Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature.
Transgender
adolescent
critical review
puberty blockers
Journal
Child and adolescent mental health
ISSN: 1475-357X
Titre abrégé: Child Adolesc Ment Health
Pays: England
ID NLM: 101142157
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
02
06
2020
revised:
08
10
2020
accepted:
18
11
2020
pubmed:
16
12
2020
medline:
26
10
2021
entrez:
15
12
2020
Statut:
ppublish
Résumé
Increasingly, early adolescents who are transgender or gender diverse (TGD) are seeking gender-affirming healthcare services. Pediatric healthcare providers supported by professional guidelines are treating many of these children with gonadotropin-releasing hormone agonists (GnRHa), which reversibly block pubertal development, giving the child and their family more time in which to explore the possibility of medical transition. We conducted a critical review of the literature to answer a series of questions about criteria for using puberty-blocking medications, the specific drugs used, the risks and adverse consequences and/or the positive outcomes associated with their use. We searched four databases: LGBT Life, PsycINFO, PubMed, and Web of Science. From an initial sample of 211 articles, we systematically reviewed 9 research studies that met inclusion/exclusion criteria. Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged 'excellent', five studies met the majority of quality criteria resulting in 'good' ratings, whereas three studies were judged fair and had serious risks of bias. Given the potentially life-saving benefits of these medications for TGD youth, it is critical that rigorous longitudinal and mixed methods research be conducted that includes stakeholders and members of the gender diverse community with representative samples.
Sections du résumé
BACKGROUND
Increasingly, early adolescents who are transgender or gender diverse (TGD) are seeking gender-affirming healthcare services. Pediatric healthcare providers supported by professional guidelines are treating many of these children with gonadotropin-releasing hormone agonists (GnRHa), which reversibly block pubertal development, giving the child and their family more time in which to explore the possibility of medical transition.
METHODS
We conducted a critical review of the literature to answer a series of questions about criteria for using puberty-blocking medications, the specific drugs used, the risks and adverse consequences and/or the positive outcomes associated with their use. We searched four databases: LGBT Life, PsycINFO, PubMed, and Web of Science. From an initial sample of 211 articles, we systematically reviewed 9 research studies that met inclusion/exclusion criteria.
RESULTS
Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged 'excellent', five studies met the majority of quality criteria resulting in 'good' ratings, whereas three studies were judged fair and had serious risks of bias.
CONCLUSION
Given the potentially life-saving benefits of these medications for TGD youth, it is critical that rigorous longitudinal and mixed methods research be conducted that includes stakeholders and members of the gender diverse community with representative samples.
Types de publication
Journal Article
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
3-14Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2020 Association for Child and Adolescent Mental Health.
Références
Achille, C., Taggart, T., Eaton, N.R., Osipoff, J., Tafuri, K., Lane, A., & Wilson, T.A. (2020). Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: Preliminary results. International Journal of Pediatric Endocrinology, 8. https://doi.org/10.1186/s13633-020-00078-2
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edn). Arlington, VA: American Psychiatric Publishing.
Ashley, F. (2019). Puberty blockers are necessary, but they don’t prevent homelessness: Caring for transgender youth by supporting unsupportive parents. The American Journal of Bioethics, 19, 87-89.
Bonifacio, H.J., & Rosenthal, S.M. (2015). Gender variance and dysphoria in children and adolescents. Pediatric Clinics of North America, 62, 1001-1016.
Campbell, D.T., & Stanley, J.C. (1963). Experimental and quasi-experimental designs for research. Boston: Houghton Mifflin Company.
Chew, D., Anderson, J., Williams, K., May, T., & Pang, K. (2018). Hormonal treatment in young people with gender dysphoria: A systematic review. Pediatrics, 14, e2017374.
Cochrane Consumer Network (n.d.) Levels of evidence. Available from: https://consumers.cochrane.org/levels-evidence
Cohen-Kettenis, P.T., Schagen, S.E.E., Steensma, T.D., DeVries, A.L.C., & Delemarre-van de Waal, H.A. (2011). Puberty suppression in a gender-dysphoric adolescent: A 22 -year follow-up. Archives of Sexual Behavior, 40, 843-847.
Cooper, H. (2017). Research synthesis and meta-analysis: A step-by-step approach (5th edn). Los Angeles: Sage.
de Vries, A.L.C., Steensma, T.D., Doreleijers, T.A.H., & Cohen-Kettenis, P.T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine, 8, 2276-2283.
