Search Results for: puberty blockers

One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria.

Medical transition, Mental health, Pre-teens, Puberty blockers
One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria. Expand
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One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria.

A British study [1] found that puberty blockers used to treat children aged 12 to 15 who have severe and persistent gender dysphoria had no significant effect on their psychological function, thoughts of self-harm, or body image.

However, as expected, the children experienced reduced growth in height and bone strength by the time they finished their treatment at age 16.

REFERENCES

[1] Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., Skageberg, E. M., Khadr, S., & Viner, R. M. (2021). Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLOS ONE 16 (2). [Link]

Medical transition
Mental health
PRE-TEENS
PUBERTY BLOCKERS

Puberty blockers and cross-sex hormones negatively impact bone health in a significant number of cases.

Medical transition, Pre-teens, Puberty blockers
Puberty blockers and cross-sex hormones negatively impact bone health in a significant number of cases. Expand
Download as PDFDownload
Puberty blockers and cross-sex hormones negatively impact bone health in a significant number of cases.

There is little long-term evidence on bone mass density in relation to puberty blockers. However, in a significant minority of cases of long-term puberty suppression related to gender identity, bone mass density scores qualify as “low for age” [1]. Low bone mass density increases risk of osteoporosis and fractures.

Adolescents who enter puberty at an older age have persistently lower bone mass density than their peers [2]: in one case study [3], an adolescent had a bone mass density -2 standard deviations below the mean after three years of blocking puberty.

It has also been noted [4] that:

In early-pubertal transgender youth, BMD [bone mass density] was lower than reference standards for sex designated at birth. This lower BMD may be explained, in part, by suboptimal calcium intake and decreased physical activity–potential targets for intervention.

Bone metabolism is also decreased as a result of taking cross-sex hormones, for both males and (in later life) females [5].

REFERENCES

[1] Biggs, M. (2021). Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria. Journal of Pediatric Endocrinology and Metabolism 34 (7): 937-939. [Link]

[2] Elhakeem, A., Frysz, M., Tilling, K., Tobias, J.H. & Lawlor, D.A. (2019). Association Between Age at Puberty and Bone Accrual From 10 to 25 Years of Age. JAMA Netw Open; 2(8). [Link]

[3] Pang, K.C., Notini, L., McDougall, R., Gillam, L., Savulescu, J., Wilkinson, D., Clark, B.A., Olson-Kennedy, J., Telfer, M.M. & Lantos, J.D. (2020). Long-term Puberty Suppression for a Nonbinary Teenager. Pediatrics 145 (2). [Link]

[4] Lee, J. Y., Finlayson, C., Olson-Kennedy, J., Garofalo, R., Chan, Y. M., Glidden, D. V., & Rosenthal, S. M. (2020). Low Bone Mineral Density in Early Pubertal Transgender/Gender Diverse Youth: Findings From the Trans Youth Care Study. Journal of the Endocrine Society 4 (9). [Link]

[5] Vlot, M.C., Wiepjes, C.M., de Jongh, R.T., T’Sjoen, G., Heijboer, A.C. & den Heijer, M. (2019). Gender-Affirming Hormone Treatment Decreases Bone Turnover in Transwomen and Older Transmen. J Bone Miner Res, 34: 1862-1872. [Link]

Medical transition
PRE-TEENS
PUBERTY BLOCKERS

Puberty blockers

  • Puberty blockers are more than a ‘pause button’: roughly 98% of children who take them go on to take cross-sex hormones. Expand
    Download as PDFDownload
    Puberty blockers are more than a ‘pause button’: roughly 98% of children who take them go on to take cross-sex hormones.

    A 2021 study from the UK [1] found that only 1 out of 44 children placed on puberty blockers did not continue to take cross-sex hormones.

    Similarly, a Dutch study [2] reported that only 1.9% of adolescents who started puberty suppression treatment abandoned this course and did not take cross-sex hormones.

    In fact, in a different Dutch study [3], “[n]o adolescent withdrew from puberty suppression, and all started cross‐sex hormone treatment, the first step of actual gender reassignment.”

    Puberty blockers are drugs which change young bodies in ways we have yet to understand, and may be permanent. This is an experimental treatment program: puberty blockers have never been licensed to treat children with gender dysphoria, in any country.

