Note: The terminology used in each summary reflects the language as presented in the specific research papers. We have adhered to the original terminology for consistency, so some do not necessarily align with the language and terminology that TransActual would use when talking about trans people or our lived experiences.
This page summarises the findings of research studies into hormone replacement therapy in trans adults and into the use of hormone blockers and hormone replacement therapy for under 18s.
Note: This page is a work in progress — we are aware of at least 40 more studies and will add them to this page when our team have reviewed them.
HRT – over 18s
Full citation:
British Association of Gender Identity Specialists (BAGIS). (2024). Recommended minimum standards for provision and commissioning of gender-affirming care in the UK (1st ed.). https://bagis.co.uk/wp-content/uploads/2024/11/BAGIS-Minimum-Standards.pdf
Full citation:
Doyle, D. M., Lewis, T. O. G., & Barreto, M. (2023). A systematic review of psychosocial functioning changes after gender‑affirming hormone therapy among transgender people. Nature Human Behaviour, 7(8), 1320–1331. https://doi.org/10.1038/s41562-023-01605-w
Sample size:
Forty-six relevant journal articles (six qualitative, 21 cross-sectional, 19 prospective cohort) were identified.
Key findings:
- The most consistent evidence across qualitative and quantitative studies, both cross-sectional and prospective cohorts, is that gender-affirming hormone therapy reduces depressive symptoms and psychological distress
- There was also some evidence of potential reduction in general anxiety among those on masculinizing hormone therapy
Full citation:
Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., … Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8 (International Journal of Transgender Health, 23(Supplement 1), S1–S258). https://doi.org/10.1080/26895269.2022.2100644
Sample size:
N/A (WPATH guidelines)
Key findings:
Focussing on the sections related explicitly to medical transition:
- Cites regret rates of 0-4% for transmasculine top surgery; 0-8% for transfeminine bottom surgery; notes limited research on regret for transmasculine bottom surgery citing no instances of regret
- Considers adults are able to consent, though some may need the time to properly consider their options
- Clearly notes the difference between a trans identity and gender exploration
- Provides details on HRT regimens and monitoring, highlighting (discussed elsewhere) health risks associated with HRT while stressing the benefits and medical necessity
Full citation:
Giovanardi, G., Vitelli, R., Fortunato, A., Testa, R. J., & Lingiardi, V. (2021). Defensive functioning of individuals diagnosed with gender dysphoria at the beginning of their hormonal treatment. Psychology of Sexual Orientation and Gender Diversity, 8(2), 123–132. https://doi.org/10.1037/sgd0000457
Full citation:
Islam, N., Nash, R., Zhang, Q., Panagiotakopoulos, L., Daley, T., Bhasin, S., Getahun, D., Sonya Haw, J., McCracken, C., Silverberg, M. J., Tangpricha, V., Vupputuri, S., & Goodman, M. (2022). Is There a Link Between Hormone Use and Diabetes Incidence in Transgender People? Data From the STRONG Cohort. The Journal of clinical endocrinology and metabolism, 107(4), e1549–e1557. https://doi.org/10.1210/clinem/dgab832
Sample size:
Researchers used data from an electronic health record-based cohort study of persons 18 years and
older enrolled in 3 integrated health care systems. The cohort included 2869 transfeminine members matched to 28 300 cisgender women and 28 258 cisgender men on age, race/ethnicity, calendar year, and site, and 2133 transmasculine members similarly matched to 20 997 cisgender women and 20 964 cisgender men.
Key findings:
- Although transfeminine people may be at higher risk for T2DM compared with cisgender females, the corresponding difference relative to cisgender males is not discernable.
- There is little evidence that T2DM occurrence in either transfeminine or transmasculine persons is attributable to GAHT use.
Full citation:
Grimstad, F. W., Fowler, K. G., New, E. P., Ferrando, C. A., Pollard, R. R., Chapman, G., Gray, M., Gomez Lobo, V. (2020). Ovarian histopathology in transmasculine persons on testosterone: A multicenter case series. The Journal of Sexual Medicine, 17(9), 1807–1818. https://doi.org/10.1016/j.jsxm.2020.05.029
Sample size:
85 patients were included in the study. At the time of oophorectomy, the mean age and body
mass index (BMI) of the cohort were 30.4 ± 8.4 years and 30.2 ± 7.3 kg/m2, and the average
interval from initiation of testosterone to oophorectomy was 36 .3 ± 37.9 months.
Key findings:
- The results of this study find benign histopathology in ovaries of a large cohort of
transmasculine persons on testosterone which should be included when counseling
patients on ovarian retention - In general, ovaries in this cohort were within range for reproductive age ovaries and noted to have benign spectrum of pathology including folliculogenesis, and simple cysts.
Full citation:
Banks, K., Kyinn, M., Leemaqz, S. Y., Sarkodie, E., Goldstein, D., & Irwig, M. S. (2021). Blood pressure effects of gender-affirming hormone therapy in transgender and gender-diverse adults. Hypertension, 77(6), 2066–2074. https://doi.org/10.1161/HYPERTENSIONAHA.120.16839
Sample size:
Researchers followed the blood pressure of 470 transgender and gender-diverse adult patients (247
transfeminine and 223 transmasculine; mean age, 27.8 years).
Key findings:
- Within 2 to 4 months of starting GAHT, mean systolic blood pressure was lower in the trans feminine group by 4.0 mm Hg (P<0.0001) and higher in the trans masculine group by 2.6 mm Hg (P=0.02). These blood pressure changes were maintained during the whole follow-up period.
- There were no changes to diastolic blood pressure for either group.
- Data support routine blood pressure monitoring after the initiation of GAHT.
Full citation:
Baker, K. E., Wilson, L. M., Sharma, R., Dukhanin, V., McArthur, K., & Robinson, K. A. (2021). Hormone therapy, mental health, and quality of life among transgender people: A systematic review. Journal of the Endocrine Society, 5(4), bvab011. https://doi.org/10.1210/jendso/bvab011
Sample size:
Researchers reviewed 20 studies reported in 22 publications. Fifteen were trials or prospective cohorts, one was a retrospective cohort, and 4 were cross-sectional. Seven assessed QOL, 12 assessed depression, 8 assessed anxiety, and 1 assessed death by suicide. Three studies included trans-feminine people only; 7 included trans-masculine people only, and 10 included both. Three studies focused on adolescents.
Key findings:
- Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety.
- No studies showed that hormone therapy harms mental health or quality of life among transgender people.
Full citation:
Garcia, M., & Zaliznyak, M. (2020, April). Effects of feminizing hormone therapy on sexual function of transgender women [Abstract MP45‑20]. Journal of Urology, 203, e672. https://doi.org/10.1097/JU.0000000000000900.020
Sample size:
126 consecutive transgender women who presented to either undergo initial vaginoplasty surgery (N=63), or who had previously had vaginoplasty (N=63) by a single surgeon.
Key findings:
- Average of 73 percent increase in sexual satisfaction (71 pre surgery, 71/77/83 post surgery)
- On HRT and pre/post surgery participants report positive changes in orgasm
Full citation:
Spanos, C., Bretherton, I., Zajac, J. D., & Cheung, A. S. (2020). Effects of gender-affirming hormone therapy on insulin resistance and body composition in transgender individuals: A systematic review. World Journal of Diabetes, 11(3), 66–77. https://doi.org/10.4239/wjd.v11.i3.66
Sample size:
The search strategy identified 221 studies. After exclusion of studies that did not meet inclusion criteria, 26 were included (2 cross-sectional, 21 prospective-uncontrolled and 3 prospective-controlled).
