title: Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria.
abstract: BACKGROUND
  Puberty suppression by gonadotropin-releasing hormone analogs (GnRHa) is prescribed to relieve the distress associated with pubertal development in adolescents with gender dysphoria (GD) and thereby to provide space for further exploration. However, there are limited longitudinal studies on puberty suppression outcome in GD. Also, studies on the effects of psychological support on its own on GD adolescents' well-being have not been reported.
  
  
  OBJECTIVE
  This study aimed to assess GD adolescents' global functioning after psychological support and puberty suppression.
  
  
  METHODS
  Two hundred one GD adolescents were included in this study. In a longitudinal design we evaluated adolescents' global functioning every 6 months from the first visit.
  
  
  METHODS
  All adolescents completed the Utrecht Gender Dysphoria Scale (UGDS), a self-report measure of GD-related discomfort. We used the Children's Global Assessment Scale (CGAS) to assess the psychosocial functioning of adolescents.
  
  
  RESULTS
  At baseline, GD adolescents showed poor functioning with a CGAS mean score of 57.7 ± 12.3. GD adolescents' global functioning improved significantly after 6 months of psychological support (CGAS mean score: 60.7 ± 12.5; P < 0.001). Moreover, GD adolescents receiving also puberty suppression had significantly better psychosocial functioning after 12 months of GnRHa (67.4 ± 13.9) compared with when they had received only psychological support (60.9 ± 12.2, P = 0.001).
  
  
  CONCLUSIONS
  Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents.
authors.affiliation: Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, Tavistock Centre, London, UK.|Department of Medical Basic Sciences, Neuroscience and Sense Organs, University of Bari "A. Moro, Bari, Italy.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Costa
authors.affiliation: Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, Tavistock Centre, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Dunsford
authors.affiliation: Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, Tavistock Centre, London, UK.
authors.forename: Elin
authors.initials: E
authors.lastname: Skagerberg
authors.affiliation: Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, Tavistock Centre, London, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Holt
authors.affiliation: Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, Tavistock Centre, London, UK.
authors.forename: Polly
authors.initials: P
authors.lastname: Carmichael
authors.affiliation: Department of Medical Basic Sciences, Neuroscience and Sense Organs, University of Bari "A. Moro, Bari, Italy.|Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Colizzi
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D016497:Adolescent Health Services; D003376:Counseling; D056344:Executive Function; D005260:Female; D000068116:Gender Dysphoria / Q000503:physiopathology / Q000523:psychology; D005783:Gender Identity; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011627:Puberty / Q000187:drug effects / Q000523:psychology*; D057829:Gender-Affirming Procedures; D012741:Sexual Maturation; D014189:Transsexualism / Q000188:drug therapy / Q000523:psychology*
chemical_list: D007987:Gonadotropin-Releasing Hormone
keywords: Adolescents; Gender Dysphoria; Psychosocial Functioning; Puberty Suppression