    REFERENCES

    [1] Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., Skageberg, E. M., Khadr, S., & Viner, R. M. (2021). Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLOS ONE 16 (2). [Link]

    [2] Wiepjes, C.M., Nota, N.M., de Blok, C.J.M., Klaver, M., de Vries, A.L.C., Wensing-Kruger, S.A., de Jongh, R.T., Bouman, M.B., Steensma, T.D., Cohen-Kettenis, P., Gooren, L.J.G., Kreukels, B.P.C. & den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. Journal of Sexual Medicine 15 (4). [Link]

    [3] de Vries, A.L.C., Steensma, T.D., Doreleijers, T.A. & Cohen-Kettenis, P.T. (2011). Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 8 (8): 2276-83. [Link]

    Hormones
    Medical transition
    Pre-teens
    Puberty blockers
    Teenagers

  • There is limited evidence that medical transition leads to positive outcomes. Expand
    Download as PDFDownload
    There is limited evidence that medical transition leads to positive outcomes.

    A number of different studies have noted the paucity of good quality evidence for transition.

    An Australian paper [1] states that most available evidence indicating positive outcomes for gender reassignment is of poor quality.

    A German study [2] “found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition”, adding that “[t]his lack of studies shows a gap between current clinical practice and clinical research.”

    A British review [3] conducted by the National Institute for Health and Care Excellence (NICE) graded certainty of evidence for puberty blocker use as “very low” in every category, including impact on gender dysphoria, mental health, body image, global functioning, psychosocial functioning, cognitive functioning, bone density and adverse effects.

    A chapter [4] in an edited volume details the low evidence base for treatment pathways employed at the UK’s Gender Identity Development Service, demonstrating how negative evidence was “ignored or suppressed”.

    Finally, a systematic review [5] commissioned by the World Professional Association for Transgender Health (WPATH) to “systematically review the effect of gender-affirming hormone therapy on psychological outcomes among transgender people” noted that, in some areas, there was low quality or insufficient evidence.

    REFERENCES

    [1] D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry 26 (5): 460-463. [Link]

    [2] Haupt, C., Henke, M., Kutschmar, A., Hauser, B., Baldinger, S., Saenz, S.R. & Schreiber, G. (2020). Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women. Cochrane Database of Systematic Reviews 11. [Link]

    [3] National Institute for Health and Care Excellence (2021). Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria. National Institute for Health and Care Excellence (NICE); NHS England; NHS Improvement. [Link]

    [4] Biggs, M. (2019). The Tavistock’s Experiment with Puberty Blockers. In: Moore, M. & Brunskell-Evans, H. (eds.). Inventing Transgender Children and Young People. Cambridge Scholars Publishing. [Link]

    [5] Baker, K.E., Wilson, L.M., Sharma, R., Dukhanin, V., McArthur, K. & Robinson, K.A. (2021) Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review. Journal of the Endocrine Society 5 (4). [Link]

    Hormones
    Medical transition
    Puberty blockers
    Research quality

  • There is little evidence that medical transition decreases suicidality. Expand
    Download as PDFDownload
    There is little evidence that medical transition decreases suicidality.

    When it comes to gender dysphoric children, there is little evidence that medical transition decreases suicide rates. There is little evidence to assert that puberty blockers are necessary to prevent suicide [1].

    After sex reassignment surgery, one study showed that adult transsexual clients were 4.9 times more likely to have made a suicide attempt and 19.1 times more likely to have died from suicide, after adjusting for prior psychiatric comorbidity [2]. Similarly, an Australian paper [3] notes that many patients have poor outcomes, which puts them at risk of suicide.

    A prominent study [4] claiming that medical transition alleviated suicidality had to be corrected [5], to clarify that it proved “no advantage of surgery” in this regard.

    A long-term Swedish study [6] finds that post-operative transgender people have “considerably higher risks” for suicidal behavior.

    Similarly, a study in the European Journal of Endocrinology [7] demonstrates that suicide rates among transgender male-to-females were 51% higher than the general population.

    REFERENCES

    [1] Biggs, M. (2020). Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria. Archives of Sexual Behavior (49): 2227–2229. [Link]

    [2] Zucker, K.J., Lawrence, A.A., Kreukels, B.P. (2016). Gender Dysphoria in Adults. Annu Rev Clin Psychol. 12: 217-47. [Link]

    [3] D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry 26 (5): 460-463. [Link]

    [4] Bränström, R. & Pachankis, J. E. (2019). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. American Journal of Psychiatry 177 (8): 727-734. [Link]

    [5] American Journal of Psychiatry (2020). Correction to Bränström and Pachankis. Published online: 1 August 2020. [Link]

    [6] Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., & Landén, M. (2011). ‘Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden’. PLoS ONE, 6(2). [Link]

    [7] Asscheman, H., Giltay, E. J., Megens, J. A. J., de Ronde, W., van Trotsenburg, M. A. A. & Gooren, L. J. G. (2011). A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. European Journal of Endocrinology 164 (4). [Link]

    Medical transition
    Mortality
    Puberty blockers
    Research quality
    Suicide

  • Puberty blockers and cross-sex hormones negatively impact bone health in a significant number of cases. Expand
    Download as PDFDownload
    Puberty blockers and cross-sex hormones negatively impact bone health in a significant number of cases.

