Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study.
BACKGROUND
Puberty suppression by means of gonadotropin-releasing hormone analogues (GnRHa) is used for young transsexuals between 12 and 16 years of age. The purpose of this intervention is to relieve the suffering caused by the development of secondary sex characteristics and to provide time to make a balanced decision regarding actual gender reassignment.


OBJECTIVE
To compare psychological functioning and gender dysphoria before and after puberty suppression in gender dysphoric adolescents.


METHODS
Of the first 70 eligible candidates who received puberty suppression between 2000 and 2008, psychological functioning and gender dysphoria were assessed twice: at T0, when attending the gender identity clinic, before the start of GnRHa; and at T1, shortly before the start of cross-sex hormone treatment.


METHODS
Behavioral and emotional problems (Child Behavior Checklist and the Youth-Self Report), depressive symptoms (Beck Depression Inventory), anxiety and anger (the Spielberger Trait Anxiety and Anger Scales), general functioning (the clinician's rated Children's Global Assessment Scale), gender dysphoria (the Utrecht Gender Dysphoria Scale), and body satisfaction (the Body Image Scale) were assessed.


RESULTS
Behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression. Feelings of anxiety and anger did not change between T0 and T1. While changes over time were equal for both sexes, compared with natal males, natal females were older when they started puberty suppression and showed more problem behavior at both T0 and T1. Gender dysphoria and body satisfaction did not change between T0 and T1. No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment.


CONCLUSIONS
Puberty suppression may be considered a valuable contribution in the clinical management of gender dysphoria in adolescents.
de Vries
Annelou L C
AL
Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, the Netherlands. alc.devries@vumc.nl
Steensma
Thomas D
TD
Doreleijers
Theo A H
TA
Cohen-Kettenis
Peggy T
PT
D000293:Adolescent; D005500:Follow-Up Studies; D005783:Gender Identity; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use*; D006801:Humans; D011446:Prospective Studies; D011627:Puberty / Q000187:drug effects*; D012727:Sex Characteristics; D057829:Gender-Affirming Procedures; D014189:Transsexualism / Q000188:drug therapy* / Q000523:psychology*
D007987:Gonadotropin-Releasing Hormone