Key findings:
- Evidence in transgender men suggests that testosterone therapy increases lean mass, decreases fat mass and has no impact on insulin resistance.
- Evidence in transgender women suggests that feminising hormone therapy (estradiol, with or without anti-androgen agents) decreases lean mass, increases fat mass, and may worsen insulin resistance.
- Results for insulin resistance are less consistent and uncertain.
Full citation:
Cocchetti, C., Ristori, J., Romani, A., Maggi, M., & Fisher, A. D. (2020). Hormonal treatment strategies tailored to non‑binary transgender individuals. Journal of Clinical Medicine, 9(6), 1609. https://doi.org/10.3390/jcm9061609
Sample size:
Literature review
Key findings:
- Requests for non-standard hormonal treatments are increasing but there is a lack of data in the literature around possible therapeutic strategies.
- Sections 3 and 4 detail variations of HRT for non-binary individuals (monotherapy oestrogen, testosterone regimens, use of finasteride and nandrolone, use of progesterone alongside oestrogen or testosterone, etc).
- More research is needed on HRT for non-binary people.
Full citation:
Aldridge, Z., Patel, S., Guo, B., et al. (2021). Long-term effect of gender-affirming hormone treatment on depression and anxiety symptoms in transgender people: A prospective cohort study. Andrology, 9(6), 1808–1816. https://doi.org/10.1111/andr.12884
Sample size:
178 participants selected from 1,271 invited to take part through a national transgender health
service in Nottingham, UK.
Key findings:
- GAHT reduces symptoms of depression which are predicted by having higher levels of social support.
- Although anxiety symptoms also reduce, the changes are not significant and high levels of anxiety still remain post-GAHT.
Full citation:
Chen, S., & Loshak, H. (2020). Primary care initiated gender-affirming therapy for gender dysphoria: A review of evidence based guidelines. Canadian Agency for Drugs and Technologies in Health. https://www.ncbi.nlm.nih.gov/books/NBK563451/
Sample size:
One evidence-based guideline (WPATH 2012) met the inclusion criteria and was included in this report
Key findings:
- WPATH’s 2012 guidelines suggest that with appropriate training, hormone therapy in patients with gender dysphoria can be managed by a variety of healthcare providers, including primary care providers.
- The guidelines don’t indicate whether primary care can initiate prescribing HRT.
- Concludes that the recommendation around primary care prescribing should be interpreted with caution due to lack of information on the methods used in searching for evidence and formulating it.
Full citation:
Cai, X., Hughto, J. M. W., Reisner, S. L., Pachankis, J. E., & Levy, B. R. (2019). Benefit of Gender-Affirming Medical Treatment for Transgender Elders: Later-Life Alignment of Mind and Body. LGBT health, 6(1), 34–39. https://doi.org/10.1089/lgbt.2017.0262
Sample size:
- Sample consisted of 2420 individuals, with 1442 (59.59%) transgender men and 978 (40.41%) transgender women.
- This study analyzed data from the National Transgender Discrimination Survey.
- A total of 597 participants with missing data on the key variables of age and QOL were excluded.
Key findings:
- Participants who initiated medical treatment had higher QOL than those who did not. Age moderated this association. The QOL difference was greater for older than for younger transgender individuals.
- Among all transgender men and women, gender-affirming medical treatment can be especially beneficial for elders.
- Transgender elders, regardless of whether they had recent gender-affirming medical treatment, tended to have significantly higher QOL than younger transgender individuals.
Full citation:
Rowniak, S., Bolt, L., & Sharifi, C. (2019). Effect of cross-sex hormones on the quality of life, depression, and anxiety of transgender individuals: A quantitative systematic review. JBI Database of Systematic Reviews and Implementation Reports, 17(9), 1826–1854. https://doi.org/10.11124/JBISRIR-2017-003869
Sample size:
Literature review – seven observational studies met the inclusion criteria. The total number of
transgender participants in all the included studies was 552. Population sizes in the studies
ranged from 14 to 163.
Key findings:
The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred.
Full citation:
Ashley, F. (2019). Gatekeeping hormone replacement therapy for transgender patients is dehumanising. Journal of Medical Ethics, 45(7), 480–482. https://doi.org/10.1136/medethics-2018-105293
Sample size:
N/A
Key findings:
More than just unjustified, these requirements are dehumanising and pathologising for
trans people and should be abandoned.
Full citation:
Connelly, P. J., Freel, E. M., Perry, C., Ewan, J., Touyz, R. M., Currie, G., & Delles, C. (2019). Gender-affirming hormone therapy, vascular health and cardiovascular disease in transgender adults. Hypertension, 74(6), 1141–1147. https://doi.org/10.1161/HYPERTENSIONAHA.119.13080
Sample size:
N/A – review article.
Key findings:
- Current evidence suggests that the use of estrogen by TGFs confers an increased risk of MI and ischemic stroke, Whether this is a consequence of GHT or legacy effect of natal sex remains unclear.
- TGMs lack any consistent or convincing evidence of increased risk of cardiovascular or cerebrovascular disease despite blood pressure elevations and dyslipidemia.
Full citation:
Goldstein, Z., Khan, M., Reisman, T., & Safer, J. D. (2019). Managing the risk of venous thromboembolism in transgender adults undergoing hormone therapy. Journal of Blood Medicine, 10, 209‑216. https://doi.org/10.2147/JBM.S166780
Full citation:
Getahun, D., Nash, R., Flanders, W. D., Baird, T. C., Becerra-Culqui, T. A., Cromwell, L., Hunkeler, E., Lash, T. L., Millman, A., Quinn, V. P., Robinson, B., Roblin, D., Silverberg, M. J., Safer, J., Slovis, J., Tangpricha, V., & Goodman, M. (2018). Cross-sex hormones and acute cardiovascular events in transgender persons: A cohort study. Annals of Internal Medicine, 169(4), 205–213. https://doi.org/10.7326/M17-2785
Sample size:
2842 transfeminine and 2118 transmasculine members with a mean follow-up of 4.0 and 3.6 years, respectively, matched to 48 686 cisgender men and 48 775 cisgender women.
Key findings:
- The overall analyses for ischemic stroke and myocardial infarction demonstrated similar incidence across groups.
- More pronounced differences for venous thromboembolism and and to a lesser extent, ischemic stroke were observed among transfeminine participants who initiated hormone therapy during follow-up.
- Myocardial infarction rates were greater among transfeminine participants than in matched cisgender women but were similar to those observed among cisgender men.
- The evidence was insufficient to draw conclusions about increased risk for any of the ACVEs of interest among transmasculine participants.
