ESPE Yearbook of Paediatric Endocrinology

J Sex Med. 2025 Jan 3;22(1):196-204. doi: 10.1093/jsxmed/qdae152

Brief summary: This retrospective questionnaire-based study explored sexual functioning and difficulties among 37 transgender women (male sex registered at birth) who had started treatment with a GnRH analogue in adolescence followed by estogen treatment and vaginoplasty. The large majority experienced sexual desire (91%), arousal (86%) and orgasm (78%). Although those treated from early puberty (Tanner stage G2-3, n=16) had less commonly experienced orgasm before surgery compared to those who had started treatment in late puberty (Tanner stage G4-5, n=21) (19 vs 58%), the percentage was comparable after surgery (87 vs 71%).

This study addresses a knowledge gap (1), on outcomes with regard to sexual function and dysfunction after GnRH analogue treatment in adolescence for gender dysphoria. Outcomes were similar to those previously described for transgender individuals who started medical treatment in adulthood. While the sample size was small and findings need to be confirmed in larger studies, the results suggest that GnRH analogue treatment to suppress puberty may not have a lasting impact on the ability to experience sexual desire, arousal and orgasm. At the same time, sexual difficulties were common among those that had sexual intercourse (n=21), with 52% experiencing pain during intercourse. A second study by van der Meulen et al. (2) that also included transgender men that had received GnRH analogue treatment in adolescence (n=50), found that sexual dysfunction was common among transgender men too (58%), with difficulty initiating sexual contact being the most frequently reported. No difference was observed between those who had started treatment in early (Tanner stage B2-3) vs late (Tanner stage B4-5) puberty (67 vs 56%), although again groups were small. Sexual satisfaction was found to be comparable to that in the general population.

These first studies on sexual outcomes will be informative when counselling transgender adolescents and their parents considering hormonal treatment. They also point out the need to provide ongoing support to address sexual difficulties that transgender individuals encounter, which are not only related to physical complaints but also frequently to psychosocial challenges.

References: 1. Miroshnychenko A, Roldan Y, Ibrahim S, Kulatunga-Moruzi C, Montante S, Couban R, Guyatt G, Brignardello-Petersen R. Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis. Arch Dis Child. 2025 May 16;110(6):429-436. PMID: 39855724.2. van der Meulen IS, Arnoldussen M, van der Miesen AIR, Hannema SE, Steensma TD, de Vries ALC, Kreukels BPC. Sexual satisfaction and dysfunction in transgender adults following puberty suppression treatment during adolescence. J Sex Med. 2025 Jun 17:qdaf095. PMID: 40577261.