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

• 该综述找到24项关于平均年龄26岁以下人群使用跨性别激素的研究：9项比较了接受治疗和未接受治疗的人，13项测量了人们的前后变化，2项只描述了接受治疗的患者。
• 没有随机试验，即通过随机方式分配治疗的试验。
• 关于性别痛苦、日常功能和抑郁的证据大多被评为极低质量。
• 一项研究发现，使用激素的人抑郁的可能性略低（几率约低四分之一），但这被评为低质量证据。
• 在一项记录研究中，3,875名女性中有151人（3.9%）在开始使用睾酮后7个月至9年间发生了心脏或血管事件；另一项研究在约2年后发现1,893人中有3人（0.2%）。
• 在一项研究中，315人中有2人（0.6%）在2年内死于自杀，但这一证据被评为非常薄弱。
• 许多研究没有考虑精神科治疗、其他心理健康状况、收入或家庭支持，有几项研究只有不到一半人的结果。
• 作者的结论是，无法排除获益或伤害，并呼吁开展向前追踪人群的谨慎研究。

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.