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Estudo de bloqueadores financiado pelo NIH: sem melhora na saúde mental em 2 anos; sem controle, 37% de dados ausentes

Saúde mental e emocional de jovens após 24 meses de cuidado médico de afirmação de gênero iniciado com supressão puberal

Estudos de coorte e registrosBloqueadores da puberdadeSaúde mental e suicídio
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 jovens de 8 a 16 anos (média de 11; 52% nascidos do sexo masculino; a maioria no início da puberdade) que iniciaram bloqueadores da puberdade em quatro clínicas dos EUA foram acompanhados por 2 anos.
  • Seus próprios relatos de depressão e saúde emocional, e os relatos dos pais sobre problemas, não mostraram mudança mensurável ao longo de 2 anos; apenas o comportamento de quebrar regras diminuiu ligeiramente.
  • 18% tinham depressão moderada ou grave no início (16 de 88) e 23% aos 2 anos (13 de 59).
  • Apenas 59 dos 94 tinham dados de depressão aos 2 anos, de modo que 37% estavam faltando.
  • 11 começaram estrogênio ou testosterona no primeiro ano e mais 20 no segundo, de modo que um terço tomou hormônios cruzados durante o estudo.
  • 11 jovens relataram pensamentos suicidas nos 6 meses anteriores ao início e 5 aos 2 anos; não houve mortes por suicídio.
  • Os autores concluíram que os bloqueadores "provavelmente" evitam que a saúde mental piore, embora, sem grupo de comparação, o estudo não pudesse testar isso.
  • O relatório de progresso do NIH esperava quedas na depressão, na ansiedade, nos sintomas de trauma, na automutilação e nos pensamentos suicidas, e melhor imagem corporal e qualidade de vida; essas melhorias não foram demonstradas.

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.)