    There is little long-term evidence on bone mass density in relation to puberty blockers. However, in a significant minority of cases of long-term puberty suppression related to gender identity, bone mass density scores qualify as “low for age” [1]. Low bone mass density increases risk of osteoporosis and fractures.

    Adolescents who enter puberty at an older age have persistently lower bone mass density than their peers [2]: in one case study [3], an adolescent had a bone mass density -2 standard deviations below the mean after three years of blocking puberty.

    It has also been noted [4] that:

    In early-pubertal transgender youth, BMD [bone mass density] was lower than reference standards for sex designated at birth. This lower BMD may be explained, in part, by suboptimal calcium intake and decreased physical activity–potential targets for intervention.

    Bone metabolism is also decreased as a result of taking cross-sex hormones, for both males and (in later life) females [5].

    REFERENCES

    [1] Biggs, M. (2021). Revisiting the effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria. Journal of Pediatric Endocrinology and Metabolism 34 (7): 937-939. [Link]

    [2] Elhakeem, A., Frysz, M., Tilling, K., Tobias, J.H. & Lawlor, D.A. (2019). Association Between Age at Puberty and Bone Accrual From 10 to 25 Years of Age. JAMA Netw Open; 2(8). [Link]

    [3] Pang, K.C., Notini, L., McDougall, R., Gillam, L., Savulescu, J., Wilkinson, D., Clark, B.A., Olson-Kennedy, J., Telfer, M.M. & Lantos, J.D. (2020). Long-term Puberty Suppression for a Nonbinary Teenager. Pediatrics 145 (2). [Link]

    [4] Lee, J. Y., Finlayson, C., Olson-Kennedy, J., Garofalo, R., Chan, Y. M., Glidden, D. V., & Rosenthal, S. M. (2020). Low Bone Mineral Density in Early Pubertal Transgender/Gender Diverse Youth: Findings From the Trans Youth Care Study. Journal of the Endocrine Society 4 (9). [Link]

    [5] Vlot, M.C., Wiepjes, C.M., de Jongh, R.T., T’Sjoen, G., Heijboer, A.C. & den Heijer, M. (2019). Gender-Affirming Hormone Treatment Decreases Bone Turnover in Transwomen and Older Transmen. J Bone Miner Res, 34: 1862-1872. [Link]

    Medical transition
    PRE-TEENS
    PUBERTY BLOCKERS

  • One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria. Expand
    Download as PDFDownload
    One study found that puberty blockers did not alleviate negative thoughts in children with gender dysphoria.

    A British study [1] found that puberty blockers used to treat children aged 12 to 15 who have severe and persistent gender dysphoria had no significant effect on their psychological function, thoughts of self-harm, or body image.

    However, as expected, the children experienced reduced growth in height and bone strength by the time they finished their treatment at age 16.

    REFERENCES

    [1] Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., Skageberg, E. M., Khadr, S., & Viner, R. M. (2021). Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLOS ONE 16 (2). [Link]

    Medical transition
    Mental health
    PRE-TEENS
    PUBERTY BLOCKERS

  • Medical transition puts both males and females at risk of infertility. Expand
    Download as PDFDownload
    Medical transition puts both males and females at risk of infertility.

    A wide-ranging study [1] found that gender-related drug regimens place patients at risk of infertility:

    Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear.

    On surgeries, the study noted that cross-sex surgery that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility.

    REFERENCES

    [1] Cheng, P.J., Pastuszak, A.W., Myers, J.B., Goodwin, I.A. & Hotaling, J.M. (2019). Fertility concerns of the transgender patient. Transl Androl Urol. 8 (3): 209-218. [Link]

    Hormones
    Females
    Fertility
    Males
    Medical transition
    PUBERTY BLOCKERS
    Surgery

Puberty blockers are more than a ‘pause button’: roughly 98% of children who take them go on to take cross-sex hormones.

