Gender dysphoria is the psychological phenomena in which an individual’s experienced gender is different from the sex they were assigned at birth. This can cause distress or impairment in important areas of functioning (Carmichael, 2021). This can be reduced through psychosocial support, therapy, and medical or surgical interventions to align the body with the identified gender. Sex reassignment surgery is an example of a common surgical intervention. 

When it comes to younger individuals aged 12 to 15, sex reassignment surgery may not be a suitable option due to their age, however unresolved gender dysphoria often continues into adulthood, therefore exacerbating their condition. As such, it is recommended that adolescents undergo pubertal suppression treatments to suppress the sex hormones, estradiol and testosterone, that arise during puberty. These treatments involve utilizing gonadotropin-releasing hormone agonist (GnRHa), a substance that stimulates gonadotropin release, which desensitizes its receptors, resulting in reversible suppression of sex hormone production (Carmichael, 2021). This allows adolescents to delay unwanted body changes related to puberty, to further explore their gender identity. In most of these treatments, the use of GnRHa ceases at age 16 due to the potential negative side effects with long-term use (Butler, 2018). At this point, the adolescent is faced with the decision to either return to the sex hormones produced by their body or begin cross-sex hormones, also known as transitioning.

Polly Carmichael, et. al. conducted an uncontrolled prospective observational study on 44 adolescents with gender dysphoria who underwent GnRHa treatment (Carmichael, 2021). In this type of study, the researchers followed their participants through several years and did not intervene in any way. The paper they published discussed the medical, psychological, and social outcomes during the treatment. Participants had follow-ups for data collection at 12 months, 24 months, and 36 months. Liver function, hematology (blood tests), and biochemistry were normal in participants at 3-6 months. Furthermore, birth-registered females reported the absence of periods about 3 months after starting GnRHa treatment. Weight was normal but height growth continued more slowly than expected for the participants’ age. Spinal fluid samples taken from the spine and the hip showed that bone mineral content (BMC) and bone mineral density (BMD) were normal at 12 months, 24 months, and 36 months. However, samples taken from the lumbar spine (lower back) showed increased BMC and BMD numbers. There were also no significant changes in self-harm index scores recorded from the Youth Self Report (YSR).

Most participants reported generally positive, or a mix of positive and negative changes in their life as a result of treatment (Figure 1). Positive changes included feeling happier, relieved, less facial hair, or the absence of periods. Negative changes include hot flushes, tiredness, and feeling more emotional (Figure 2). The reports of mood changes showed mostly improvement and mixed changes in mood to a lesser extent. Some participants reported having experienced more mood swings or feeling low. The reports of change in family and peer relationships were mostly positive or neutral. Positive changes included feeling closer to their family, feeling more appreciated, and having fewer arguments.

All adverse or unfavorable events were minor and anticipated, due to the changes in hormone levels. Some of these were mild headaches, mild fatigue, sleep problems, and weight gain. These events became less common after 12 months of treatment. By the end of the study, 43 out of 44 participants decided to undergo cross-sex hormone therapy. The study also found that GnRHa treatment had no significant benefit nor harm to psychological function. Gender dysphoria and body image changed very little, which was anticipated since GnRHa prevents further masculinization and feminization of the body.

Since the sample size was small and confined to the UK, the study was limited in properly identifying and assessing small changes in outcomes. Additionally, it was an uncontrolled observational study, so it was not possible to infer a relationship between cause and effect.  Furthermore, some participants chose not to answer some questions in the given questionnaires, resulting in incomplete and unusable data. The goal of the study was to figure out if any psychological or medical issues could arise in adolescents undergoing GnRHa treatment during a short period. While this 2021 study shows that there are no psychological or medical issues during GnRHa treatment in adolescence, it’s hard to tell if there will be any issues in the future. Carmichael, et. al. states in their research article that there will be a follow-up to this study, which will be looking into the effects of the treatment in early adulthood (Carmichael, 2021). Perhaps this 2021 study and the future research article to be released will allow the parents of adolescents to allow their children to undergo GnRHa treatment to help with their gender dysphoria.

References

Butler G., De Graaf N., Wren B., et. al. Assessment and support of children and adolescents with gender dysphoria. Arch Dis Child. 2018; 103(7):631-6.

Carmichael P., Butler G., Masic U., et. al. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLOS ONE. 2021; 16(20)