April 10, 2024

expert reaction to systematic reviews looking at puberty blockers and hormone treatment for gender transition in children

Several reviews have been published looking at puberty blockers and gender dysphoria in children. 

Dr Gavin Stewart, Senior Lecturer in Evidence Synthesis, Newcastle University, said:

“The reviews meet current methodological expectations and can be considered reliable.  This research synthesis identifies major deficiencies in the evidence base concerning puberty blockers and hormone treatment for gender transition.  It highlights uncertainties that are not reflected in guidelines that are too dogmatic and prescriptive given their reliance on expert judgement.  Little can be said with any certainty regarding puberty blockers and hormone treatment for gender transition and this should be more widely acknowledged by health professionals and advocates alike.”

Prof Ashley Grossman FMedSci, Emeritus Professor of Endocrinology, University of Oxford, said:

“For many years we have been using puberty blockers in young children who are going into early puberty to delay puberty to a normal time – this has been very successful with much detailed evidence.

“This is a different situation – this set of reviews is looking at using these drugs to delay normal puberty.  This very detailed set of analyses now suggests that there are not enough good data showing the long-term effects in children with gender dysphoria.  Indeed there are some recent early data (although not yet peer-reviewed or published) suggesting some of their effects on testes and sperm may not be reversible (https://www.biorxiv.org/content/10.1101/2024.03.23.586441v1).

“One must realise that coming to terms that one may be trans-gender can be extremely distressing, and we certainly need more facilities to assist such individuals, and as adults treat them as rapidly as possible within specialist centres.  However, for children with gender dysphoria, these studies have shown that there is no good evidence for the routine use of puberty blockers, although that is not to discount that in occasional children and young adults they could be helpful.  What it does emphasise is that children in this category, who seem to be of greatly increased numbers, need very careful counselling, assistance and help through this difficult time.  It may be that a small number of these children should in the long term transition to a different sex, but routine puberty blocking treatment for this use has not yet been adequately studied, and many of these children may have other problems for which they need help.  More carefully run clinical trials are needed so that we can understand how and when such agents are justified and of benefit.”

Review 1: ‘Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review’ by Jo Taylor et al. was published in Archives of Disease in Childhood at 00:01 UK time on Wednesday 10 April 2024.

DOI: 10.1136/archdischild-2023-326669

Review 2: ‘Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review’ by Jo Taylor et al. was published in Archives of Disease in Childhood at 00:01 UK time on Wednesday 10 April 2024.

DOI: 10.1136/archdischild-2023-326670

Review 3: ‘Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)’ by Jo Taylor et al. was published in Archives of Disease in Childhood at 00:01 UK time on Wednesday 10 April 2024.

DOI: 10.1136/archdischild-2023-326499

Review 4: ‘Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)’ by Jo Taylor et al. was published in Archives of Disease in Childhood at 00:01 UK time on Wednesday 10 April 2024.

DOI: 10.1136/archdischild-2023-326500

Editorial: ‘Holistic approach to gender questioning children and young people’ by Camilla C Kingdon was published in Archives of Disease in Childhood at 00:01 UK time on Wednesday 10 April 2024.

DOI: :10.1136/archdischild-2024-327100

Declared interests

Dr Gavin Stewart: “No conflict of interest.”

Prof Ashley Grossman: “None.”