Table 3 Literature data on GnRH analogues treatment in gender dysphoria and associated outcomes
First author | Year | Mean age at GnRH treatment (years) | Number of individuals treated with GnRHa | Country | Type of treatments | Outcomes |
|---|---|---|---|---|---|---|
De Vries [68] | 2011 | 13.1 AMAB, 14.1 AFAB | 70 | The Netherlands | GnRHa | Significant decrease in behavioral and emotional problems of the total problem scale, the internalizing and externalizing scale of both CBCL and YSR. Percentage of adolescents scoring in the clinical range significantly decreased on the CBCL total problem scale and the internalizing scale of the YSR. Depressive symptom scores on the BDI-II significantly decreased and global functioning ratings on the CGAS significantly increased. No significant change was observed in TPI (anger) or STAI (anxiety). |
De Vries [69] | 2014 | 13.6 | 55 | The Netherlands | GnRHa → GAHT → surgery | Improvements in psychological functioning evaluated with UGDS, global functioning (CGAS), depression (BDI), anxiety (STAI), anger (TPI) |
Costa [74] | 2015 | 16.5 | 35 | United Kingdom | GnRHa | Improvements in mental health evaluated with UGDS and CGAS, with significantly better psychosocial functioning after 12 months of GnRHa compared with when they had received only psychological support |
Staphorsius [11] | 2015 | >12 | 20 | Belgium/The Netherlands | GnRHa | No significant changes in terms of psychological functioning (CBCL), cognitive function (executive function task) |
Vrouenraets [75] | 2016 | 15.8 | 12 | The Netherlands | GnRHa | Most adolescents found it difficult to define an appropriate age limit for starting puberty suppression and saw it as a dilemma Most adolescents stated that the lack of long-term data did not and would not stop them from wanting puberty suppression Some adolescents were positive about the role of the social context, but others raised doubts about it. |
Nahata [76] | 2017 | 15.3 | 9 | USA | GnRHa | Transgender youth face significant barriers in accessing appropriate hormone therapy: only 8 received insurance coverage for GnRHa; of 16 individuals who had been denied insurance coverage for GnRHa, 4 began GAHT |
Lopez [77] | 2018 | 14 | 92 | USA | GnRHa | Utilization of histrelin acetate implants increased dramatically. AMAB are more likely to receive implants and also more likely to receive implants at an older age. Treated transgender individuals are more likely to be White when compared to central precocious puberty |
Giovanardi [78] | 2019 | 37.4 | 10 | Italy | GnRHa | Interview results: - treatment protocol considered an opportunity to prevent the body dysphoria and social phobia trans-people experience with puberty. - present the need to focus more on internal and psychological aspects of GD |
Kuper [79] | 2020 | 14.9 | 148 | USA | GAHT | Reduced body dissatisfaction (assessed via BIS). Modest initial improvements in mental health (depression and anxiety). |
Turban [70] | 2020 | 18-36 | 89 | USA | GnRHa | Treatment with pubertal suppression among those who wanted it associated with lower odds of lifetime suicidal ideation when compared with those who wanted pubertal suppression but did not receive it. |
Becker-Hebly [80] | 2020 | 15.5 | 75 | Germany | GnRHa CSHT | Improvements in psychosocial health outcome, measured with CGAS, psychosocial functioning (YSR/ ASR) |
Cantu [81] | 2020 | 15 | 80 | USA | GnRHa GAHT | No change in psychosocial functioning, evaluated with PHQ-9, GAD-7, no change in acute distress or suicidality idea |
Perl [82] | 2020 | 14 | 48 | Israel | GnRHa GAHT | Possible increase in DBP in transgender male adolescents upon GHRH administration, and testosterone treatment may restore it, but further larger studies indicated |
Carmichael [83] | 2021 | 13.6 | 44 | UK | GnRHa | No change in psychological functioning (CBCL, YSR), Self-harm, BIS, HRQoL |
Van der Loos [84] | 2021 | 11-17 | 322 | The Netherlands | GnRHa GAHT | Development of hip bone geometry in transgender adolescents resembled that of the experienced gender if the GnRHa treatment was initiated during early puberty. Participants starting GnRHa during mid or late puberty continued within the curve of their gender assigned at birth. |
Schulmeister [85] | 2021 | 11.5 | 92 | USA | GnRHa | TGD youth treated with GnRH have heigh velocity similar to that of prepubertal children, but TGD youth who start GnRHa later in puberty have an high velocity below the prepubertal range |
Nos [58] | 2022 | 15.4 | 434 | USA | GnRH → GAHT | GnRHa use not associated with increased subsequent GAHT use, clinicians can offer the benefits of GnRHa treatment without concern for increasing rates of future GAH use |
Tordoff [86] | 2022 | 15.8 | 104 | USA | GnRH → GAHT | Gender affirming medical interventions associated with lower odds of depression and suicidality over 12 months |
Van der Loos [67] | 2023 | 15 | 876 | The Netherlands | GnRH → GAHT | Trajectories in diagnostic evaluation and medical treatment in children and adolescents referred for gender dysphoria are diverse. Initiating medical treatment and need for surgical procedures depends on not only personal characteristics but societal and legal factors as well |