Full citation:
Chan, K. J., Jolly, D., & Safer, J. D. (2018). Exogenous testosterone does not induce or exacerbate the metabolic features associated with PCOS among transgender men. Endocrine Practice, 24(7), 677–683. https://doi.org/10.4158/EP-2018-0100
Sample size:
34 transgender men treated with testosterone over 6 years
Key findings:
- Participants experienced marked but statistically insignificant decreases in BMI but also HDL cholesterol
- No resulting dyslipidaemia, or HbA1C abnormalities associated with diabetes risk
Full citation:
Nguyen, H. B., Chavez, A. M., Lipner, E., Hantsoo, L., Kornfield, S. L., Davies, R. D., & Epperson, C. N. (2018). Gender-affirming hormone use in transgender individuals: Impact on behavioral health and cognition. Current Psychiatry Reports, 20(12), 110. https://doi.org/10.1007/s11920-018-0973-0
Sample size:
Both cross-sectional and longitudinal studies within the last 5 years investigating GAHT effects on mood and behavioral/psychological/mental health were prioritized.
Key findings:
- Research tends to support that GAHT reduces symptoms of anxiety and depression, lowers perceived and social distress, and improves quality of life and self-esteem in both male-to-female and female-to-male transgender individuals.
- Clinically, prescribing GAHT can help with gender dysphoria-related mental distress. Thus, timely hormonal intervention represents a crucial tool for improving behavioral wellness in transgender individuals, though effects on cognitive processes fundamental for daily living are unknown.
Full citation:
Bisson, J. R., Chan, K. J., & Safer, J. D. (2018). Prolactin levels do not rise among transgender women treated with estradiol and spironolactone. Endocrine Practice, 24(7), 646–651. https://doi.org/10.4158/EP-2018-0101
Sample size:
98 transgender women who visited the Endocrinology Clinic at Boston Medical Center (BMC) for estrogen therapy.
Key findings:
Despite extended exposure to high doses of estrogens along with high doses of testosterone-lowering medication (the estrogens themselves along with spironolactone), there was no statistically discernable change in prolactin levels.
Full citation:
Gava, G., Mancini, I., Cerpolini, S., Baldassarre, M., Seracchioli, R., & Meriggiola, M. C. (2018). Testosterone undecanoate and testosterone enanthate injections are both effective and safe in transmen over 5 years of administration. Clinical Endocrinology (Oxford), 89(6), 878–886. https://doi.org/10.1111/cen.13821
Sample size:
Fifty trans men between 21 and 42 years of age were enrolled. Twenty-five received T undecanoate 1000 mg IM (weeks 0 and 6 then every 12-16 weeks), and 25 received T enanthate 250 mg IM (every 3-4 weeks).
Key findings:
- Both T treatments led to a similar increase in haemoglobin and haematocrit which always remained within the physiological range.
- T administration was associated with an increase in total cholesterol, low-density lipoprotein cholesterol and triglycerides and a slight reduction in high-density lipoprotein cholesterol.
- Coagulative and glucidic profiles and blood pressure did not change significantly in either group.
- Body weight and BMI showed a slight but not significant increase in both groups, while lean mass rose significantly in both groups.
- Liver enzymes showed a significant and progressive increase during follow-up, but never exceeded the physiological range.
- There were no adverse events during 5 years of follow-up.
- Global satisfaction was increased at years 1 and 5 in both groups.
- Preliminary results from this pilot study suggest that administration of either TU or TE for 5 years in young transmen is both effective and safe.
Full citation:
Braun, H., Nash, R., Tangpricha, V., Brockman, J., Ward, K., & Goodman, M. (2017). Cancer in transgender people: Evidence and methodological considerations. Epidemiologic Reviews, 39(1), 93–107. https://doi.org/10.1093/epirev/mxw003
Sample size:
Literature review
Key findings:
- Limited data suggests increased risk of cancer due to differing rates of HIV and HPV
- Difficult to discern any hormone-related cancers
Full citation:
Fisher, A. D., Castellini, G., Ristori, J., Casale, H., Cassioli, E., Sensi, C., Fanni, E., Amato, A. M. L., Bettini, E., Mosconi, M., Dèttore, D., Ricca, V., & Maggi, M. (2016). Cross-sex hormone treatment and psychobiological changes in transsexual persons: Two-year follow-up data. The Journal of Clinical Endocrinology & Metabolism, 101(11), 4260–4269. https://doi.org/10.1210/jc.2016-1276
Sample size:
A consecutive series of 359 gender-dysphoric persons (GDs) was considered for a cross-sectional section of the study. In addition, 54 GDs were studied in a 2-year follow-up.
Key findings:
- GDs undergoing cross-sex hormone treatment (CHT) reported significantly lower subjective levels of gender dysphoria, body uneasiness, and depressive symptoms as compared with those without.
- CHT-induced body modifications were significantly associated with a better psychological adjustment.
- During CHT, GDs reported a significant reduction of general psychopathology, depressive symptoms, and subjective GD, whereas social and legal indicators of GD showed a significant increase across time.
- The results support the efficacy of CHT intervention in improving subjective perception of one’s own body, which was partially associated with objective changes.
Full citation:
White Hughto, J. M., & Reisner, S. L. (2016). A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health, 1(1), 21–31. https://doi.org/10.1089/trgh.2015.0008
Sample size:
Three uncontrolled prospective cohort studies, enrolling 247 transgender adults (180 male-to-female [MTF], 67 female-to-male [FTM]) initiating hormone therapy for the treatment of gender identity disorder
Key findings:
- Studies broadly found statistically significant positive psychological outcomes associated with treatment.
- Identified biases of studies, broadly found to be low.
Full citation:
Deutsch, M. B., Bhakri, V., & Kubicek, K. (2015). Effects of cross-sex hormone treatment on transgender women and men. Obstetrics and gynecology, 125(3), 605–610. https://doi.org/10.1097/AOG.0000000000000692
Sample size:
Sixteen transgender women and 31 transgender men completed the study.
Key findings:
- In transgender women, estrogen therapy, with or without anti-androgen therapy, was associated with lower blood pressure.
- In transgender men, testosterone therapy was associated with increased body mass index. Observed weight and body mass index changes were modest at most.
- Monitoring of hormone levels to guide therapy appears to be useful.
- This study found normal range median blood pressure and median lipid values before and after 6 months of cross sex hormone therapy in a mixed sample of transgender women and men.
Full citation:
Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven sampling study in Ontario, Canada. BMC Public Health, 15, 525. https://doi.org/10.1186/s12889-015-1867-2
Sample size:
Analysis is based on 380 participants (87.8 %) who completed items on past-year suicide ideation and attempts (n = 433), 16+.
Key findings:
INCLUDES SUICIDE STATISTICS
- Medical transition (in process/completed) associated with lower ideation; higher risk of attempt in those in the process of medical transition compared to those planning transition; completed transition and facilitating transition associated with strong decrease in ideation, and potential decrease in attempts, though no statistically significant effect on risk.
- 35.1% report suicidal ideation in past year; 11.2% reported suicide attempt in same period.
- High social support correlated with decreased suicidal ideation and risk; parental support associated with statistically significant reduced risk of ideation but not of risk; support from social/community leaders associated with increased risk of attempt in those experiencing ideation; having at least one matching ID document associated with reduced ideation.
- Experiencing transphobia associated with increased ideation/risk and vice versa.
Full citation:
Colizzi, M., Costa, R., & Todarello, O. (2014). Transsexual patients’ psychiatric comorbidity and positive effect of cross-sex hormonal treatment on mental health: Results from a longitudinal study. Psychoneuroendocrinology, 39, 65-73. https://doi.org/10.1016/j.psyneuen.2013.09.029
Sample size:
The study investigated 118 patients before starting the hormonal therapy and after about 12 months.
