GnRHa use not linked to increased gender-affirming hormone use by transgender youths
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Gonadotropin-releasing hormone analogue use was not associated with increased use of subsequent gender-affirming hormones among transgender and gender-diverse youths, according to a retrospective cohort study published in JAMA Network Open.
“In the United Kingdom, a court ruled that gonadotropin-releasing hormone analogue treatment could not be administered to transgender patients younger than 16 years without a court order because they assert that this treatment inevitably leads to use of gender-affirming hormones. This ruling also suggested that gender-affirming care for patients aged 16 and 17 years old should be restricted as well,” Andrea L. Nos, MD, clinical assistant professor in the department of pediatrics at the University of Missouri-Kansas City School of Medicine and the division of adolescent medicine at Children’s Mercy Kansas City, Missouri, and colleagues wrote. “In the U.S., three states have outlawed all gender-affirming medical care for minors, one state government has taken administrative action to classify gender-affirming medical care for minors as child abuse and 16 state public medical insurance programs for those with limited income or resources do not pay for gender-affirming medical care. An additional 19 state legislatures are considering laws to make some or all aspects of gender-affirming medical care for minors illegal.”
Researchers conducted a retrospective cohort study collecting administrative records of 434 patients (mean age, 15.4 years; 71.9% girls) between 2009 and 2018. All participants were enrolled in the U.S. Military Health System with an initial transgender and gender-diverse-related encounter from age 10 to 17 years.
Gonadotropin-releasing hormone analogue (GnRHa) use was most common among patients who were assigned male at birth compared with patents who were assigned female at birth (23% vs. 13.5%). However, gender-affirming hormone use was not. In addition, socioeconomic status was not associated with GnRHa or gender-affirming hormone use.
Patients who were aged 10 to 13 years at the time of their initial transgender and gender-diverse-related encounter experienced a higher rate of GnRHa use (57.1% vs. 10.1%) compared with patients aged 14 to 17 years. These patients also experienced a longer median time to starting gender-affirming hormone use.
In addition, researchers observed a decrease in the median time from the initial encounter to beginning gender-affirming hormones, from 2.3 years between October 2009 and December 2014 to 0.5 years between September 2016 and April 2018. Those prescribed GnRHa experienced a longer median time to gender-affirming hormone initiation compared with patients who were not prescribed GnRHa (1.8 vs. 1 years). Patients prescribed GnRHa were also less likely to initiate gender-affirming hormones during the 6 years after their first transgender gender-diverse-related encounter (HR = 0.52; 95% CI, 0.37-0.71).
When assessing the 54 patients aged 10 to 13 years who were ineligible to begin gender-affirming hormones at their initial encounter, GnRHa use was associated with a longer median time to initiating gender-affirming hormones. However, age at initial encounter was not associated with a longer median time.
“These data suggest that clinicians can offer the benefits of GnRHa treatment to transgender and gender-diverse youths with gender dysphoria without concern for unduly or inappropriately increasing rates of subsequent gender-affirming hormone use,” the researchers wrote.
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