Summary
Puberty blockers are often described as a "pause button" that gives teenagers time to think about their gender. This study from one Dutch clinic checked what actually happened to the 143 teens who started blockers there between 2010 and 2018. Almost all (87%) went on to cross-sex hormones, usually within a year. Only nine stopped blockers, and five of those (3.5%) no longer wanted gender treatment. The authors say the high rate of moving on may be because the clinic only chose teens very likely to continue. They openly say their study cannot tell whether blockers themselves make teens more likely to stay on the medical path. Many trans boys started blockers at about 16, when puberty was mostly over. Tracking stopped once hormones began, so the study tells us nothing about long-term health or later detransition.
Key findings
- من بين 214 مراهقاً في عيادة لايدن في سن وبلوغ كافيين، رُئي أن 143 (67%) مناسبون لحاصرات البلوغ، وبدأها جميعهم بين نوفمبر 2010 ويناير 2018.
- انتقل 125 (87%) إلى الهرمونات المغايرة بعد 10 أشهر معتادة على الحاصرات؛ وكان 5 أصغر من أن يبدؤوا الهرمونات وانتقل 6 إلى عيادات أخرى.
- توقف تسعة مراهقين (6%) عن الحاصرات. وظل أربعة منهم يريدون علاجاً جندرياً وتوقفوا بسبب آثار جانبية أو مشكلات في المزاج أو أسباب عملية؛ واستأنف واحد وبدأ ثلاثة لاحقاً الهرمونات أو أدوية لإيقاف الدورة الشهرية.
- لم يعد خمسة مراهقين (3.5%) يريدون علاجاً جندرياً. وشملت أسبابهم الشعور بأنهم لا ثنائيو الجندر، والوقوع في الحب، ومشكلات شخصية أو أسرية عرقلت استكشاف مشاعرهم.
- بقي عشرون مراهقاً على الحاصرات أطول مما اقتضته خطة العيادة، وغالباً بسبب حياة أسرية أو اجتماعية غير مستقرة، أو حالات أخرى مثل التوحد أو الاكتئاب، أو أسباب عملية.
- كان عمر البدء المعتاد 15 للفتيات المتحولات و16 للأولاد المتحولين، لذا بدأ كثيرون في أواخر البلوغ أو بعده، حين تفعل الحاصرات القليل جسدياً.
- يقر المؤلفون بأن دراستهم لا تستطيع إظهار هل تجعل الحاصرات نفسها استمرار الكرب الجندري أرجح.
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.
Conclusion
A small number of adolescents discontinued GnRHa because they no longer wished gender-affirming treatment, showing that gender identity can still fluctuate on GnRHa in some adolescents; whether gender dysphoria would have subsided in more of them without GnRHa is uncertain. Some used GnRHa for a prolonged period while regularly meeting a mental health professional, consistent with GnRHa as an extended diagnostic phase. The great majority continued to gender-affirming hormones, possibly because eligibility criteria select those highly likely to pursue further treatment, and this should be taken into account when counselling adolescents and parents.