Puberty blockers for transgender and gender diverse youth—a critical review of the literature

Background: Increasingly, early adolescents who are transgender or gender diverse (TGD) are

seeking gender-affirming health care services. Pediatric health care providers supported by

professional guidelines are treating many of these children with gonadotropin-releasing

hormone agonists (GnRHa), which block pubertal development, giving the child and their family

more time in which to explore the possibility of medical transition. Methods: We conducted a critical review of the literature to answer a series of questions about

criteria for using puberty-blocking medications, the specific drugs used, the risks and adverse

consequences and/or the positive outcomes associated with their use. We searched four

databases: LGBT Life, PsycINFO, PubMed, and Web of Science. From an initial sample of 211

articles, we systematically reviewed 9 research studies that met inclusion/exclusion criteria.
Results: Studies reviewed had samples ranging from 1-192 (N = 543). The majority (71%)

required a diagnosis of gender dysphoria to qualify for puberty suppression and were

administered medication during Tanner stages 2 through 4. Positive outcomes were decreased

suicidality in adulthood, improved affect/psychological and improved social life. Adverse factors

associated with use were changes in body composition, slow growth, decreased height velocity,

decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all

quality criteria and was judged ‘excellent’, five studies met the majority of quality criteria

resulting in ‘good’ ratings, whereas three studies were judged fair and had serious risks of bias. Conclusion: Given the potentially life-saving benefits of these medications for transgender

youth, it is critical that rigorous longitudinal and mixed methods research be conducted that

includes stakeholders and members of the gender diverse community with representative

samples.