Key findings:
- The results revealed that the majority of transsexual patients have no psychiatric comorbidity, suggesting that transsexualism is not necessarily associated with severe comorbid psychiatric findings.
- Treated patients reported less psychiatric distress. Therefore, hormonal treatment seemed to have a positive effect on transsexual patients’ mental health.
Full citation:
Gómez-Gil, E., Zubiaurre-Elorza, L., Esteva, I., Guillamon, A., Godás, T., Almaraz, M. C., Halperin, I., & Salamero, M. (2012). Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology, 37(5), 662–670. https://doi.org/10.1016/j.psyneuen.2011.08.010
Sample size:
A group of 187 transsexual patients attending a gender identity unit; 120 had undergone hormonal sex-reassignment (SR) treatment and 67 had not.
Key findings:
- The results suggest that most transsexual patients attending a gender identity unit reported subclinical levels of social distress, anxiety, and depression.
- Patients under cross-sex hormonal treatment displayed a lower prevalence of these symptoms than patients who had not initiated hormonal therapy.
Full citation:
Gorin-Lazard, A., Baumstarck, K., Boyer, L., Maquigneau, A., Gebleux, S., Penochet, J.-C., Pringuey, D., Albarel, F., Morange, I., Loundou, A., Berbis, J., Auquier, P., Lançon, C., & Bonierbale, M. (2012). Is hormonal therapy associated with better quality of life in transsexuals? A cross-sectional study. The Journal of Sexual Medicine, 9(2), 531–541. https://doi.org/10.1111/j.1743-6109.2011.02564.x
Sample size:
This study enrolled a large sample (N=446) comprised solely of FtM individuals.
Key findings:
Hormonal therapy was significantly associated with a higher QoL.
Full citation:
St. Amand, C., Fitzgerald, K. M., Pardo, S. T., & Babcock, J. (2011). The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals. Journal of Gay & Lesbian Mental Health, 15(3), 281–299. https://doi.org/10.1080/19359705.2011.581195
Sample size:
69 self-identified ftm trans adults (minimum age 18) who participated in an anonymous online survey. They had a mean age of 28, with a range of 18-68. 66% reported being on HRT (testosterone therapy), 34% reported not being on HRT (testosterone therapy).
Key findings:
- HRT in the form of testosterone for FTM participants is associated with fewer negative psychological symptoms and in addition is related to greater levels of protective factors and sources of resiliency, such as perceived social support and a higher quality of life
- The study states that: “Depression and anxiety are not typically thought to impair reality testing, and have been shown to be improved in individuals on HRT. A clinical implication is that a diagnosis of depression and/or anxiety should not contraindicate HRT.”
Full citation:
Murad, M. H., Elamin, M. B., Zumaeta Garcia, M., Mullan, R. J., Murad, A., Erwin, P. J., & Montori, V. M. (2010). Hormonal therapy and sex reassignment: A systematic review and meta‑analysis of quality of life and psychosocial outcomes. Clinical Endocrinology, 72(2), 214–231. https://doi.org/10.1111/j.1365‑2265.2009.03625.x
Sample size:
Meta-analysis of 28 studies, these studies had a total of 1833 participants (1093 MTF, 801 FTM).
Key findings:
INCLUDES SUICIDE MENTION
- Some data suggests MTF have worse outcomes than FTM in general,
- 28 studies with fairly long follow-up duration that demonstrated improvements in gender dysphoria, psychological functioning and comorbidities, lower suicide rates, higher sexual satisfaction and, overall, improvement in the quality of life.
- 80% of individuals reported significant improvement of gender dysphoria and most did not report regrets.
- 80% of individuals reported better quality of life.
- 72% of individuals reported better sexual function/satisfaction.
- Individuals with earlier onset of dysphoria may have better prognosis.
- Individuals with pre-existing psychopathology may have worse prognosis.
Full citation:
Elamin, M. B., Garcia, M. Z., Murad, M. H., Erwin, P. J., & Montori, V. M. (2010). Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analyses. Clinical endocrinology, 72(1), 1–10. https://doi.org/10.1111/j.1365-2265.2009.03632.x
Sample size:
Researchers found 16 eligible studies, mostly uncontrolled cohorts of varied follow-up durations (1471 male-to-female (MF) and 651 female-to-male (FM) individuals).
Key findings:
- There were very few reported cardiovascular events (deaths, strokes, myocardial.
- infarctions or venous thromboembolism), more commonly among MF individuals.
- Overall, no significant effect of hormones on cardiovascular outcomes.
- Very low quality evidence, downgraded due to methodological limitations of included studies, imprecision and heterogeneity, suggests that cross-sex hormone therapies increase serum triglycerides in MF and FM and have a trivial effect on HDL-cholesterol and systolic blood pressure in FM.
Full citation:
Smith, Y. L. S., van Goozen, S. H. M., Kuiper, A. J., & Cohen‑Kettenis, P. T. (2005). Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals. Psychological Medicine, 35(1), 89–99. https://doi.org/10.1017/S0033291704002776
Sample size:
325 consecutive adolescent and adult applicants for sex reassignment participated: 222 started hormone treatment, 103 did not; 188 completed and 34 dropped out of treatment.
Key findings:
- Treated group saw large reduction in dysphoria and minimal regret (1.6% of participants undergoing treatment had regrets – only 1 would not have had surgery, 5 experienced regret during treatment only), with more mix when it comes to satisfaction.
- Identified stable psychopathology and strong dysphoria as predictors for selection and non-drop-out of treatment group; unstable psychopathology and strong childhood dysphoria versus weaker present dysphoria predictors of non-treatment selection/drop-out.
- Identified need for clear information and care instructions, and support for adjustment, during/after treatment/surgery.
Full citation:
Levy, A., Crown, A., & Reid, R. (2003). Endocrine intervention for transsexuals. Clinical Endocrinology, 59(4), 409–418. https://doi.org/10.1046/j.1365-2265.2003.01821.x
Sample size:
N/A
Key findings:
- The choice of cross-sex hormone treatment is generally straightforward and complications, principally venous thromboembolism in male-to-female and potentially osteoporosis in female-to-male, are highly amenable to treatment.
- Although more evidence would be welcome, adequately treated gender dysphoria is likely to be safer than the untreated condition, which is associated with an enhanced risk of depression and suicide.
- Few transsexuals regret undergoing treatment.
- Transsexual individuals require long-term assistance to optimize cross-sex hormone treatment and should not be subject to discrimination when they seek health care.
Full citation:
Gooren, L. J., van Trotsenburg, M. A. A., Giltay, E. J., & van Diest, P. J. (2013). Breast cancer development in transsexual subjects receiving cross‑sex hormone treatment. The Journal of Sexual Medicine, 10(12), 3129‑3134. https://doi.org/10.1111/jsm.12319
Full citation:
Heylens, G., Verroken, C., De Cock, S., T’Sjoen, G., & De Cuypere, G. (2014). Effects of different steps in gender reassignment therapy on psychopathology: A prospective study of persons with a gender identity disorder. The Journal of Sexual Medicine, 11(1), 119‑126. https://doi.org/10.1111/jsm.12363
Sample size:
57 individuals with GID
Full citation:
Connelly, P. J., & Delles, C. (2021). Cardiovascular disease in transgender people: Recent research and emerging evidence. Cardiovascular Research, 117(14), e174–e176. https://doi.org/10.1093/cvr/cvab288
Sample size:
N/A (an opinion piece)
Full citation:
Murphy, C. N., Delles, C., Davies, E., & Connelly, P. J. (2023). Cardiovascular disease in transgender individuals. Atherosclerosis, 384, Article 117282. https://doi.org/10.1016/j.atherosclerosis.2023.117282
Sample size:
- medical records of all adolescents diagnosed with gender dysphoria at the Vrije Universiteit Medical Center from 1998 to December 2015 were retrospectively reviewed.
