Transgender youth who begin hormone treatment to delay puberty in adolescence are more likely to become happy, "well-functioning" young adults by the time they've undergone gender reassignment, according to new research published by Pediatrics.
By taking hormone treatments around age 14 to suppress the development of sex characteristics that are the opposite of their lived and experienced gender identity, researchers found that 55 transgender participants had better mental health, psychological well-being, and that the discord between their assigned gender at birth and their gender identity were solved after gender reassignment surgery and hormone treatment in young adulthood.
For transgender youth, the onset of puberty and the accompanying body characteristics often lead to an increase in that incongruity, described medically as "gender dysphoria" — ultimately causing additional distress and further issues with a person's perceived body image down the line.
"The first thing this study shows is that transgender young people, with appropriate treatment, can function at the same psychological level as the rest of the population," Jenifer McGuire, co-author of the study, told BuzzFeed News. "They have the same distribution as everyone else when they're treated properly."
The Dutch study, which involved 22 transgender men and 33 transgender women, found that because of the early hormone treatment, the participants ultimately had no more emotional distress, anxiety, or issues with body image than their peers in the general population after they had transitioned. They also required less gender reassignment surgery, as physical characteristics that develop during puberty were suppressed.
The study followed participants over a course of several years — first before starting puberty suppression treatment (around 14 years old), again when cross-sex hormones were introduced to begin the transition to their experienced gender (around 17 years old), and then again later at least 1 year after gender reassignment surgery (around 21 years old).
"The people included in the sample sought very early treatment and all of them wanted to transition as much as possible," said McGuire, an associate professor at the University of Minnesota Department of Family Social Science. "Because secondary sex characteristics didn't develop or only developed a little, they didn't need as much surgery and they didn't have physical characteristics that lead some transgender people to have body image problems."
Such characteristics, McGuire said, are breasts, wide hips, large shoulders, big hands, and vocal characteristics that don't match the person's experienced gender and are sometimes still present after gender-reassignment surgery.
Early hormone treatment to delay puberty is a fairly new practice in the United States and is based on a Dutch clinical protocol, said McGuire. Additionally, she said that the study outcomes were based on subjects in the Netherlands, but the same outcomes should occur here. However, McGuire notes that not many American families can afford the treatment, as very few insurance companies help cover the high costs.
Stephen M. Rosenthal, a professor of pediatrics at the University of California in San Francisco, said the treatment originated in the late 1980s for patients experiencing precocious puberty, or early onset of puberty, and was used to delay the body's changes until the appropriate time. Similarly, the same drugs were first used in the Netherlands during the late 1990s to delay puberty in youth experiencing gender dysphoria to provide them with time for gender exploration while being evaluated by medical professionals before the physical changes begin. In both instances, the effects could be reversed and puberty could begin again normally when the hormone treatment is stopped.
Additionally, not all patients who go on puberty suppression, will pursue gender reassignment surgery, but they will likely have an easier time if they do.
"Kids who meet the definition of gender dysphoria, and in whom the degree of gender dysphoria increased in puberty, are the those that are likely to be transgender adults," said Rosenthal, who recently published a paper on the topic in The Journal of Clinical Endocrinology and Metabolism. "Putting a person's puberty on pause gives that person more time to be sure they are on whatever path they are on. If it's clear that person is truly transgender, you keep that person's puberty asleep, and then you enter the hormones and allow them to go into puberty with the changes that match their affirmed gender."
Rosenthal said patients seeking such treatment sometimes encounter roadblocks with insurance coverage and cost, but that it's offered and available to patients by medical professionals at programs across the country.
As for when should be the appropriate time to begin transition-related treatment, some guidelines, such as those from Endocrine Society and the World Professional Association for Transgender Health, advise against hormonal treatment until age 16 and surgical procedures until age 18, HealthDay reported.