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Transgender teens may benefit from hormonal treatment
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Providing hormonal treatment for transgender adolescents is effective for successful attainment of desired physical outcomes and generally improves psychological functioning; however, available evidence is of low quality.
Additionally, the influence that these treatments have on psychosocial and cognitive outcomes are inadequately researched, according to Kenneth Pang, MBBS, BMedSc, FRACP, PhD, of the department of pediatrics and psychiatry at the University of Melbourne Medical School, Parkville, Australia, Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, and the inflammation division at the Walter and Eliza Hall Institute of Medical Research, and colleagues.
“We saw that estrogen and testosterone successfully resulted in physical feminization and masculinization, but their psychological impact and long-term physical effects still require more study,” Pang told Infectious Diseases in Children. “Our review also confirmed that puberty blockers achieved their intended effect of suppressing further pubertal development and were associated with improvement across multiple psychological areas.”
To assess available evidence on transgender adolescents’ physical, psychosocial and cognitive outcomes related to treatment with gonadotropin-releasing hormone analogs (GnRHa), gender-affirming hormones, antiandrogens and progestins, the researchers conducted an systematic review of studies published between Jan. 1, 1946, and June 10, 2017. All studies included were primary studies that explored psychosocial, cognitive and/or physical effects of hormonal treatments in transgender teenagers.
The analysis was completed by two researchers who independently screened for eligible studies and collected data using a consistent recording process.
Of the 13 studies that were included in the analysis, treatments included GnRHas (n = 9), estrogen (n = 3), testosterone (n = 5), antiandrogen (cyproterone acetate; n = 1) and progestin (lynestrenol; n = 1). Treatment with GnRHas and cyproterone was generally successful in suppressing sex hormones, and estrogen spurred feminine secondary sex characteristics. Testosterone treatment also was associated with successful masculinization of secondary sex characteristics.
Although treatment with GnRHas was linked to improved psychological functioning on multiple levels, it did not improve gender dysphoria as an independent symptom. Pang and colleagues note that the use of gender-affirming hormones in transgender adolescents has not been adequately studied to determine the treatments’ psychosocial effects.
“This result was not surprising since we know that some of the core symptoms of gender dysphoria relate to an individual’s desire to look like and be treated as the other gender, and puberty blockers alone cannot achieve this,” Pang said. “The team is now undertaking a 20-year longitudinal study into transgender youth called ‘Trans20.’ This study will help us to learn more about the long-term psychological and physical impact of these hormones and should ultimately help guide our clinical practice in this relatively new, but rapidly growing, field of health care.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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