Hormones, Medical transition, Pre-teens, Puberty blockers, Teenagers
Puberty blockers are more than a ‘pause button’: roughly 98% of children who take them go on to take cross-sex hormones. Expand
Download as PDFDownload
Puberty blockers are more than a ‘pause button’: roughly 98% of children who take them go on to take cross-sex hormones.

A 2021 study from the UK [1] found that only 1 out of 44 children placed on puberty blockers did not continue to take cross-sex hormones.

Similarly, a Dutch study [2] reported that only 1.9% of adolescents who started puberty suppression treatment abandoned this course and did not take cross-sex hormones.

In fact, in a different Dutch study [3], “[n]o adolescent withdrew from puberty suppression, and all started cross‐sex hormone treatment, the first step of actual gender reassignment.”

Puberty blockers are drugs which change young bodies in ways we have yet to understand, and may be permanent. This is an experimental treatment program: puberty blockers have never been licensed to treat children with gender dysphoria, in any country.

REFERENCES

[1] Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., Skageberg, E. M., Khadr, S., & Viner, R. M. (2021). Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLOS ONE 16 (2). [Link]

[2] Wiepjes, C.M., Nota, N.M., de Blok, C.J.M., Klaver, M., de Vries, A.L.C., Wensing-Kruger, S.A., de Jongh, R.T., Bouman, M.B., Steensma, T.D., Cohen-Kettenis, P., Gooren, L.J.G., Kreukels, B.P.C. & den Heijer, M. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. Journal of Sexual Medicine 15 (4). [Link]

[3] de Vries, A.L.C., Steensma, T.D., Doreleijers, T.A. & Cohen-Kettenis, P.T. (2011). Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 8 (8): 2276-83. [Link]

Hormones
Medical transition
Pre-teens
Puberty blockers
Teenagers

There is evidence that it is harder to sustain meaningful sexual relationships after medical transition.

Medical transition, Relationships
There is evidence that it is harder to sustain meaningful sexual relationships after medical transition. Expand
Download as PDFDownload
There is evidence that it is harder to sustain meaningful sexual relationships after medical transition.

A study [1] on informed consent found that male-to-female transitioners who are attracted to men may discover that men who are sexually interested in them are specifically interested in their trans status, and have no interest in serious long-term relationships. 

The same study noted that male-to-female transitioners who are attracted to women may find that lesbians are unwilling to engage in a sexual relationship with a male.

Because most female-to-male transitioners do not undergo phalloplasty, their ability to attract desirable sexual partners, and sustain relationships with them, could be compromised.

Only a single case [2] of a female-to-male transitioner treated with puberty blockers followed by cross-sex hormones and surgeries has feen followed long-term.

The individual, who was in his thirties during the follow up, reported an inability to have a satisfying sexual life due to “shame about his genital appearance and his feelings of inadequacy in sexual matters”. The researchers concluded, that despite the gender reassignment, “in the area of intimate relationships, it may remain difficult to find a suitable partner”.

REFERENCES

[1] Levine, S. (2018). Informed Consent for Transgendered Patients. Journal Of Sex & Marital Therapy, 45(3), 218-229. [Link]

[2] Cohen-Kettenis, P., Schagen, S., Steensma, T., de Vries, A., & Delemarre-van de Waal, H. (2011). Puberty Suppression in a Gender-Dysphoric Adolescent: A 22-Year Follow-Up. Archives Of Sexual Behavior 40 (4): 843-847. [Link]

Medical transition
Relationships

Vaginoplasty can result in fistula, stenosis, necrosis, prolapse and even death.

Males, Medical transition, Sexual function, Surgery
Vaginoplasty can result in fistula, stenosis, necrosis, prolapse and even death. Expand
Download as PDFDownload
Vaginoplasty can result in fistula, stenosis, necrosis, prolapse and even death.

Male-to-female genital surgery (vaginoplasty) is associated with significant long-term complications: there is a 2% risk of fistula, 14% risk of stenosis (abnormal narrowing), 1% risk of necrosis (tissue death) and 4% risk of prolapse [1].

One systematic review [2] found an overall complication rate of 32.5%.

A Dutch study [3] of 55 (out of an original 70) adolescents treated with puberty blockers, cross sex hormones, and genital surgery, showed that among 22 male-to-female patients who underwent vaginoplasty, one adolescent died as a result of necrotizing fasciitis after the surgery.