- 71 trans women and 121 trans men who started puberty blockers at 15 with subsequent addition of sex hormones at 17
Key findings:
- data shows that changes in various cardiovascular risk factors are similar to changes in those risk factors in the general adolescent population.
- at the age of 22, prevalence of obesity was higher in trans women (9.9%) and trans men (6.6%) than in reference cis women (2.2%) or cis men (3.0%).
- in trans men, obesity prevalence was higher pretreatment, but increase in prevalence (1.6%) was comparable to that of cis men (1.2%). In contrast the increase of obesity prevalence in transwomen (8.5%) was markedly higher than cis women (0.7%). The authors speculate this may be due to a more indoor sedentary lifestyle compared with the general population.
- at the age of 22, high total cholesterol levels were similar or lower: 0% for trans women, 5.3% for trans men, compared with 6.6% for reference cis women and 4.4% for reference cis men.
- no statistically significant differences between gonadectomy vs continued use of puberty blockers for any risk factor
Full citation:
Seelman, K. L., Colón-Díaz, M. J. P., LeCroix, R. H., Xavier-Brier, M., & Kattari, L. (2017). Transgender noninclusive healthcare and delaying care because of fear: Connections to general health and mental health among transgender adults. Transgender Health, 2(1), 17-28. https://doi.org/10.1089/trgh.2016.0024
Full citation:
Singh-Ospina, N., Maraka, S., Rodriguez-Gutierrez, R., Davidge-Pitts, C., Nippoldt, T. B., Prokop, L. J., & Murad, M. H. (2017). Effect of sex steroids on the bone health of transgender individuals: A systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3904–3913. https://doi.org/10.1210/jc.2017-01642
Full citation:
Spanos, C., Grace, J. A., Leemaqz, S. Y., Brownhill, A., Cundill, P., Locke, P., Wong, P., Zajac, J. D., & Cheung, A. S. (2021). The informed consent model of care for accessing gender-affirming hormone therapy is associated with high patient satisfaction. The Journal of Sexual Medicine, 18(1), 201–208. https://doi.org/10.1016/j.jsxm.2020.10.020
Full citation:
van Dijk, D., Dekker, M. J. H. J., Conemans, E. B., Wiepjes, C. M., de Goeij, E. G. M., Overbeek, K. A., Fisher, A. D., den Heijer, M., & T’Sjoen, G. (2019). Explorative prospective evaluation of short-term subjective effects of hormonal treatment in trans people—Results from the European Network for the Investigation of Gender Incongruence. The Journal of Sexual Medicine, 16(8), 1297–1309. https://doi.org/10.1016/j.jsxm.2019.05.009
Full citation:
Weinand, J. D., & Safer, J. D. (2015). Hormone therapy in transgender adults is safe with provider supervision: A review of hormone therapy sequelae for transgender individuals. Journal of Clinical & Translational Endocrinology, 2(2), 55–60. https://doi.org/10.1016/j.jcte.2015.02.003
Full citation:
Wiepjes, C. M., de Blok, C. J. M., Staphorsius, A. S., Nota, N. M., Vlot, M. C., de Jongh, R. T., & den Heijer, M. (2020). Fracture risk in trans women and trans men using long-term gender-affirming hormonal treatment: A nationwide cohort study. Journal of Bone and Mineral Research, 35(1), 64–70. https://doi.org/10.1002/jbmr.3862
Full citation:
Wierckx, K., Elaut, E., Declercq, E., Heylens, G., De Cuypere, G., Taes, Y., Kaufman, J. M., & T’Sjoen, G. (2013). Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: A case-control study. European Journal of Endocrinology, 169(4), 471–478. https://doi.org/10.1530/EJE-13-0493
Full citation:
Wierckx, K., Van Caenegem, E., Schreiner, T., Haraldsen, I. H., Fisher, A. D., Toye, K., Kaufman, J. M., & T’Sjoen, G. (2014). Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: Results from the European network for the investigation of gender incongruence. The Journal of Sexual Medicine, 11(8), 1999–2011. https://doi.org/10.1111/jsm.12571
Full citation:
van Leerdam, T. R., Zajac, J. D., & Cheung, A. S. (2023). The effect of gender-affirming hormones on gender dysphoria, quality of life, and psychological functioning in transgender individuals: A systematic review. Transgender Health, 8(1), 6–21. https://doi.org/10.1089/trgh.2020.0094
Full citation:
Totaro, M., Palazzi, S., Castellini, G., Parisi, M., D’Amato, C., Tienforti, D., Baroni, S., Francavilla, F., & Barbonetti, A. (2021). Risk of venous thromboembolism in transgender people undergoing hormone feminizing therapy: A prevalence meta-analysis and meta-regression study. Frontiers in Endocrinology, 12, 741866. https://doi.org/10.3389/fendo.2021.741866
Full citation:
Krupka, E., Curtis, S., Ferguson, T., Whitlock, R., Millar, A. C., Dahl, M., Fung, M., Ahmed, S. B., Tangri, N., & Walsh, M. (2022). The effect of gender-affirming hormone therapy on measures of kidney function: A systematic review and meta-analysis. Clinical Journal of the American Society of Nephrology, 17(9), 1281–1283. https://doi.org/10.2215/CJN.01890222
Full citation:
Kristensen, T. T., Christensen, L. L., Frystyk, J., Glintborg, D., T’Sjoen, G., Roessler, K. K., & Andersen, M. S. (2021). Effects of testosterone therapy on constructs related to aggression in transgender men: A systematic review. Hormones and Behavior, 128, 104912. https://doi.org/10.1016/j.yhbeh.2020.104912
Full citation:
Giacomelli, G., & Meriggiola, M. C. (2022). Bone health in transgender people: A narrative review. Therapeutic Advances in Endocrinology and Metabolism, 13, 20420188221099346. https://doi.org/10.1177/20420188221099346
Full citation:
Dimakopoulou, A., & Seal, L. J. (2024). Testosterone and other treatments for transgender males and non-binary trans masculine individuals. Best Practice & Research Clinical Endocrinology & Metabolism, 38(5), 101908. https://doi.org/10.1016/j.beem.2024.101908
Full citation:
D’hoore, L., & T’Sjoen, G. (2022). Gender-affirming hormone therapy: An updated literature review with an eye on the future. Journal of Internal Medicine, 291(5), 574–592. https://doi.org/10.1111/joim.13441
Full citation:
Swe, N. C., Ahmed, S., Eid, M., Poretsky, L., Gianos, E., & Cusano, N. E. (2022). The effects of gender-affirming hormone therapy on cardiovascular and skeletal health: A literature review. Metabolism Open, 13, 100173. https://doi.org/10.1016/j.metop.2022.100173
Full citation:
Aranda, G., Halperin, I., Gómez-Gil, E., Hanzu, F. A., Seguí, N., Guillamón, A., & Mora, M. (2021). Cardiovascular risk associated with gender-affirming hormone therapy in transgender population. Frontiers in Endocrinology, 12, 718200. https://doi.org/10.3389/fendo.2021.718200
Full citation:
Endocrine Society. (2020, December 16). Transgender health: An Endocrine Society position statement. https://www.endocrine.org/advocacy/position-statements/transgender-health
Full citation:
What We Know Project, Cornell University. (2018). What does the scholarly research say about the effect of gender transition on transgender well-being? https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/
Full citation:
van de Grift, T. C., Elaut, E., Cerwenka, S. C., Cohen-Kettenis, P. T., De Cuypere, G., Richter-Appelt, H., & Kreukels, B. P. C. (2017). Effects of medical interventions on gender dysphoria and body image: A follow-up study. Psychosomatic Medicine, 79(7), 815–823. https://doi.org/10.1097/PSY.0000000000000465
Full citation:
Costa, R., & Colizzi, M. (2016). The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: A systematic review. Neuropsychiatric Disease and Treatment, 12, 1953–1966. https://doi.org/10.2147/NDT.S95310
Full citation:
Bouman, W. P., Claes, L., Marshall, E., Pinner, G. T., Longworth, J., & Arcelus, J. (2016). Sociodemographic variables, clinical features, and the role of preassessment cross-sex hormones in older trans people. The Journal of Sexual Medicine, 13(4), 711–719. https://doi.org/10.1016/j.jsxm.2016.01.009
Full citation:
White Hughto, J. M., & Reisner, S. L. (2016). A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health, 1(1), 21–31. https://doi.org/10.1089/trgh.2015.0008
Full citation:
Keo-Meier, C. L., Herman, L. I., Reisner, S. L., Pardo, S. T., Sharp, C., & Babcock, J. C. (2015). Testosterone treatment and MMPI–2 improvement in transgender men: A prospective controlled study. Journal of Consulting and Clinical Psychology, 83(1), 143–156. https://doi.org/10.1037/a0037599
Full citation:
Bailey, L., Ellis, S. J., & McNeil, J. (2014). Suicide risk in the UK trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt. Mental Health Review Journal, 19(4), 209–220. https://doi.org/10.1108/MHRJ-05-2014-0015
Full citation:
Gorin-Lazard, A., Baumstarck, K., Boyer, L., Maquigneau, A., Penochet, J. C., Pringuey, D., Albarel, F., Morange, I., Bonierbale, M., Lançon, C., & Auquier, P. (2013). Hormonal therapy is associated with better self-esteem, mood, and quality of life in transsexuals. Journal of Nervous and Mental Disease, 201(11), 996–1000. https://doi.org/10.1097/NMD.0000000000000046
Full citation:
Colizzi, M., Costa, R., Pace, V., & Todarello, O. (2013). Hormonal treatment reduces psychobiological distress in gender identity disorder, independently of the attachment style. The Journal of Sexual Medicine, 10(12), 3049–3058. https://doi.org/10.1111/jsm.12155
Full citation:
Colton Meier, S. L., Fitzgerald, K. M., Pardo, S. T., & Babcock, J. (2011). The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals. Journal of Gay & Lesbian Mental Health, 15(3), 281–299. https://doi.org/10.1080/19359705.2011.581195
Full citation:
Cooney, E. E., Yeh, P. T., Kennedy, K. S., Kaptchuk, R. P., Wong, B., & Kennedy, C. E. (2025). Provision of gender-affirming hormones for trans and gender-diverse adults: A systematic review of health and quality of life outcomes, values and preferences, and costs. EClinicalMedicine, 88, 103460. https://doi.org/10.1016/j.eclinm.2025.103460
Full citation:
Brown, A., Montagner-Moraes, S., & Hamilton, B. R. (2024). The effects of gender-affirming hormone treatment on transgender musculoskeletal health: A protocol for a systematic review and meta-analysis. PROSPERO. https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42024573102
Hormone blockers and HRT – under 18s
Full citation:
de Vries, A. L. C., Richards, C., Tishelman, A. C., Motmans, J., Hannema, S. E., Green, J., & Rosenthal, S. M. (2021). Bell v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274: Weighing current knowledge and uncertainties in decisions about gender-related treatment for transgender adolescents. International Journal of Transgender Health, 22(3), 217–224. https://doi.org/10.1080/26895269.2021.1904330
Full citation:
Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., Skageberg, E. M., Khadr, S., & Viner, R. M. (2021). 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, 16(2), e0243894. https://doi.org/10.1371/journal.pone.0243894
Sample size:
44 patients aged 12–15 years old with persistent and severe gender dysphoria .44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months.
Key findings:
- At the end of the study one participant ceased GnRHa and 43 (98%) elected to start cross-sex hormones.
- Overall patient experience of changes on GnRHa treatment was positive. No changes identified in psychological function.
- Changes in Bone Mass Density were consistent with suppression of growth. Height growth continued through the study but more slowly than expected for age.
- At 15–24 months, 55% reported solely positive changes such as feeling happier, no longer experiencing side effects and feeling more comfortable with puberty suspended.
- Anticipated effects of withdrawal of sex hormones on symptoms were common and there were no unexpected adverse events.
Full citation:
Rew, L., Young, C. C., Monge, M., & Bogucka, R. (2021). Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature. Child and Adolescent Mental Health, 26(1), 3–14. https://doi.org/10.1111/camh.12437
Full citation:
Grannis, K., Kandalaft, O., Baranek, H., Dunsiger, S., & Nahata, L. (2021). Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys. The Journal of Adolescent Health, 68(6), 1203–1209. https://doi.org/10.1016/j.jadohealth.2020.10.002
Sample size:
19 adolescent transgender boys receiving testosterone treatment and 23 not receiving gonadal hormone treatment.
Key findings:
- Testosterone treatment is associated with lower levels of internalizing symptoms among transgender adolescent boys.
- Severity of anxiety and depression was significantly lower in the T treated group relative to the UT group, along with a trend of lower suicidality.
- The T group also reported less distress with body features and exhibited stronger connectivity within the amygdala-prefrontal cortex circuit compared to the UT group.
- Group differences on depression and suicidality were directly associated with body image dissatisfaction, and anxiety symptoms were moderated by amygdala-prefrontal cortex connectivity differences between groups.
Full citation:
Mullins, E. S., Geer, R., Metcalf, M., Piccola, J., Lane, A., Conard, L. A. E., & Mullins, T. L. K. (2021). Thrombosis risk in transgender adolescents receiving gender-affirming hormone therapy. Pediatrics, 147(4), e2020023549. https://doi.org/10.1542/peds.2020-023549
Full citation:
Schagen, S. E. E., Wouters, F. M., Cohen-Kettenis, P. T., Gooren, L. J., & Hannema, S. E. (2020). Bone development in transgender adolescents treated with GnRH analogues and subsequent gender-affirming hormones. The Journal of Clinical Endocrinology & Metabolism, 105(12), e4252–e4263. https://doi.org/10.1210/clinem/dgaa604
Full citation:
Kuper, L. E., Stewart, S., Preston, S., Lau, M., & Lopez, X. (2020). Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy. Pediatrics, 145(4), e20193006. https://doi.org/10.1542/peds.2019-3006
Sample size:
Participants (n = 148; ages 9–18 years; mean age 14.9 years) were receiving gender-affirming hormone therapy at a multidisciplinary program in Dallas, Texas (n = 25 puberty suppression only; n = 123 feminizing or masculinizing hormone therapy).