Delemarre-van de Waal, H.A., & Cohen-Kettenis, P.T. (2006). Clinical management of gender identity disorder in adolescents: A protocol on psychological and paediatric endocrinology aspects. European Journal of Endocrinology, 155, S131-S137.
DiVasta, A., & Laufer, M.R. (2013). The use of gonadotropin releasing hormone analogues in adolescent and young patients with endometriosis. Current Opinion in Obstetrics and Gynecology, 25, 287-292.
Drummond, K.D., Bradley, S.J., Peterson-Badali, M., & Zucker, K.J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34-45.
Edwards-Leeper, L., Leibowitz, S., & Sangganjanavanich, V.F. (2016). Affirmative practice with transgender and gender nonconforming youth: Expanding the model. Psychology of Sexual Orientation and Gender Diversity, 3, 165-172.
Endocrine Society (2017). Guidelines and clinical practice. Available from: practice/clinical-practice-guidelines/gender-dysphoria-gender-https://www.endocrine.org/guidelines-and-clinical-incongruence [last accessed 25 June 2019].
Gallagher, J.S., Missmer, S.A., Hornstein, M.D., Laufer, M.R., Gordon, C.M., & DiVasta, A.D. (2018). Long-term effects of gonadotropin-releasing agonists and add-back in adolescent endometriosis. Journal of Pediatric and Adolescent Gynecology, 31, 376-381.
Gray, S.A.O., Sweeney, K.K., Randazzo, R., & Levitt, H.M. (2016). “Am I doing the right thing?”: Pathways to parenting a gender variant child. Family Process, 55, 123-138.
Hembree, W.C., Cohen-Kettenis, P., Delemarre-van de Waal, H.A., Gooren, L.J., Meyer, W.J., Spack, N.P., … & Montori, V.M. (2009). Endocrine treatment of transsexual persons: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology, and Metabolism, 94, 3132-3154.
Hembree, W.C., Cohen-Kettenis, P.T., Gooren, L., Hannema, S.E., Meyer, W.J., Murad, M.H., … & T’Sjoen, G.G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An endocrine Society* Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism, 102, 3869-3903.
Joanna Briggs Institute (2018). Critical appraisal tools. The University of Adelaide. Available from. http://joannabriggs.org/research/critical-appraisal-tools.html [last accessed 5 May 2019].
Johns, M.A., Lowry, R., Andrzejewski, J., Barrios, L.D., Demissie, Z., McManus, T., … & Underwood, J.M. (2019). Transgender identitiy and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students-19 states and large urban school districts, 2017. Morbidity and Mortality Weekly Report, 68, 67-71.
Khatchadourian, K., Amed, S., & Metzer, D.L. (2014). Clinical management of youth with gender dysphoria in Vancouver. The Journal of Pediatrics, 164, 906-911.
Kimberly, L.L., Folkers, K.M., Friesen, P., Sultan, D., Quinn, G.P., Bateman-House, A., … & Salas-Humara, C. (2018). Ethical issues in gender-affirming care for youth. Pediatrics, 142, e20181537.
Klaver, M., de Mutsert, R., Wiepjes, C.M., Twisk, J.W.R., den Heijer, M., Rotteveel, J., & Klink, D.T. (2018). Early hormonal treatment affects body composition and body shape in young transgender adolescents. Journal of Sexual Medicine, 15, 251-260.
Krishna, K.B., Fuqua, J.S., Rogol, A.D., Klein, K.O., Popovic, J., Houk, C.P., … & Lee, P.A. (2019). Use of gonadotropin-releasing ormone analogs in children: Update by an international consortium. Hormone Research in Paediatrics, 91, 357-372.
Lee, J.W., Kim, H.J., Choe, Y.M., Kang, H.S., Kim, S.I., Jun, Y.H., & Lee, J.E. (2014). Significant adverse reactions to long-acting gonadotropin-releasing hormone agonists for the treatment of central precocious puberty and early onset puberty. Annual Pediatric Endorinology Metabolism, 19, 135-140.
Liu, R.T., & Mustanski, B. (2012). Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth. American Journal of Preventive Medicine, 42, 221-228.