REFERENCES

[1] Manrique, O., Adabi, K., Martinez-Jorge, J., Ciudad, P., Nicoli, F. and Kiranantawat, K. (2018). Complications and Patient-Reported Outcomes in Male-to-Female Vaginoplasty—Where We Are Today. Annals of Plastic Surgery 80 (6): 684-691. [Link]

[2] Dreher, P.C., Edwards, D., Hager, S., Dennis, M., Belkoff, A., Mora, J., Tarry, S. & Rumer, K.L. (2018). Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clin Anat. 31 (2):191-199. [Link]

[3] de Vries, A., McGuire, T., Steensma, E., Wagenaar, T., Doreleijers, P. & Cohen-Kettenis, P. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. [Link]

Males
Medical transition
Sexual function
Surgery

Medical transition puts both males and females at risk of infertility.

Females, Fertility, Hormones, Males, Medical transition, Puberty blockers, Surgery
Medical transition puts both males and females at risk of infertility. Expand
Download as PDFDownload
Medical transition puts both males and females at risk of infertility.

A wide-ranging study [1] found that gender-related drug regimens place patients at risk of infertility:

Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear.

On surgeries, the study noted that cross-sex surgery that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility.

REFERENCES

[1] Cheng, P.J., Pastuszak, A.W., Myers, J.B., Goodwin, I.A. & Hotaling, J.M. (2019). Fertility concerns of the transgender patient. Transl Androl Urol. 8 (3): 209-218. [Link]

Hormones
Females
Fertility
Males
Medical transition
PUBERTY BLOCKERS
Surgery

There is little evidence that medical transition decreases suicidality.

Medical transition, Mortality, Puberty blockers, Research quality, Suicide
There is little evidence that medical transition decreases suicidality. Expand
Download as PDFDownload
There is little evidence that medical transition decreases suicidality.

When it comes to gender dysphoric children, there is little evidence that medical transition decreases suicide rates. There is little evidence to assert that puberty blockers are necessary to prevent suicide [1].

After sex reassignment surgery, one study showed that adult transsexual clients were 4.9 times more likely to have made a suicide attempt and 19.1 times more likely to have died from suicide, after adjusting for prior psychiatric comorbidity [2]. Similarly, an Australian paper [3] notes that many patients have poor outcomes, which puts them at risk of suicide.

A prominent study [4] claiming that medical transition alleviated suicidality had to be corrected [5], to clarify that it proved “no advantage of surgery” in this regard.

A long-term Swedish study [6] finds that post-operative transgender people have “considerably higher risks” for suicidal behavior.

Similarly, a study in the European Journal of Endocrinology [7] demonstrates that suicide rates among transgender male-to-females were 51% higher than the general population.

REFERENCES

[1] Biggs, M. (2020). Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria. Archives of Sexual Behavior (49): 2227–2229. [Link]

[2] Zucker, K.J., Lawrence, A.A., Kreukels, B.P. (2016). Gender Dysphoria in Adults. Annu Rev Clin Psychol. 12: 217-47. [Link]

[3] D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry 26 (5): 460-463. [Link]

[4] Bränström, R. & Pachankis, J. E. (2019). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. American Journal of Psychiatry 177 (8): 727-734. [Link]

[5] American Journal of Psychiatry (2020). Correction to Bränström and Pachankis. Published online: 1 August 2020. [Link]

[6] Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., & Landén, M. (2011). ‘Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden’. PLoS ONE, 6(2). [Link]

[7] Asscheman, H., Giltay, E. J., Megens, J. A. J., de Ronde, W., van Trotsenburg, M. A. A. & Gooren, L. J. G. (2011). A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. European Journal of Endocrinology 164 (4). [Link]

Medical transition
Mortality
Puberty blockers
Research quality
Suicide

About

When it comes to gender, the phrase from Scottish novelist and folklorist Andrew Lang fits: statistics are often used “as a drunken man uses lampposts – for support rather than for illumination”.

There is a huge amount of misinformation about gender – frequently in numerical form. Many will have heard that 41% of teenagers who wish to transition will commit suicide if denied cross-sex hormones. Or that cross-sex surgeries are “no more dangerous than wisdom teeth removal”. Or that “1.7% of people are born neither male nor female”. All of these are questionable assertions which should attract proper scrutiny.

Some of these assertions, transmitted via social media, have become cemented in the popular consciousness. They are repeated on news outlets, in school classrooms and in diversity trainings. Yet they crumble on inspection.

