Transgender Adolescents and the Gender-Affirming Interventions: Pubertal Suppression, Hormones, Surgery, and Other Pharmacological Interventions

  • Samantha M. BusaEmail author
  • Scott Leibowitz
  • Aron Janssen


For adolescents with gender dysphoria, puberty is an especially complicated time that may cause anxiety and distress, more so than what is typically experienced by cisgender adolescents. These physical and physiological changes can be addressed through medical interventions that are recognized by the World Professional Association of Transgender Health Standards of Care. Multidisciplinary teams that consist of psychologists, psychiatrists, pediatricians, social workers, advanced nurse specialists, and pediatric endocrinologists can guide families in the decision-making process around gender-affirming medical care. These exogenous interventions progress from most reversible to irreversible as an adolescent matures. This chapter aims to review pubertal stages for youth, to present the medical interventions recommended for adolescents who are experiencing gender dysphoria, and to comprehensively review the guidelines provided by the Endocrine Society and the World Professional Association for Transgender Health.


Transgender youth Gender-affirming medical interventions Gender dysphoria Mental health Cross-sex hormones Puberty suppression Menstrual suppression Spironolactone Gender confirmation surgery Sex reassignment surgery 


  1. 1.
    Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970;45(239):13–23.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13(4):165–232.CrossRefGoogle Scholar
  4. 4.
    Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869–903. Scholar
  5. 5.
    Delemarre-van de Waal HA, Cohen-Kettenis PT. Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects. Eur J Endocrinol. 2006;155(Suppl 1):S131–7.CrossRefGoogle Scholar
  6. 6.
    Steensma TD, Kreukels BP, de Vries AL, Cohen-Kettenis PT. Gender identity development in adolescence. Horm Behav. 2013;64:288–97.CrossRefPubMedGoogle Scholar
  7. 7.
    Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ. The treatment of adolescent transsexuals: changing insights. J Sex Med. 2008;5(8):1892–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Wren B. Early physical intervention for young people with atypical gender identity development. Clin Child Psychol Psychiatry. 2000;5(2):220–31.CrossRefGoogle Scholar
  9. 9.
    de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134(4):696–704. Scholar
  10. 10.
    Lawrence AA. Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Arch Sex Behav. 2003;32(4):299–315.CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen-Kettenis PT, Schagen SEE, Steensma TD, de Vries AL, Delemarre-van de Waal HA. Puberty suppression in a gender-dysphoric adolescent: a 22-year follow-up. Arch Sex Behav. 2011;40:843–7. Scholar
  12. 12.
    de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011;8(8):2276–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Leibowitz S, de Vries AL. Gender dysphoria in adolescence. Int Rev Psychiatry. 2016;28(1):21–35.CrossRefPubMedGoogle Scholar
  14. 14.
    Staphorsius AS, Kreukels BP, Cohen-Kettenis PT, Veltman DJ, Burke SM, Schagen SE, et al. Puberty suppression and executive functioning: an fMRI-study in adolescents with gender dysphoria. Psychoneuroendocrinology. 2015;56:190–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Klink D, Caris M, Heijboer A, van Trotsenburg M, Rotteveel J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab. 2015;100:E270–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Nahata L, Chelvakumar G, Leibowitz S. Gender-affirming pharmacological interventions for youth with gender dysphoria: when treatment guidelines are not enough. Ann Pharmacotherapy. 2017;51(11):1023–32.CrossRefGoogle Scholar
  17. 17.
    Altshuler AL, Hillard PJ. Menstrual suppression for adolescents. Curr Opin Obstet Gynecol. 2014;26:323–31.CrossRefPubMedGoogle Scholar
  18. 18.
    Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJIII, Spack NP, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–54.CrossRefPubMedGoogle Scholar
  19. 19.
    Steever J. Cross-gender hormone therapy in adolescents. Pediatr Ann. 2004;43(6):e138–44.CrossRefGoogle Scholar
  20. 20.
    Klein C, Gorzalka BB. Continuing medical education: sexual functioning in transsexuals following hormone therapy and genital surgery: a review (CME). J Sex Med. 2009;6(11):2922–39.CrossRefPubMedGoogle Scholar
  21. 21.
    Gijs L, van der Putten-Bierman E, De Cuypere G. Psychiatric comorbidity in adults with gender identity problems. In: Kreukels BPC, Steensma TD, de Vries AL, editors. Gender dysphoria and disorders of sex development: progress in care and knowledge. New York: Springer; 2014. p. 255–76.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Samantha M. Busa
    • 1
    Email author
  • Scott Leibowitz
    • 2
    • 3
  • Aron Janssen
    • 4
  1. 1.Department of Child and Adolescent PsychiatryHassenfeld Children’s Hospital at NYU LangoneNew YorkUSA
  2. 2.Department of Psychiatry, THRIVE Gender and Sex Development ProgramNationwide Children’s HospitalColumbusUSA
  3. 3.Department of PsychiatryThe Ohio State University College of MedicineColumbusUSA
  4. 4.Department of Child and Adolescent PsychiatryNYU Langone Health, NYU Child Study CenterNew YorkUSA

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