ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Lancet Diabetes Endocrinol. 2019, Jun; 7: 484–98. doi: https://www.ncbi.nlm.nih.gov/pubmed/30528161

This review overviews the published literature on mental and physical health outcomes and treatment effects after gender-affirming hormone therapy and surgery in transgender adolescents and highlights important evidence gaps.

There is trend towards increasing incidence of transgender adolescents asking for gender transformation treatment, but many open questions remain. The authors state that gender-affirming hormone therapy is safe, and seems to improve gender dysphoria, mental health and quality of life. Testosterone treatment in transgender male adolescents affects on brain activity, increases hemoglobin concentrations and hematocrit, decreases high-density lipoprotein concentrations and promotes a leaner body composition. Estrogen treatment in transgender females increases high-density lipoprotein concentrations and body fat, and decreases lean body mass, waist-to-hip ratio and bone mineral density. Gender dysphoria and psychological functioning improve in transgender male adolescents who undergo mastectomy, and age at surgery has no influence on the risk of surgery complications. There are no quantitative studies on vaginoplasty in transgender female adolescents, probably because this feminizing surgery is rare in this young population.

The findings of this review are inconsistent with other studies published during the past years concluding that cardiovascular disease risk seems to increase with gender confirming hormone therapy, especially in female to male transition (see paper 6.20 by Klaver et al. below, and four other papers cited therein). Most of the few existing studies reviewed here face limitations, and larger, prospective studies are needed to provide more evidence on the effect of gender-affirming interventions during adolescence. The authors present a useful list of open key issues for future research. One of these research priorities is to investigate whether an earlier start of cross-hormone treatment improves health outcomes.