Most transgender adolescents continue to use gender-affirming hormones in adulthood
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Most transgender adolescents who used pubertal blockers and were later prescribed gender-affirming hormone therapy in the Netherlands continued to use hormones as adults, according to data published in The Lancet Child & Adolescent Health.
“Puberty blockers play an important role in postponing puberty in adolescents with gender identity issues,” Marianne van der Loos, MD, a researcher in endocrinology at Amsterdam University Medical Centers, told Healio. “Our study showed that almost all youngsters who started with sex hormone treatment after a period of using puberty blockers and psychological care continue to use them.”
Van der Loos and colleagues analyzed data from the Amsterdam Cohort of Gender dysphoria of adolescents younger than 18 years who visited the gender identity clinic at Amsterdam University Medical Centers and used a gonadotropin-releasing hormone agonist for a minimum of 3 months prior to starting gender-affirming HT. Use of ongoing gender-affirming HT was identified through a prescription at the end of the study period on Dec. 31, 2018. Prescriptions were identified through the clinic’s prescription registry or through data from Statistics Netherlands, which contains information from all drug prescriptions reimbursed by basic health insurance. Researchers conducted multivariable analysis to assess whether certain variables increased one’s risk for having no active gender-affirming HT prescription in adulthood.
There were 720 people included in the study, of whom 69% were assigned female at birth. Median duration of gender-affirming HT at the conclusion of the study was 3.5 years for people assigned male at birth and 2.3 years for those assigned female at birth.
Of the study cohort, 98% had a prescription for gender-affirming HT consistent with their affirmed gender at the end of the study period. There were 16 people with no prescription for HT, of whom nine were assigned male at birth and seven assigned female at birth. Of those with no active prescription for gender-affirming HT, 75% had undergone a gonadectomy.
In multivariable analysis, there were no variables associated with the likelihood of continuing to receive gender-affirming HT. There were also no associations observed in univariable models that included additional patients who were externally referred and began medical treatment at another clinic.
Van der Loos said the findings were reassuring considering recent increases in public concern about regret of transition. Researchers were not surprised by the findings, however, according to van der Loos, as transgender adolescents treated at the clinic went through a diagnostic process and were consulted by a mental health professional before and during the start of treatment.
Van der Loos said more research is needed on the effects of gender-affirming HT among adolescents.
“The reasons to why people possibly stop gender-affirming hormones should be studied,” van der Loos said. “Additionally, long-term effects of this combined approach with puberty suppression and gender-affirming hormones should be focused on as well, for example, regarding the long-term effects on bone health.”
For more information:
Marianne van der Loos, MD, can be reached at m.vanderloos@amsterdamumc.nl.
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In recent years, the prevalence of transgender youths has increased, leading to more families seeking care. Based on a recent survey, 1.4% of adolescents in the U.S. identified as transgender. Gender-affirming care is associated with improved quality of life and mental health and lower rates of suicide. Gender affirming care of adolescents often progresses directly from pubertal suppression with gonadotropin-releasing hormone agonists to gender-affirming hormone therapy.
Van der Loos and colleagues investigate the percentage of individuals who carry on with gender-affirming hormones into adulthood within a cohort of 720 transgender individuals who started gonadotropin-releasing hormone agonists at age younger than 18 years. At follow-up, 98% still had active prescriptions for gender-affirming hormones. Of the 16 without active prescriptions for gender-affirming hormones, 12 underwent gonadectomy. It was not determined why the 2% discontinued gender-affirming hormones. However, discontinuation may not necessarily be due to regret. There was a trend toward discontinuation of gender-affirming hormones with older age at first visit, start of gonadotropin-releasing hormone agonist treatment and start of gender-affirming hormones. However, the associations were not statistically significant.
The rate of continued gender-affirming hormone use into adulthood in this study is higher than previously reported, and the authors acknowledge their thorough diagnostic process before gonadotropin-releasing hormone agonists and gender-affirming HT. This underscores the importance of mental health services in collaboration with medical therapy.
Their finding conveys persistence of gender identity over time and is notably reassuring against the current backdrop of growing public concern over future regret of gender-affirming hormones. Further studies are needed to determine factors associated with discontinued gender-affirming hormones.
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