Many parents with gender-questioning kids are presented with statistics which make transition sound like paradise, and present any less hasty path as abusive or even dangerous. When kids ask for puberty blockers or cross-sex hormones, parents find themselves cast into PhD level research, scouring scientific papers late into the night, trying to sort fact from fiction.

Teachers, journalists, politicians and decision-makers are often confronted with data that make it seem like there’s only one option. Yet many are inwardly skeptical of the headlong rush towards transition. They think about people they know who were gender-non-conforming in their youth, and wonder what would have become of them had they grown up in an era so obsessed with gender expression.

The absence of a single, easy-to-use portal for statistics and facts about gender has hindered parents and professionals alike. That’s why Genspect created Stats For Gender.

We believe that the public has a right to reliable data, intuitively categorized, and phrased in simple, jargon-free terms. We want those who are questioning their gender to have full access to the facts. And we want their families, friends and loved ones to be able to see the bigger picture.

There is limited evidence that medical transition leads to positive outcomes.

Hormones, Medical transition, Puberty blockers, Research quality
There is limited evidence that medical transition leads to positive outcomes. Expand
Download as PDFDownload
There is limited evidence that medical transition leads to positive outcomes.

A number of different studies have noted the paucity of good quality evidence for transition.

An Australian paper [1] states that most available evidence indicating positive outcomes for gender reassignment is of poor quality.

A German study [2] “found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition”, adding that “[t]his lack of studies shows a gap between current clinical practice and clinical research.”

A British review [3] conducted by the National Institute for Health and Care Excellence (NICE) graded certainty of evidence for puberty blocker use as “very low” in every category, including impact on gender dysphoria, mental health, body image, global functioning, psychosocial functioning, cognitive functioning, bone density and adverse effects.

A chapter [4] in an edited volume details the low evidence base for treatment pathways employed at the UK’s Gender Identity Development Service, demonstrating how negative evidence was “ignored or suppressed”.

Finally, a systematic review [5] commissioned by the World Professional Association for Transgender Health (WPATH) to “systematically review the effect of gender-affirming hormone therapy on psychological outcomes among transgender people” noted that, in some areas, there was low quality or insufficient evidence.

REFERENCES

[1] D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry 26 (5): 460-463. [Link]

[2] Haupt, C., Henke, M., Kutschmar, A., Hauser, B., Baldinger, S., Saenz, S.R. & Schreiber, G. (2020). Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women. Cochrane Database of Systematic Reviews 11. [Link]

[3] National Institute for Health and Care Excellence (2021). Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria. National Institute for Health and Care Excellence (NICE); NHS England; NHS Improvement. [Link]

[4] Biggs, M. (2019). The Tavistock’s Experiment with Puberty Blockers. In: Moore, M. & Brunskell-Evans, H. (eds.). Inventing Transgender Children and Young People. Cambridge Scholars Publishing. [Link]

[5] Baker, K.E., Wilson, L.M., Sharma, R., Dukhanin, V., McArthur, K. & Robinson, K.A. (2021) Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review. Journal of the Endocrine Society 5 (4). [Link]

Hormones
Medical transition
Puberty blockers
Research quality

Social transition – changing names, pronouns, clothing and bathroom use – correlates with the persistence of transgender identity.

Desistance, Pronouns, Social transition
Social transition – changing names, pronouns, clothing and bathroom use – correlates with the persistence of transgender identity. Expand
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Social transition – changing names, pronouns, clothing and bathroom use – correlates with the persistence of transgender identity.

Pediatric transition doctors in the Netherlands who first pioneered the use of puberty blockers in dysphoric children observe that social transition correlates with an increase in young people’s persistence when it comes to gender identity [1]. This led them to caution against social transition before puberty.

Another paper [2] notes that gender dysphoria is more persistent into adolescence where social transition has occurred, and as such asserts that social transition is a “psychosocial intervention [which] might be characterized as iatrogenic” – a medical problem caused by the treatment itself.

There is evidence [3] that social transition by the child was found to be strongly correlated with persistence for natal boys, more so than for girls.

REFERENCES

[1] de Vries, A. L., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality 59 (3): 301–320. [Link]

[2] Zucker, K. J. (2019). Debate: Different strokes for different folks. Child and Adolescent Mental Health 25(1): 36-37. [Link]

[3] Steensma, T.D., McGuire, J.K., Kreukels, B.P., Beekman, A.J. & Cohen-Kettenis, P.T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. J Am Acad Child Adolesc Psychiatry. 52 (6): 582-90. [Link]

Desistance
Pronouns
Social transition