Puberty Suppression in Adolescents With Gender Identity Disorder: A Prospective Follow-Up Study

Abstract

Introduction Puberty suppression by means of gonadotropin-releasing hormone analogues (GnRHa) is used for young transsexuals between 12 and 16 years of age. The purpose of this intervention is to relieve the suffering caused by the development of secondary sex characteristics and to provide time to make a balanced decision regarding actual gender reassignment. Aim To compare psychological functioning and gender dysphoria before and after puberty suppression in gender dysphoric adolescents. Methods Of the first 70 eligible candidates who received puberty suppression between 2000 and 2008, psychological functioning and gender dysphoria were assessed twice: at T0, when attending the gender identity clinic, before the start of GnRHa; and at T1, shortly before the start of cross-sex hormone treatment. Main Outcome Measures Behavioral and emotional problems (Child Behavior Checklist and the Youth-Self Report), depressive symptoms (Beck Depression Inventory), anxiety and anger (the Spielberger Trait Anxiety and Anger Scales), general functioning (the clinician's rated Children's Global Assessment Scale), gender dysphoria (the Utrecht Gender Dysphoria Scale), and body satisfaction (the Body Image Scale) were assessed. Results Behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression. Feelings of anxiety and anger did not change between T0 and T1. While changes over time were equal for both sexes, compared with natal males, natal females were older when they started puberty suppression and showed more problem behavior at both T0 and T1. Gender dysphoria and body satisfaction did not change between T0 and T1. No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment. Conclusion Puberty suppression may be considered a valuable contribution in the clinical management of gender dysphoria in adolescents.

Beyond Discrete Categories: Studying Multiracial, Intersex, and Transgender Children Will Strengthen Basic Developmental Science

“…On the one hand, if these children will desist in their behaviors and identities anyway, some argue, why not try to make that behavior desist earlier (e.g., Meyer-Bahlburg, 2002) and therefore reduce anxiety and/or peer maltreatment that results from the gender nonconformity (Wilson, Griffin, & Wren, 2005)? On the other hand, if a gender-nonconforming child is highly likely to be a transgender adult, one might suggest providing familial (Hidalgo et al, 2013) and medical (de Vries, Steensma, Doreleijers, & Cohen-Kettenis, 2011) support, especially given that both have been linked to better mental health among transgender adults (e.g., de Vries et al, 2011;Hill, Menvielle, Sica, & Johnson, 2010;Olson, Durwood, DeMeules, & McLaughlin, 2016). Thus, increasing the ability to identify which children will (or will not) identify as transgender adults is of utmost importance.…”

Psychological and Medical Care of Gender Nonconforming Youth

“…43 The benefits of pubertal blockers have been demonstrated in a follow-up study of GN adolescents who had improved scores on scales assessing behavioral and emotional problems, depressive symptoms, and general functioning after treatment with such medications. 44 Another benefit of pubertal suppression, especially when initiated at earlier Tanner stages, is prevention of full maturation of endogenous secondary sexual characteristics. Some gender specialists purport that this approach enhances being able to present and be perceived in accordance with one' s affirmed gender after going on to receive cross-sex hormones and/ or gender-affirming surgery later.…”

Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment

“…12 Puberty suppression is only started after the adolescent actually enters the first stages of puberty (Tanner stages 2-3), because although in most prepubertal children GD will desist, onset of puberty serves as a critical diagnostic stage, because the likelihood that GD will persist into adulthood is much higher in adolescence than in the case of childhood GD. 15,16 Despite the apparent usefulness of puberty suppression, there is only limited evidence available about the effectivenessofthisapproach.Inthefirstcohort of adolescents who received GnRHa, we demonstrated an improvement in several domains of psychological functioning after, on average, 2 years of puberty suppression while GD remained unchanged. 16 The current study is a longerterm evaluation of the same cohort, on average, 6 years after their initial presentation at the gender identity clinic.…”

“…15,16 Despite the apparent usefulness of puberty suppression, there is only limited evidence available about the effectivenessofthisapproach.Inthefirstcohort of adolescents who received GnRHa, we demonstrated an improvement in several domains of psychological functioning after, on average, 2 years of puberty suppression while GD remained unchanged. 16 The current study is a longerterm evaluation of the same cohort, on average, 6 years after their initial presentation at the gender identity clinic. This time, we were not only interested in psychological functioning and GD, but added as important outcome measures objective and subjective well-being (often referred to as "quality of life"), that is, the individuals'social life circumstances and their perceptions of satisfaction with life and happiness.…”