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Meget lav sikkerhed: Stort review sår tvivl om fordele for mental sundhed ved krydskønshormoner for under 26-årige

Kønsbekræftende hormonbehandling for personer med kønsdysfori under 26 år: en systematisk gennemgang og metaanalyse

Systematiske & evidensgennemgangeKønshormonerMentalt helbred & selvmord
Authors
Anna Miroshnychenko, Sara Ibrahim, Yetiani Roldan, Chan Kulatunga-Moruzi, Steven Montante, Rachel Couban, Gordon Guyatt, Romina Brignardello-Petersen
Journal
Archives of Disease in Childhood
Year
2025
Source
pubmed.ncbi.nlm.nih.gov/39855725/

Summary

This review collected studies up to September 2023 on testosterone or oestrogen for teens and young adults with gender distress, and rated the evidence. Of 24 studies, none was a randomised trial, where people are assigned to treatment by chance. Most ignored other mental health care, family support or missing results. Almost every finding on mental health and gender distress was rated very low quality. One study linked hormones to somewhat less depression, but this too was weak evidence. In one study, about 4% of females on testosterone had a heart or blood vessel event over several years. With no comparison group, this cannot show the hormones caused them. The authors conclude benefit or harm cannot be ruled out. The findings match other reviews, but the review was commissioned and paid for by SEGM, a group critical of youth transition, and newer studies are not included.

Key findings

  • Gennemgangen fandt 24 studier af krydskønshormoner hos personer med en gennemsnitsalder under 26: 9 sammenlignede behandlede og ubehandlede, 13 målte folk før og efter, og 2 beskrev kun behandlede patienter.
  • Der var ingen randomiserede forsøg, hvor folk tildeles behandling ved lodtrækning.
  • Evidens om kønslidelse, daglig funktion og depression blev for det meste vurderet som af meget lav kvalitet.
  • Ét studie fandt, at folk på hormoner var noget mindre tilbøjelige til at være deprimerede (omkring en fjerdedel lavere odds), men dette blev vurderet som evidens af lav kvalitet.
  • I ét journalstudie fik 151 af 3.875 kvinder (3,9 %) en hjerte- eller karhændelse mellem 7 måneder og 9 år efter start på testosteron; et andet studie fandt 3 af 1.893 (0,2 %) efter omkring 2 år.
  • I ét studie døde 2 af 315 personer (0,6 %) ved selvmord inden for 2 år, men denne evidens blev vurderet som meget svag.
  • Mange studier tog ikke højde for psykiatrisk behandling, andre psykiske tilstande, indkomst eller støtte fra familien, og flere havde resultater for under halvdelen af personerne.
  • Forfatterne konkluderer, at gavn eller skade ikke kan udelukkes, og opfordrer til omhyggelige studier, der følger folk fremad i tid.

Abstract

Objective In this systematic review and meta-analysis, we assessed and summarised the certainty of the evidence about the effects of gender affirming hormone therapy (GAHT) in individuals with gender dysphoria (GD). Methods We searched Medline, Embase, PsychINFO, Social Sciences Abstracts, LGBTQ+ Source and Sociological Abstracts from inception to September 2023. We included studies comparing GAHT with no GAHT in individuals aged <26 years with GD. Outcomes of interest included psychological and physical effects. Pairs of reviewers independently screened articles, abstracted data and assessed the risk of bias in the included studies. We performed meta-analyses and assessed the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach. Results We included 24 studies. Comparative observational studies (n=9) provided mostly very low certainty evidence regarding GD, global function and depression. One comparative observational study reported that the odds of depression may be lower (OR 0.73 (95% CI 0.61 to 0.88), n (number of studies)=1, low certainty) in individuals who received GAHT compared with those who did not. Before-after studies (n=13) provided very low certainty evidence about GD, global function, depression and bone mineral density. Case series studies (n=2) provided high certainty evidence that the proportion of individuals with cardiovascular events 7-109 months after receiving GAHT was 0.04 (95% CI 0.03 to 0.05, n=1, high certainty). Conclusion There is considerable uncertainty about the effects of GAHT and we cannot exclude the possibility of benefit or harm. Methodologically rigorous prospective studies are needed to produce higher certainty evidence. Trial registration number PROSPERO CRD42023452171.

Conclusion

The best available evidence reporting on the effects of GAHT in individuals with GD ranged from moderate to high certainty for cardiovascular events and low to very low certainty for the outcomes of GD, global function, depression, sexual dysfunction, BMD and death by suicide. We did not find evidence of sexual dysfunction in NMs. The evidence in this SR and meta-analysis does not exclude the possibility of benefit or harm upon receipt of GAHT. Prospective studies giving higher certainty evidence are needed to understand the short and long term effects of GAHT.