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The effect of early puberty suppression on treatment options and outcomes in transgender patients

Nature Reviews Urology volume 17, pages 626–636 (2020)Cite this article

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Abstract

In the past 10–15 years, paediatric transgender care has emerged at the forefront of several general practice and subspecialty guidelines and is the topic of continuing medical education for various medical disciplines. Providers in specialties ranging from family medicine, paediatrics and adolescent medicine to endocrinology, gynaecology and urology are caring for transgender patients in increasing numbers. Current and evolving national and international best practice guidelines recommend offering a halt of endogenous puberty for patients with early gender dysphoria, in whom impending puberty is unacceptable for their psychosocial health and wellness. Pubertal blockade has implications for fertility preservation, transgender surgical care and psychosocial health, all of which must be considered and discussed with the patient and their family and/or legal guardian before initiation.

Key points

  • Puberty blockade is the earliest point of medical intervention indicated in paediatric patients expressing gender dysphoria and should be initiated as soon as signs of puberty are observed on physical examination.

  • Puberty blockade has been shown to positively affect mental health outcomes in adolescent patients with gender incongruence.

  • Blockade of puberty does affect future fertility options for transgender adults treated early in adolescence and patients should be counselled regarding the options available to them for future fertility.

  • Blockade of puberty prevents the development of secondary sexual characteristics and, therefore, reduces the number of gender-affirming therapies required to transition and also reduces the cost of surgical care.

  • A number of questions remain surrounding early intervention and pubertal blockade, including the future effects on surgical outcomes, cancer risk and economic outcomes.

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Fig. 1: Typical physical milestones of progression through male and female puberty according to Tanner stage.
Fig. 2: Theoretical examples of clinical and social progression of gender dysphoria when it is supported and unsupported, based on collective clinical experience.

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Authors and Affiliations

  1. Department of Paediatrics, Division of Paediatric Endocrinology, Emory University, Atlanta, GA, USA

    Leonidas Panagiotakopoulos

  2. Department of Paediatrics, Chief of Adolescent Medicine, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Veenod Chulani

  3. Department of Paediatrics, Emory University, Atlanta, GA, USA

    Atsuko Koyama

  4. Department of Gynecology, Emory University, Atlanta, GA, USA

    Krista Childress

  5. Warren Alpert School of Medicine, Brown University, Providence, RI, USA

    Michelle Forcier

  6. Division of Adolescent Medicine, Hasbro Children’s Hospital, Providence, RI, USA

    Michelle Forcier

  7. Division of Adolescent Medicine, Departments of Paediatrics and Obstetrics/Gynecology, University of Rochester Medical Center, Rochester, NY, USA

    Gwen Grimsby

  8. Division of Paediatric Urology, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Katherine Greenberg

Authors
  1. Leonidas Panagiotakopoulos
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  2. Veenod Chulani
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  3. Atsuko Koyama
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  4. Krista Childress
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  5. Michelle Forcier
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  6. Gwen Grimsby
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  7. Katherine Greenberg
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Contributions

All authors researched data for the article and wrote the manuscript. L.P. made substantial contributions to discussion of content and reviewed and edited the manuscript before submission.

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Correspondence to Leonidas Panagiotakopoulos.

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Nature Reviews Urology thanks G. Quinn, J. Warus and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Panagiotakopoulos, L., Chulani, V., Koyama, A. et al. The effect of early puberty suppression on treatment options and outcomes in transgender patients. Nat Rev Urol 17, 626–636 (2020). https://doi.org/10.1038/s41585-020-0372-2

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