NEW YORK (Reuters Health) – Evidence that hormonal treatments for transgender adolescents can achieve desired physical effects is “low,” and studies regarding their psychosocial impact are lacking, researchers in Australia say.
The term “transgender” describes an individual whose gender identity differs from their sex assigned at birth. This mismatch can cause distress and functional impairment, resulting in gender dysphoria (previously called “gender identity disorder”), according to Dr. Kenneth Pang of the University of Melbourne in Parkville, Australia and colleagues.
Several hormonal treatments are available for gender dysphoria, they note, but their use depends on the individual’s developmental stage. While the physical and psychosocial impact of these treatments have been studied in adults, studies in young people are “scarce.”
For their systematic review, the researchers searched the literature from 1946 to 2017 for primary studies on the effects of gonadotropin-releasing hormone analogs (GnRHas), gender-affirming hormones, antiandrogens, and progestins on transgender adolescents.
As reported online March 7 in Pediatrics, 13 out of 83 potentially relevant studies met the inclusion criteria: nine examined GnRHa; three, estrogen; five, testosterone; and one each looked at antiandrogen (cyproterone acetate) and progestin (lynestrenol).
Most treatments achieved their intended physical effects – GnRHas and cyproterone acetate suppressed sex hormones, and estrogen or testosterone led to feminization or masculinization of secondary sex characteristics.
GnRHa treatment was associated with improvement across multiple measures of psychological functioning, but not gender dysphoria itself. The psychosocial impact of gender-affirming hormones hasn’t yet been adequately studied in adolescents.
Overall, even evidence for the physical impact of hormone treatment was “low,” the authors note. In all studies, there was a medium-to-high risk of bias and small sample sizes. Only two studies had controls, with no blinding or randomization. Most studies were retrospective and there was often “significant” loss to followup.
“Large, prospective longitudinal studies, such as have been recently initiated, with sufficient follow-up time and statistical power and the inclusion of well-matched controls will be important, as will the inclusion of outcome measures that investigate beyond the physical manifestations,” the authors conclude.
In the meantime, Dr. Pang told Reuters Health by email, “For adolescents undergoing hormonal treatment, it is important that they continue to have ongoing access to a mental health clinician, who can assist with any psychosocial issues that may arise.”
“For example,” he added, “we know that many transgender youth unfortunately continue to experience discrimination and harassment, and having suitably-trained professionals and other resources to provide support is vital.”
Dr. Caroline Salas-Humara, an adolescent pediatrician at Hassenfeld Children’s Hospital at NYU Langone Health in New York City, said she agrees with the “call to action for more research to be conducted in academic settings to help understand long-term physiologic and psychologic outcomes.”
“Patients and families right now do their best to weigh the risk and benefits of opting for medical interventions, (given) the limitations in the current evidence available for long-term outcomes,” she told Reuters Health by email.
“The risk-benefit analysis,” she said, “often includes weighing the risk of unknown long-term outcomes with the more immediate benefit of avoiding adverse mental health outcomes, including the risk for suicide.”
“In clinical practice, I often see that after my patients’ transition – including with the use of medical intervention – they become more self-assured and thrive in their lives,” Dr. Salas-Humara concluded.
SOURCE: http://bit.ly/2D8tnYu
Pediatrics 2018.
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