Lowry, R., Johns, M.M., Gordon, A.R., Austin, B., Robin, L.E., & Kann, L.K. (2018). Nonconforming gender expression and associated mental distress and substance use among high school students. JAMA Pediatrics, 172, 1020-1028.
McConnell, E., Birkett, M., & Mustanski, B. (2016). Families matter: Social support and mental health trajectories among lesbian, gay, bisexual, and transgender youth. Journal of Adolescent Health, 59, 674-680.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & the PRISMA Group (2009). Reprint-Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. Physical Therapy, 89, 873-880.
Nahata, L., Quinn, G.P., Caltabellotta, N.M., & Tishelman, A.C. (2017). Mental health concerns and insurance among transgender adolescents. LGBT Health, 4, 188-193.
Olson, J., Schrager, S.M., Belzer, M., Simons, L.K., & Clark, L.F. (2015). Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. Journal of Adolescent Health, 57, 374-380.
Olson-Kennedy, J., Chan, Y.-M., Garofalo, R., Spack, N., Chen, D., Clark, L., … & Rosenthal, S. (2019). Impact of early medical treatment for transgender youth: Protocol for the longitudinal, observational trans youth care study. JMIR Research Protocols, 8, e14434.
Padula, W.V., & Baker, K. (2017). Coverage for gender-affirming care: Making health insurance work for transgender Americans. LGBT Health, 4(4), 244-247.
Reisner, S.L., Deutsch, M.B., Bhasin, S., Bockting, W., Brown, G.R., Feldman, J., … & Goodman, M. (2016). Advancing methods for US transgender health research. Current Opinion in Endocrinology Diabetes Obesity, 23, 198-207.
Schagen, S.E.E., Cohen-Kettenis, P.T., Delemarre-van de Waal, H.A., & Hannema, S.E. (2016). Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. The Journal of Sexual Medicine, 13, 1125-1132.
Schneider, M.A., Spritzer, P.M., Soll, B.M.B., Fontanari, A.M.V., Carneiro, M., Tovar-Moll, F., … & Lobato, M.I.R. (2017). Brain maturation, cognition and voice pattern in a gender dysphoria case under pubertal suppression. Frontiers in Human Neuroscience, 11, 528.
Shields, J.P., Cohen, R., Glassman, J.R., Whitaker, K., Franks, H., & Bertolini, I. (2013). Estimating population size and demographic characteristics of lesbian, gay, bisexual, and transgender youth in middle school. Journal of Adolescent Health, 42, 248-250. https://doi.org/10.1016/j.jadohealth.2012.06.016
Stevens, J., Gomez-Lobo, V., & Pine-Twaddell, E. (2015). Insurance coverage of puberty blocker therapies for transgender youth. Pediatrics, 136, 1029-1031.
Turban, J.L. (2017). Transgender youth: The building evidence base for early social transition. Journal of the American Academy of Child and Adolescent Psychiatry, 56, 101-102.
Turban, J.L., King, D., Carswell, J.M., & Keuroghlian, A.S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145, e20191725.
Vassar, M., & Holzmann, M. (2013). The retrospective chart review: Important methodological considerations. Journal of Educational Evaluation for Health Professions, 10, 1-7.
Vlot, M.C., Klink, D., den Heijer, M., Blankenstein, M.A., Rotteveel, J., & Heijboer, A. (2017). Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents. Bone, 95, 11-19.
Vrouenraets, L.J.J.J., Fredriks, A.M., Hannema, S.E., Cohen-Kettenis, P.T., & DeVries, M.C. (2015). Early medical treatment of children and adolescents with gender dysphoria: An empirical ethical study. Journal of Adolescent Health, 57, 367-373.
Vrouenraets, L.J.J.J., Fredriks, A.M., Hannema, S.E., Cohen-Kettenis, P.T., & DeVries, M.C. (2016). Perceptions of sex, gender, and puberty suppression: A qualitative analysis of transgender youth. Archives of Sexual Behavior, 45, 1697-1703.
World Professional Association for Transgender Health (2011). Standards of care for the health of transsexual, transgender, and gender nonconforming people (7th version). Available from: https://www.wpath.org/media/cms/Documents/Web%20Transfer/SOC/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf [last accessed 10 December 2020].
Yu, R., Yang, S., & Hwang, T. (2019). Psychological effects of gonadotropin-releasing hormone agonist treatment in girls with central precocious puberty. Journal of Pediatric Endocrinology and Metablism, 32, 1071-1075.