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

• 回顧找到 24 項針對平均年齡 26 歲以下者使用跨性別荷爾蒙的研究：9 項比較了接受治療與未接受治療的人，13 項在前後測量人們，2 項只描述了接受治療的患者。
• 沒有隨機試驗，也就是以抽籤的方式分配治療的試驗。
• 關於性別困擾、日常功能和憂鬱的證據大多被評為極低品質。
• 有一項研究發現使用荷爾蒙的人憂鬱的可能性稍低（機率約低四分之一），但這被評為低品質的證據。
• 在一項紀錄研究中，3,875 名女性中有 151 人（3.9%）在開始使用睪固酮後 7 個月至 9 年間發生心臟或血管事件；另一項研究則發現約 2 年後 1,893 人中有 3 人（0.2%）。
• 在一項研究中，315 人中有 2 人（0.6%）在 2 年內死於自殺，但這項證據被評為非常薄弱。
• 許多研究沒有考慮精神科治療、其他心理健康狀況、收入或家庭支持，數項研究只有不到半數人的結果。
• 作者的結論是無法排除有益處或有傷害，並呼籲進行仔細的研究，及時往前追蹤人們。

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.