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美国国立卫生研究院资助的阻断剂研究发现2年内心理健康没有改善；无对照组，24个月时37%数据缺失

以青春期抑制开始的性别肯定医疗24个月后青少年的心理与情绪健康

队列与登记研究青春期阻滞剂心理健康与自杀
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

  • 在四家美国诊所开始使用青春期阻断剂的94名8至16岁（平均11岁；52%出生时为男性；多数处于青春期早期）的青少年被追踪了2年。
  • 他们自己报告的抑郁和情绪健康，以及家长报告的问题，在2年中没有可测量的变化；只有违反规则的行为略有减少。
  • 开始时18%有中度或重度抑郁（88人中的16人），2年时为23%（59人中的13人）。
  • 94人中只有59人在2年时有抑郁数据，因此缺失了37%。
  • 11人在第一年内开始使用雌激素或睾酮，第二年又有20人，因此三分之一的人在研究期间使用了跨性别激素。
  • 11名青少年报告在开始前6个月有自杀想法，2年时为5人；没有自杀死亡。
  • 作者的结论是，阻断剂“很可能”防止了心理健康恶化，但由于没有对照组，该研究无法检验这一点。
  • NIH的进展报告预期抑郁、焦虑、创伤症状、自伤和自杀想法会下降，身体形象和生活质量会改善；这些改善并未得到显示。

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.)