Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria
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ORIGINAL PAPER
Trajectories of Adolescents Treated with Gonadotropin‑Releasing Hormone Analogues for Gender Dysphoria Tessa Brik1 · Lieke J. J. J. Vrouenraets2,3 · Martine C. de Vries1,3 · Sabine E. Hannema1,4 Received: 13 November 2018 / Revised: 9 February 2020 / Accepted: 10 February 2020 © The Author(s) 2020
Abstract Gonadotropin-releasing hormone analogues (GnRHa) are recommended as initial treatment for adolescents diagnosed with gender dysphoria, providing time to follow gender identity development and consider further treatment wishes without distress caused by unwanted pubertal changes. This has been described as an extended diagnostic phase. However, there are also concerns about the physical, neurocognitive, and psychosocial effects of this treatment. In this retrospective study, we document trajectories after the initiation of GnRHa and explore reasons for extended use and discontinuation of GnRHa. Treatment was considered appropriate in 143 (67%) of the 214 adolescents eligible for GnRHa treatment by virtue of their age/pubertal status, and all started GnRHa (38 transgirls, 105 transboys; median age, 15.0 years [range, 11.1–18.6] and 16.1 years [range, 10.1–17.9]). After a median duration of 0.8 years (0.3–3.8) on GnRHa, 125 (87%) started gender-affirming hormones (GAH). Nine (6%) discontinued GnRHa, five of whom no longer wished gender-affirming treatment. Thirteen had used GnRHa for longer than required by protocol for reasons other than logistics and regularly met with a mental health professional during this time, supporting the use of GnRHa treatment as an extended diagnostic phase. In conclusion, the vast majority who started GnRHa proceeded to GAH, possibly due to eligibility criteria that select those highly likely to pursue further gender-affirming treatment. Due to the observational character of the study, it is not possible to say if GnRHa treatment itself influenced the outcome. Few individuals discontinued GnRHa, and only 3.5% no longer wished gender-affirming treatment. Keywords Gender dysphoria · Transgender · Gonadotropin-releasing hormone analogues · Hormone treatment · Gender identity
Introduction Increasing numbers of young people diagnosed with gender dysphoria are seen by pediatric endocrinologists. Gender dysphoria is the persistent feeling of incongruence between gender identity (sense of being a man, woman, or other) and * Sabine E. Hannema [email protected] 1
Department of Pediatrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
2
Department of Pediatric and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Leiden, The Netherlands
3
Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
4
Department of Paediatric Endocrinology, Sophia Children’s Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
the sex assigned at birth. The diagnosis gender dysphoria can be made if the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria are m
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