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Systematic Review: Puberty suppression with GnRH analogues in adolescents with gender incongruity

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Gender incongruence is defined as disharmony between assigned gender and gender identity. Several interventions are liable in this case including genital affirming surgery among other surgical interventions such as harmonization, and also the use of gonadotropin-releasing hormone agonists (GnRHa) for gonadal shielding. This aids in preventing the development of secondary sexual characteristics related to the genetic sex.


Systematically review the treatment of gender incongruity with GnRHa analogues.

Data sources

The data source of this research is from Pubmed-Medline and Embase.

Study selection

Articles published between 2009 and 2019 which studied transgender adolescents treated with GnRHa were carefully selected.

Data extraction

Were extracted: design, sample size, study context, targeted subjects of intervention, outcome measures, and results.


Eleven studies were included. The use of GnRHa seems to be well tolerated by the studied population. When started in pubertal transition, it was associated with a more distinct resemblance to body shape than to the affirmed sex. In addition to preventing the irreversible phenotypic changes that occur in cross-hormonal therapy, the use of GnRHa can equally contribute to the mental health of these adolescents.


There are few consistent studies on the use of GnRHa for gender incongruence.


As the population of transgender children and adolescents grows, they acquire knowledge and greater access to the various forms and stages of treatment for sex reassignment. The medical community needs to be adequately prepared to better serve this population and offer the safest resources available.

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Fig. 1

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Gonadotropin-releasing hormone agonists


Bone mineral density


Apparent bone mineral density


Luteinizing hormone


Follicle-stimulating hormone


Alkaline phosphatase

GT range:

Glutamyl transferase range


Gender incongruence


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Any resources needed were provided by the researchers themselves. There was no other source of funding or ways of support for the systematic review.

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Authors and Affiliations



CATD and PTC: conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript; ACSM and GGFR: designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript; APAB and EZ: conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to G. G. F. Ramos.

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The other authors have no conflicts of interest to disclose.

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There were no individual′s person data requiring consent for publication, nor the research directly involved human participants and/or animals.

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Informed consent is not applicable because the study is a systematic review.

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Ramos, G.G.F., Mengai, A.C.S., Daltro, C.A.T. et al. Systematic Review: Puberty suppression with GnRH analogues in adolescents with gender incongruity. J Endocrinol Invest 44, 1151–1158 (2021).

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