) were performed in April 2022, with results assessed independently by two reviewers. An adapted version of the Newcastle-Ottawa Scale for cohort studies was used to appraise study quality. Only moderate-quality and high-quality studies were synthesised. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were used.Results11 cohort, 8 cross-sectional and 31 pre-post studies were included (n=50). One cross-sectional study was high quality, 25 studies were moderate quality (including 5 cohort studies) and 24 were low quality. Synthesis of moderate-quality and high-quality studies showed consistent evidence demonstrating efficacy for suppressing puberty. Height increased in multiple studies, although not in line with expected growth. Multiple studies reported reductions in bone density during treatment. Limited and/or inconsistent evidence was found in relation to gender dysphoria, psychological and psychosocial health, body satisfaction, cardiometabolic risk, cognitive development and fertility.ConclusionsThere is a lack of high-quality research assessing puberty suppression in adolescents experiencing gender dysphoria/incongruence. No conclusions can be drawn about the impact on gender dysphoria, mental and psychosocial health or cognitive development. Bone health and height may be compromised during treatment. More recent studies published since April 2022 until January 2024 also support the conclusions of this review.PROSPERO registration numberCRD42021289659.

Critically Appraising the Cass Report: Methodological Flaws and Unsupported Claims

“…Seven systematic reviews were commissioned by the Cass Report and published in the BMJ Archives of Disease in Childhood [2][3][4][5][6][7][8] with a single systematic review protocol registered in PROSPERO for all seven reviews 9 . To evaluate their risk of bias we applied the ROBIS tool 10 as recommended by Cochrane 11,12 .…”

Guidelines on gender related treatment flouted standards and overlooked poor evidence, finds Cass review

“…The research carried out by York University, published in the Archives of Disease in Childhood , found that the evidence on the use of puberty blockers and hormones in young people with gender related distress was wholly inadequate, making it impossible to gauge their effectiveness or their effects on mental and physical health 4567. “No conclusions can be drawn about the impact on gender dysphoria, mental and psychosocial health, or cognitive development,” the research concluded.…”

The Cass review: an opportunity to unite behind evidence informed care in gender medicine

“…That verdict is supported by a series of review papers published in Archives of Disease in Childhood , a journal published by BMJ and the Royal College of Paediatrics and Child Health (doi:10.1136/archdischild-2023-326669 doi:10.1136/archdischild-2023-326670 doi:10.1136/archdischild-2023-326499 doi:10.1136/archdischild-2023-326500). 3456 The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider—from social transition to hormone treatment.…”