Four recent studies confirm benefits of medical transition for trans adolescents

Zinnia JonesPuberty-blocking medications are used in gender-dysphoric adolescents as a means of temporarily and reversibly inhibiting an undesired natal puberty. In the event that their dysphoria desists, the medication can be discontinued, and their natal puberty will resume; if their dysphoria persists, this treatment allows them to avoid the unwanted masculinization or feminization associated with natal puberty, instead undergoing an induced puberty with cross-sex hormone therapy. Since the advent of this protocol in the early 1990s, the use of puberty blockers and hormone therapy in trans adolescents has repeatedly been shown to provide substantial benefits to these youth:

  • Cohen-Kettenis & van Goozen (1997) studied 15 trans men and 7 trans women who had undergone treatment with puberty blockers and cross-sex hormones in adolescence, followed by gender-affirming surgery. With an average followup time of 4.5 years, this cohort showed a decrease of gender dysphoric symptoms into the range of cisgender controls, an increase in satisfaction with primary and secondary sex characteristics, and increases in extroversion and self-esteem. There were no reports of regret of transitioning.
  • Smith, van Goozen, & Cohen-Kettenis (2001) studied 13 trans men and 7 trans women who received puberty blockers followed by cross-sex hormones in adolescence, and later underwent gender-affirming surgery. At an average followup of 4.4 years, this group showed a significant decrease in gender dysphoria, along with increased body satisfaction and psychological functioning comparable to cisgender controls. Again, there were no reports of regret.
  • de Vries et al. (2011) studied 37 trans men and 33 trans women, comparing their mental and emotional health before starting puberty blockers, and after starting puberty blockers but before starting HRT. After an average of almost two years on puberty blockers, the subjects had a significant decrease in depressive symptoms and both internalizing and externalizing emotional and behavioral problems, while experiencing a significant increase in global functioning scores. No significant changes were exhibited for measures of gender dysphoria or body image. de Vries et al. (2014) continued to study 33 trans men and 22 trans women from this cohort following the initiation of HRT and receiving gender-affirming surgery, at which point they reported the remission of gender-dysphoric symptoms and improvements in body satisfaction. There were no reports of regret.

Despite decades of consistently positive results for trans youth undergoing this treatment as well as the endorsement of numerous professional endocrinology organizations, medical transition for adolescents has continued to be a point of public controversy, with several state legislatures attempting to outlaw providing this care to minors. Adolescent transition has variously been maligned as an arbitrary and impulsive choice (it’s not), something that youth can’t possibly offer meaningful consent to (they can), and even as a method of anti-gay conversion therapy (it isn’t). Over the past several months, four additional studies of trans youth have further contributed to the body of consistent evidence for these denialists to ignore or dismiss:

  • Allen et al. (2019) studied 47 trans youth before and after receiving hormone therapy at Children’s Mercy Hospital of Kansas City. This group showed a significant increase in general well-being scores and a significant decrease in suicidality. Additionally, those who had received puberty blockers for some time prior to hormone therapy ultimately reported even lower suicidality than those who had not previously received puberty blockers, possibly because those already receiving puberty blockers began receiving treatment at a younger age.
  • van der Miesen et al. (2020) compared the psychological health of 272 adolescents who had been referred for assessment for gender dysphoria at Amsterdam’s VU University Medical Center and had not yet received puberty blockers or hormones, and 178 adolescents who had been diagnosed with gender dysphoria and were taking puberty blockers but had not started hormone therapy. Those who hadn’t received any treatment had higher scores on measures of internalizing problems, suicidality, and problems with peer relations than the group receiving puberty blockers and a group of cis controls. However, the group taking puberty blockers showed no differences in self-harm or suicidality compared to the cis control group, and even scored lower than cis controls for internalizing problems.
  • López de Lara et al. (2020) studied 23 trans youth aged 14 to 18 attending the San Carlos Clinical Hospital of Madrid before and after receiving one year of hormone therapy. At the end of a year of treatment, this group showed a significant decline of gender dysphoria as measured by the Utrecht Gender Dysphoria Scale, decreasing from the clinical range into the nonclinical range after treatment. They also exhibited significant decreases in their emotional symptoms, hyperactivity symptoms and behavior problems, and increases in prosocial behavior. While they experienced a significant decrease in depressive symptoms as well as trait and state anxiety, their levels of these symptoms were still higher than those of cisgender controls.
  • Achille et al. (2020) surveyed 50 trans youth receiving treatment at the Stony Brook University Pediatric Endocrine department from 2013 to 2018, evaluating their depression, suicidal ideation, and quality of life at three points in time, extending to one year after any endocrine intervention (puberty blockers or hormone therapy). This group showed a significant decrease of depressive symptoms into the nonclinical range over time, as well as nonsignificant trends toward lower levels of suicidal ideation and greater quality of life. Because this study is ongoing, these results are only preliminary.

Each of these studies shows the kind of evidence we would expect to see if medical transition is indeed beneficial for appropriately evaluated and diagnosed gender-dysphoric adolescents, and we would not expect to see evidence such as this if transition treatment in adolescence had harmful effects. A recent abstract by Sorbara et al. (2020), along with an accompanying thesis by Sorbara (2019), also found that youth who presented for treatment at a gender clinic at an older age or later stage of puberty experienced worse mental health than those who sought treatment at a younger age.

Treatment in adolescence helps trans youth, and earlier access to treatment appears to maximize those benefits. Researchers have now reported nearly 30 years of clinical experience with the use of puberty blockers to treat trans youth – as Giordano & Holm (2020) note, “the puberty delaying efficacy of GnRHa in adolescents with severe gender dysphoria is well evidenced and not experimental.”

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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