1. Gonadotropin-releasing hormone analogue is not associated with subsequent gender affirming hormone use
2. Gonadotropin-releasing hormone analogue and its benefits on mental health and cosmetics can be used without an increased likelihood of further hormone use
Evidence Rating Level: 2 (Good)
1.8% of high school students in the US identify as transgender. Gonadotropin releasing hormone analogues (GnRHa) can be used to reversibly suppress further pubertal development. In those with gender dysphoria. Reversibly halting the development of secondary sex characteristics and allowing one to fully confirm gender identity before making a decision about gender affirming treatment plays a strong positive role in those with gender dysphoria. Treatment can improve global functioning, depression, suicidal ideation, and overall behavioural and emotional problems. Additionally, pubertal suppression can also affect cosmetic outcomes, decreasing the need for further interventions such as surgeries. Prior studies have shown that 96.5-98.1% of individuals who started GnRHa then also used gender affirming hormones with irreversible effects, leading some to believe that GnRHa treatment advances the decision to use gender affirming hormones, prior to an age of cognitive maturity. This retrospective cohort study examined the association between GnRHa use and use of gender affirming hormones among transgender youth. The 434 youth in the study had an initial health care encounter for gender dysphoria between the ages of 10 and 17, with at least one medical encounter after the age of 14. They were also required to be capable of providing meaningful informed consent. It was found that younger patients were more likely to be started on GnRHa. Compared with patients without GnRHa use, GnRHa use was associated with a longer median gap between the initial appointment and starting gender-affirming hormones (1.8 years [95% CI, 1.1-2.4 years] vs 1.0 years [95% CI, 0.8-1.2 years]) and a lower hazard of starting gender-affirming hormones (hazard ratio, 0.52; 95% CI, 0.37-0.71). This study only included children of active or retired members of the US military, and likely had higher socioeconomic standing, higher levels of parental education, better health coverage and more geographic mobility making it difficult to generalize the findings. Overall however, in this cohort study, GnRHa was not associated with increased hazard of subsequent gender affirming use, suggesting that the benefits can be offered to youth with gender dysphoria with concern for inappropriately increasing rates of gender affirming hormone use.
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