Key findings:
- Youth reported large improvements in body dissatisfaction.
- Results provide further evidence of the critical role of gender-affirming hormone therapy in reducing body dissatisfaction.
Full citation:
Klaver, M., de Blok, C. J. M., Wiepjes, C. M., Nota, N. M., Dekker, M. J. H. J., & den Heijer, M. (2020). Hormonal treatment and cardiovascular risk profile in transgender adolescents. Pediatrics, 145(3), e20190741. https://doi.org/10.1542/peds.2019-0741
Sample size:
- medical records of all adolescents diagnosed with gender dysphoria at the Vrije Universiteit Medical Center from 1998 to December 2015 were retrospectively reviewed.
- 71 trans women and 121 trans men who started puberty blockers at 15 with subsequent addition of sex hormones at 17
Key findings:
- data shows that changes in various cardiovascular risk factors are similar to changes in those risk factors in the general adolescent population.
- at the age of 22, prevalence of obesity was higher in trans women (9.9%) and trans men (6.6%) than in reference cis women (2.2%) or cis men (3.0%).
- in trans men, obesity prevalence was higher pretreatment, but increase in prevalence (1.6%) was comparable to that of cis men (1.2%). In contrast the increase of obesity prevalence in transwomen (8.5%) was markedly higher than cis women (0.7%). The authors speculate this may be due to a more indoor sedentary lifestyle compared with the general population.
- at the age of 22, high total cholesterol levels were similar or lower: 0% for trans women, 5.3% for trans men, compared with 6.6% for reference cis women and 4.4% for reference cis men.
- no statistically significant differences between gonadectomy vs continued use of puberty blockers for any risk factor
Full citation:
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, 2020, 8. https://doi.org/10.1186/s13633-020-00078-2
Sample size:
Between 2013 and 2018, 50 participants (mean age 16.2 + 2.2 yr) who were naïve to endocrine intervention completed 3 waves of questionnaires.
Key findings:
- Mean depression scores and suicidal ideation decreased over time while mean quality of life scores improved over time. When controlling for psychiatric medications and engagement in counseling, regression analysis suggested improvement with endocrine intervention.
- Results suggest that endocrine intervention is associated with improved mental health among transgender youth.
Full citation:
van der Miesen, A. I. R., Steensma, T. D., de Vries, A. L. C., Bos, H. M. W., & Popma, A. (2020). Psychological functioning in transgender adolescents before and after gender‑affirmative care compared with cisgender general population peers. Journal of Adolescent Health, 66(6), 699–704. https://doi.org/10.1016/j.jadohealth.2019.12.018
Sample size:
A sample of 272 adolescents referred to a specialized gender identity clinic who had not yet received any affirmative medical treatment, compared with 178 transgender adolescents receiving affirmative care consisting of puberty suppression, compared with 651 Dutch high school cisgender adolescents from the general population.
Key findings:
INCLUDES SELF-HARM AND SUICIDE MENTION
- Adolescents with GD receiving puberty suppression had fewer emotional and behavioural problems than the referred group, and had similar or fewer problems to compared with cisgender peers on the Youth Self-Report domains.
- Transgender adolescents show poorer psychological well-being before treatment but show similar or better psychological functioning compared with cisgender peers from the general population after the start of specialized transgender care involving puberty suppression.
- Before treatment, adolescents referred to the gender identity clinic showed more internalising problems and reported increased self-harm, suicidal thoughts, and poorer peer relations compared with cisgender peers on the Youth Self-Report domains.
Full citation:
Becker-Hebly, I., Fahrenkrug, S., Campion, F., Richter-Appelt, H., Schulte-Markwort, M., & Barkmann, C. (2021). Psychosocial health in adolescents and young adults with gender dysphoria before and after gender-affirming medical interventions: A descriptive study from the Hamburg Gender Identity Service. European Child & Adolescent Psychiatry, 30(11), 1755–1767. https://doi.org/10.1007/s00787-020-01640-2
Sample size:
75 adolescents and young adults (n = 64 trans-male/birth-assigned female and n = 11 trans-female/birth-assigned male adolescents) measured at their initial intake and on average 2 years later (M treatment duration = 21.4 months). Four cohorts: 1) No medical intervention, 2) puberty suppression, 3) HRT, 4) surgery
Key findings:
- Psychological functioning and health-related quality of life were significantly impaired at baseline compared to norms.
- For those who received no medical interventions the scores still indicated this, as did clinicians’ ratings of global functioning.
- Adolescents who underwent puberty suppression or GA (hormonal and surgical) interventions showed better scores in some of the psychosocial health dimensions.
- Adolescents who had undergone a full social transition and medical treatment presented psychosocial health scores that were improved (closer to the norm) from their initial scores, and compared to the scores of the groups who had received no medical interventions or only puberty suppression
- Baseline difficulties, as reflected in the total problem score and internalizing problems score, persisted throughout the follow-up period in the puberty suppression group. Similar problems persisted in the HRT and surgery groups, but their scores were more similar to the baseline.
Full citation:
Kaltiala, R., Heino, E., Työläjärvi, M., & Suomalainen, L. (2019). Adolescent development and psychosocial functioning after starting cross-sex hormones for gender dysphoria. Nordic Journal of Psychiatry, 74(3), 213–219. https://doi.org/10.1080/08039488.2019.1691260
Sample size:
52 adolescents who came into gender identity assessment before age 18, were diagnosed with transsexualism and started hormonal gender reassignment.
Key findings:
- Those who did well in terms of psychiatric symptoms and functioning before cross-sex hormones mainly did well during real-life.
- Those who had psychiatric treatment needs or problems in school, peer relationships and managing everyday matters outside of home continued to have problems during real-life.
- Medical gender reassignment is not enough to improve functioning and relieve psychiatric comorbidities among adolescents with gender dysphoria. Appropriate interventions are warranted for psychiatric comorbidities and problems in adolescent development.
Full citation:
Olson-Kennedy, J., Chan, Y. M., Garofalo, R., Spack, N., Chen, D., Clark, L., Ehrensaft, D., Hidalgo, M., Tishelman, A., & Rosenthal, S. (2019). Impact of early medical treatment for transgender youth: Protocol for the longitudinal, observational Trans Youth Care Study. JMIR Research Protocols, 8(7), e14434. https://doi.org/10.2196/14434
Full citation:
Gülgöz, S., Glazier, J. J., Enright, E. A., Alonso, D. J., Durwood, L. J., Fast, A. A., Lowe, R., Ji, C., Heer, J., Martin, C. L., & Olson, K. R. (2019). Similarity in transgender and cisgender children’s gender development. Proceedings of the National Academy of Sciences, 116(49), 24480–24485. https://doi.org/10.1073/pnas.1909367116
Sample size:
317 transgender children aged 3-12, “who, in early childhood, are identifying and living as a gender different from their assigned sex”.
