Gender Dysphoria and Psychological Functioning in Adolescents Treated with GnRHa: Comparing Dutch and English Prospectiv
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LETTER TO THE EDITOR
Gender Dysphoria and Psychological Functioning in Adolescents Treated with GnRHa: Comparing Dutch and English Prospective Studies Michael Biggs1 Received: 31 December 2019 / Revised: 4 June 2020 / Accepted: 6 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
The number of children and adolescents presenting with gender dysphoria (previously labeled as gender identity disorder) has increased rapidly in Western countries. Over the last 15 years, referrals to the Tavistock and Portman NHS Foundation Trust’s Gender Identity Development Service in London multiplied by a factor of 60 (Di Ceglie, 2018; Gender Identity Development Service, 2019), while those to the Center of Expertise on Gender Dysphoria in Amsterdam increased tenfold (Arnoldussen et al., 2020). It has become standard to administer gonadotropin-releasing hormone analogs (GnRHa) to young adolescents diagnosed with gender dysphoria, in order to suppress puberty. Pioneered in the Netherlands, this treatment is known as the Dutch model (Cohen-Kettenis & Goozen, 1998; Delemarre–van de Waal & Cohen-Kettenis, 2006). One aim is to prevent the development of unwanted secondary sex characteristics and thus to facilitate subsequent physical transition with cross-sex hormones and surgery. Another aim is diagnostic, “to provide time to make a balanced decision regarding actual gender reassignment” (de Vries, Steensma, Doreleijers, & Cohen-Kettenis, 2011, p. 2276). This treatment is still experimental, as GnRHa is not licensed for gender dysphoria, though it is to treat precocious puberty (Thornhill, 2020). The GIDS has administered GnRHa to around 300 adolescents aged under 15 since 2011 (Tavistock and Portman NHS Foundation Trust, 2019). The Amsterdam clinic provided this treatment to almost 200 adolescents between 2012 and 2015 (van der Miesen, Steensma, de Vries, Bos, & Popma, 2020). Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10508-020-01764-1) contains supplementary material, which is available to authorized users. * Michael Biggs [email protected] 1
Department of Sociology, St Cross College, University of Oxford, 42 Park End Street, Oxford OX1 1JD, UK
Despite the increasing prevalence of GnRHa treatment for gender dysphoria, evidence for its effects is thin. There is a particular lack of prospective or longitudinal studies, which take measures from the same subjects before treatment and afterward. (The Appendix describes how the literature was searched.) The most important is a study of gender dysphoria and psychological functioning among Dutch adolescents (de Vries et al., 2011). The sample numbered 70, though not all measures were available for all subjects, and so the number of observations is as few as 41. A recent study examined depression and quality of life for 23 American adolescents whose puberty was suppressed (by GnRHa or other drugs); almost half the subjects who entered the study did not complete the questionnaire, but the h
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