ESPE Yearbook of Paediatric Endocrinology

LGBT Health. 2022 May-Jun;9(4):238-246. PMID:35475663, doi: 10.1089/lgbt.2020.0494.

Brief Summary: This study reports changes in wellbeing and quality of life in 70 adolescents (49 transgender men and 21 transgender women) from the Amsterdam Center for Expertise on Gender Dysphoria. It finds evidence of improvements in functioning on GAH.

The purpose of gender-affirming hormone (GAH) treatments, and if chosen gender affirming surgery, for transgender adolescents is to improve wellbeing and quality of life and reduce the dysphoria-associated distress. In this cohort, self-perception was assessed before the start of GAH treatment (mean 14.65 years, SD 2.08) and at least 6 months after gender-affirming surgeries (mean 20.70 years, SD 1.49) by the Self-Perception Profile for Adolescents (SPPA), which is a self-report measure that examines self-perception on seven different domains: scholastic competence, social acceptance, athletic competence, physical appearance, behavioural conduct, close friendship, and global self-worth. The domains of physical appearance and global self-worth improved over the course of treatment. No domain worsened. Scholastic competence, social acceptance, athletic competence, and close friendship remained stable over time.

Thus we are now beginning to see objective evidence of the physical intervention pathways. Other population surveys are also pointing in the same direction suggesting that GAH treatment reduce depression and suicidality [1]. However, the mechanisms are unclear. In another study, Grannis et al. found increased amygdala-prefrontal cortex connectivity using functional MRI (fMRI) scanning in 19 testosterone treated compared with 23 untreated transgender adolescents, and noted lower anxiety and depression indices, and improved body satisfaction on treatment in a battery of self-report measures [2]. Although changes were seen on fMRI scans, it was impossible to infer a direct assoiciation between specific patterns of cerebral activity and GAH treatment.

References: 1. Green AE, DeChants JP, Price MN, Davis CK. Association of Gender-Affirming Hormone Therapy With Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth. J Adolesc Health. 2022 Apr;70(4):643–649. doi: 10.1016/j.jadohealth.2021.10.036. Epub 2021 Dec 14. PMID: 34920935.2. Grannis C, Leibowitz SF, Gahn S, Nahata L, Morningstar M, Mattson WI, Chen D, Strang JF, Nelson EE. Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys. Psychoneuroendocrinology. 2021 Oct;132:105358. doi: 10.1016/j.psyneuen.2021.105358. Epub 2021 Jul 17. PMID: 34333318.