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NIH-finansiert blokkerstudie: ingen bedring i mental helse over 2 år; ingen kontrollgruppe, 37 % manglet ved 24 måneder

Mental og emosjonell helse hos unge etter 24 måneder med kjønnsbekreftende medisinsk behandling startet med pubertetsundertrykking

Kohort- og registerstudierPubertetsblokkerePsykisk helse og selvmord
Authors
Johanna Olson-Kennedy, Ramon Durazo-Arvizu, Liyuan Wang, Carolyn F. Wong, Diane Chen, Diane Ehrensaft, Marco A. Hidalgo, Yee-Ming Chan, Robert Garofalo, Asa E. Radix, Stephen M. Rosenthal
Journal
medRxiv (preprint)
Year
2025
Source
https://doi.org/10.1101/2025.05.14.25327614

Summary

This NIH-funded study followed 94 children and young teens (average age 11) who started puberty blockers at four large US gender clinics. Over two years, their own reports of depression and emotional wellbeing, and parents' reports of behaviour, did not measurably improve. Average scores were normal from the start. The authors read this as a sign blockers probably prevented a decline, but with no comparison group that claim is untested. More than a third of depression data were missing at two years, about a third started cross-sex hormones during the study, and the results reported differ from those first planned. In 2024 the lead author told The New York Times she had delayed publishing for fear the results would be "weaponized"; they appeared as an unreviewed preprint (early version) in May 2025. It shows no measurable mental health benefit.

Key findings

  • 94 unge i alderen 8 til 16 år (gjennomsnitt 11, 52 % født som gutter, de fleste tidlig i puberteten) som begynte på pubertetsblokkere ved fire amerikanske klinikker ble fulgt i 2 år.
  • Deres egne rapporter om depresjon og følelsesmessig helse, og foreldrenes rapporter om problemer, viste ingen målbar endring over 2 år. Bare regelbrytende atferd falt litt.
  • 18 % hadde moderat eller alvorlig depresjon ved starten (16 av 88) og 23 % etter 2 år (13 av 59).
  • Bare 59 av 94 hadde depresjonsdata etter 2 år, så 37 % manglet.
  • 11 begynte på østrogen eller testosteron i løpet av det første året og 20 til i det andre, så en tredjedel brukte kryssjønnede hormoner under studien.
  • 11 unge rapporterte selvmordstanker i de 6 månedene før starten og 5 etter 2 år. Det var ingen dødsfall ved selvmord.
  • Forfatterne konkluderte med at blokkere «trolig» forhindrer at psykisk helse blir verre, selv om studien uten sammenligningsgruppe ikke kunne teste dette.
  • NIHs fremdriftsrapport forventet fall i depresjon, angst, traumesymptomer, selvskading og selvmordstanker, og bedre kroppsbilde og livskvalitet. Disse bedringene ble ikke vist.

Abstract

BACKGROUND AND OBJECTIVES: Medical interventions for youth with gender dysphoria can include the use of gonadotropin releasing hormone analogs (GnRHas) for suppression of endogenous puberty. This analysis aimed to understand the impact of medical intervention initiated with GnRHas on psychological well-being among youth with gender dysphoria over 24 months.

METHODS: Participants were enrolled as part of the Trans Youth Care United States Study. Eligibility criteria for youth included a diagnosis of Gender Dysphoria and pubertal initiation. Youth with precocious puberty or pre-existing osteoporosis were ineligible. Youth reported on depressive symptoms, emotional health and suicidality at baseline, 6, 12, 18 and 24 months after initiation of GnRHas. Parent/caretaker completed the Child Behavior Checklist at baseline, 12 and 24 months after initiation of GnRHas. Latent Growth-Curve Models analyzed trajectories of change over the 24-month period.

RESULTS: Ninety-four youth aged 8-16 years (mean=11.2 y) were predominately Non-Hispanic White (56%), early pubertal (86%) and assigned male at birth (52%). Depression symptoms, emotional health and CBCL constructs did not change significantly over 24 months. At no time points were the means of depression, emotional health or CBCL constructs in a clinically concerning range.

CONCLUSION: Participants initiating medical interventions for gender dysphoria with GnRHas have self- and parent-reported psychological and emotional health comparable with the population of adolescents at large, which remains relatively stable over 24 months. Given that the mental health of youth with gender dysphoria who are older is often poor, it is likely that puberty blockers prevent the deterioration of mental health.

Conclusion

Participants initiating medical interventions for gender dysphoria with GnRHas have self- and parent-reported psychological and emotional health comparable with the population of adolescents at large, which remains relatively stable over 24 months. Given that the mental health of youth with gender dysphoria who are older is often poor, it is likely that puberty blockers prevent the deterioration of mental health. (Full-text conclusion: the average mental health as reported by both the youth and parents remains in a clinically non-significant range over two years.)