medwireNews: The research to date suggests that hormonal treatments achieve the intended physical results in transgender adolescents, but the evidence quality is low and psychosocial issues are barely addressed, say the authors of a systematic review.

Denise Chew (University of Melbourne, Victoria, Australia) and co-workers identified a total of 12 studies of hormonal treatment in transgender adolescents, each including between 21 and 201 patients. Eight of the studies assessed only the physical effects of treatment, two looked at psychosocial outcomes and two at cognitive outcomes.

Nine of the studies investigated gonadotropin-releasing hormone analogues (GnRHas) for suppressing the development of secondary sexual characteristics, and five looked at testosterone and three at oestrogen for respectively masculinizing and feminizing patients’ physical appearance. Anti-androgen (cyproterone acetate), for counteracting the effects of endogenous testosterone, and progestin (lynestrenol), for suppressing menses, were each examined in just one study.

These scarce data mean that clinicians treating transgender adolescents frequently have to base their decisions on findings in adults, despite the very different challenges presented by the rapid development during adolescence and the frequent need for different hormone dosing regimens, say the researchers.

Overall, Chew and team found that the identified studies in adolescents provide “qualified support” for the treatments tested. “[T]hese hormonal treatments appear to provide some therapeutic benefits in terms of physical effects and are generally well-tolerated on the basis of current evidence,” they write in Pediatrics.

However, they say that more research is needed, particularly concerning the effects of hormone treatment on patients’ bone mineral density and adult height, which require longer follow-up.

The two studies that looked at the effects of treatment on psychosocial symptoms found improved psychological functioning in patients receiving GnRHas. The psychological effects of gender-affirming hormones in adolescents have not been addressed, however, despite their physical effects being only partially reversible.

The research team describes this as “a critical knowledge gap given the high rates of mental health problems observed in transgender youth”, on which the justification for hormonal treatments at this age is based.

Eleanor McDermid

Pediatrics 2018; Advance online publication

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