Hormones for gender dysphoria

Rapidly increasing numbers of young people are choosing to adopt a different gender to that to which they were born, and this presents huge challenges to us as paediatricians. More are requesting and receiving hormone treatments to delay development of secondary sexual characteristics before or during puberty, or to alter them post-puberty. There is evidence to guide use of some hormonal treatments in adult transsexuals, but not much in children and adolescents. A systematic review by Australian authors looked at what there is (Chew D et al. Pediatrics 2018. doi: 10.1542/peds.2017–3742). They cast their net widely, to pick up all studies looking at effectiveness and any physical or psychosocial effects. They found 13 studies that dealt with young people up to 25 years of age. The drugs used were gonadotrophin-releasing hormone analogues (GnRHas) (nine studies), oestrogen (3), testosterone (5), cyproterone (an anti-androgen) (1), and progestin (1). The data were not robust enough to meta-analyse. The puberty-blocking drugs GnRHas and cyproterone were effective in suppressing both hormone levels and pubertal development. Oestrogen and testosterone effectively produced feminisation and masculinisation as seen in adults. Adverse effects were a potential concern: testosterone and anti-oestrogen drugs in trans-males could effectively stop menstruation but could …