Key findings:
- Noted identification and preferences stereotypically associated with cisgender children.
- Statistical similarities observed in gender identification, gendered toy preferences and preferences for same-gender peers in mean and variability.
- Trans and cis children show similar gender coherence (i.e. children with stronger gendered toy preferences had stronger gendered clothing preferences etc).
- Indicates trans children have neither stronger nor weaker identities or preferences based on the length for which they have identified as trans.
Full citation:
Chew, D., Anderson, J., Williams, K., May, T., & Pang, K. (2018). Hormonal treatment in young people with gender dysphoria: A systematic review. Pediatrics, 141(4), e20173742. https://doi.org/10.1542/peds.2017-3742
Sample size:
Thirteen studies met our inclusion criteria, in which researchers examined GnRHas (n = 9), estrogen (n = 3), testosterone (n = 5), antiandrogen (cyproterone acetate) (n = 1), and progestin (lynestrenol) (n = 1).
Key findings:
- The researchers stated that “Low-quality evidence suggests that hormonal treatments for transgender adolescents can achieve their intended physical effects, but evidence regarding their psychosocial and cognitive impact are generally lacking.”
Full citation:
Vrouenraets, Lieke & Fredriks, A. & Hannema, Sabine & Cohen-Kettenis, Peggy & de Vries, Martine. (2016). Perceptions of Sex, Gender, and Puberty Suppression: A Qualitative Analysis of Transgender Youth. Archives of Sexual Behavior. 45. 10.1007/s10508-016-0764-9.
Sample size:
All 13 adolescents, except for one, were treated with puberty suppression; five adolescents were trans girls and eight were trans boys. Their ages ranged between 13 and 18 years, with an average age of 16 years and 11 months, and a median age of 17 years and 4 months.
Key findings:
- Most adolescents stated that the lack of long-term data did not and would not stop them from wanting puberty suppression.
- However, the adolescents also showed that they seriously weighed the short- and long-term consequences, and consciously chose for the treatment.
Full citation:
Vrouenraets, L. J. J. J., Fredriks, A. M., Hannema, S. E., Cohen‑Kettenis, P. T., & de Vries, M. C. (2015). Early medical treatment of children and adolescents with gender dysphoria: An empirical ethical study. Journal of Adolescent Health, 57(4), 367–373. https://doi.org/10.1016/j.jadohealth.2015.04.004
Sample size:
Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinolo-gists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide.
Key findings:
- Many of the informants felt that the lack of an explanatory model for gender dysphoria does not affect the way adolescents with GD should be treated (cause is irrelevant to treatment).
- Many varying opinions among treatment teams as to whether adolescents should receive medical treatment (blockers and/or hormones).
- Debate around whether the age (12 years old) needs to be lowered or at least be more flexible as puberty seems to be happening at increasingly younger ages.
Full citation:
Costa, R., Dunsford, M., Skagerberg, E., Holt, V., Carmichael, P., & Colizzi, M. (2015). Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. The Journal of Sexual Medicine, 12(11), 2206–2214. https://doi.org/10.1111/jsm.13034
Sample size:
201 GD adolescents after psychological support and puberty suppression.
Key findings:
- Noted improvement in CGAS score for all participants.
- CGAS score improvement higher in patients that received puberty blockers than compared with psychological support alone (not statistically significant).
- Both psychological support and puberty blockers are considered beneficial.
Full citation:
de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696–704. https://doi.org/10.1542/peds.2013-2958
Sample size:
A total of 55 young transgender adults (22 trans women and 33 trans men) who had received
puberty suppression during adolescence were assessed 3 times: before the start of puberty
suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age,
16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years).
Key findings:
- In young adulthood, gender dysphoria had resolved, psychological functioning had steadily improved, and well-being was comparable to same-age peers. The clinical protocol including puberty suppression had provided these formerly gender dysphoric youth the opportunity to develop into well-functioning young adults.
- After gender reassignment, in young adulthood, the Gender Dysphoria was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being.
- A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.
- It is not only early medical intervention that determines this success, but also a comprehensive multidisciplinary approach that attends to the adolescents’ Gender Dysphoria as well as their further well-being and a supportive environment.
Full citation:
Cohen-Kettenis, P., Schagen, S., Steensma, T., de Vries, A., & de Waal, H. (2011). Puberty suppression in a gender-dysphoric adolescent: A 22-year follow-up. Archives of Sexual Behavior, 40(5), 843–847. https://doi.org/10.1007/s10508-011-9758-9
Sample size:
Case report on a 22-year follow-up of a female-to-male transsexual, treated with GnRH analogues at 13 years of age and considered eligible for androgen treatment at age 17, and who had gender reassignment surgery at 20 and 22 years of age.
Key findings:
- All observed anthropometric measurements were within the normal range.
- Although B would have liked to be taller, they did not find unfavourable medical outcomes. Therefore, the fear that GnRH analogue treatment will result in poor long-term outcome was not supported in this case.
- Pubertal suppression averts the despair of gender dysphoric adolescents because of their physical changes and it may contribute to more self-confidence when socially interacting in adolescence and adulthood.
Full citation:
Kreukels, B. P., & Cohen-Kettenis, P. T. (2011). Puberty suppression in gender identity disorder: The Amsterdam experience. Nature Reviews Endocrinology, 7, 466-472. http://dx.doi.org/10.1038/nrendo.2011.78
Sample size:
For this literature review, researchers searched the literature database PubMed (MEDLINE) with the terms “adolescence” OR “puberty” AND “gender identity disorder” OR “gender dysphoria” OR “transsexual” AND “treatment” OR “puberty suppression” from 1998 onwards, because in this year the first paper
was published reporting on pubertal delay as part of the clinical management of gender identity
disorder in adolescence in the English language. They excluded papers focusing on disorders of
sex development and papers focusing on surgery and surgical techniques. They also checked
reference lists of retrieved papers for further leads.
Key findings:
- The suppression of puberty, followed by cross-sex hormone treatment and surgery seems to have undeniable benefits for transsexual youths.
- Early intervention not only seemed to lead to a better psychological outcome, but also to a physical appearance that made being accepted as a member of the new gender much easier, compared with those who began treatment in adulthood.
- The current literature does not indicate that GnRHa treatment (followed by administration of cross-sex hormones and sex-reassignment surgery) results in physical or psychological harm.
- If treatment with GnRHa is stopped, puberty in line with the natal sex will continue to develop. In this sense, the treatment is reversible.
- The fear that GnRHa treatment might have a negative effect on the patient’s psychological functioning has thus far not been supported by the few studies that have been conducted at the Amsterdam Gender Identity Clinic.
Full citation:
Cohen-Kettenis, P. T., & van Goozen, S. H. M. (1998). Pubertal delay as an aid in diagnosis and treatment of a transsexual adolescent. European Child & Adolescent Psychiatry, 7(4), 246–248. https://doi.org/10.1007/s007870050073
Sample size:
One trans male patient (puberty blockers and therapy at 13, HRT and mastectomy, hysterectomy and oophorectomy at 18).
Key findings:
- Patient prescribed LHRH agonists after persistent identification as male prior to contact with clinic.
- Extremely positive follow up 1 year post- surgery with no regret about transition generally (noted some disappointment with the speed of certain changes).
- Consideration for early treatment (i.e. puberty blockers <16) having significant benefits for young people.
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