Gender Dysphoria and Psychological Functioning in Adolescents Treated with GnRHa: Comparing Dutch and English Prospective Studies

Appendix: Prospective Studies on the Psychological Outcomes of Suppressing Puberty with GnRHa

Prospective studies were identified in two ways. Citations in Hembree et al. (2017) on the treatment of adolescents (section 2) yielded 52 articles. Searching PubMed (on May 24, 2020) for all articles published since 2016 with the search string “(transsexualism or transgender) and (gonadotropin or gnrha or gnrh)” yielded 84 articles. For each potential reference, I examined the title, and where necessary the abstract, to see whether it met the key criteria. Studies of physiological outcomes, such as bone density, were excluded.

Aside from de Vries et al. (2011)—cited by 65 articles in PubMed—and Costa et al. (2015)—cited by 14—two other studies meet these criteria. Schneider et al. (2017)—cited by two articles—reported various cognitive outcomes for one male; after 2 years and 4 months of GnRHa treatment, IQ had dropped by 10 points. Achille et al. (2020) reported outcomes for 15 males and 8 females after puberty suppression either using GnRHa or using antiandrogens (for males) or medroxyprogesterone (for females). After 12 months of puberty suppression, males reported lower depression, controlling for psychiatric medication and engagement with counseling, as measured by the Center for Epidemiologic Studies Depression Scale (p = .008). Other improvements were not statistically significant. The study, which included another group of subjects treated with cross-sex hormones, had an overall attrition rate of 47%. There was no explanation for why almost half the subjects who entered the study failed to complete the three waves of questionnaires and were thus excluded from the analysis.