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

• 검토는 평균 연령 26세 미만의 사람들에 대한 반대 성 호르몬 연구 24건을 찾았습니다. 9건은 치료받은 사람과 받지 않은 사람을 비교했고, 13건은 전후를 측정했으며, 2건은 치료받은 환자를 기술만 했습니다.
• 사람들을 우연으로 치료에 배정하는 무작위 시험은 없었습니다.
• 성별 불쾌감, 일상 기능, 우울에 대한 근거는 대부분 매우 낮은 품질로 평가되었습니다.
• 한 연구는 호르몬을 쓰는 사람이 우울할 가능성이 다소 낮다고 밝혔지만(오즈 약 4분의 1 낮음), 이는 낮은 품질의 근거로 평가되었습니다.
• 한 기록 연구에서 여성 3,875명 중 151명(3.9%)이 테스토스테론 시작 후 7개월에서 9년 사이에 심장이나 혈관 사건을 겪었고, 다른 연구에서는 약 2년 후 1,893명 중 3명(0.2%)이었습니다.
• 한 연구에서 315명 중 2명(0.6%)이 2년 안에 자살로 사망했지만, 이 근거는 매우 약하다고 평가되었습니다.
• 많은 연구가 정신과 치료, 다른 정신 건강 상태, 소득, 가족 지원을 고려하지 않았고, 여러 연구는 사람들의 절반도 안 되는 수에 대한 결과만 있었습니다.
• 저자들은 이익도 해도 배제할 수 없다고 결론짓고 사람들을 시간 순으로 추적하는 신중한 연구를 요구합니다.

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.