By Will Boggs MD

NEW YORK—Gender-affirming hormones and surgery appear to improve mental health and quality of life in transgender adolescents, according to a new literature review.

"The consensus from the authors of the studies we reviewed is that short-term changes in metabolic and safety variables do not pose a clinical risk in trans adolescents, as long as treatment is medically supervised and monitored," said Dr. Florian Daniel Zepf of Jena University Hospital in Germany and his colleagues in a joint email to Reuters Health.

"Clinical decisions on eligibility should be weighed up on an individual basis and should be informed by expert guidelines (e.g., Endocrine Society Practice Guidelines, Australian SoC Guidelines for trans and gender diverse children and adolescents, World Professional Association for Transgender Health Standards of Care)," they said.

Numerous studies have explored the benefits and risks of hormonal and surgical interventions in transgender adults, but there have been few studies in transgender adolescents.

Dr. Zepf's team reviewed the available published evidence on the effects of gender-affirming cross-sex hormones (CSHs) and surgery on total health outcomes, cognitive and physical outcomes, and safety variables in transgender adolescents.

Almost all the studies they identified used longitudinal retrospective methods with limited follow-up and small sample sizes. Moreover, intervention regimens were heterogeneous, and adherence was not always consistent.

In general, the limited available data suggest that gender-affirming hormones are associated with improvements in gender dysphoria or mental health, or both, in transgender adolescents, as has been reported for transgender adults.

There were insufficient data to ascertain whether starting CSHs at a younger age improves quality of life of transgender adolescents or is associated with increased rates of regret or detransition.

Gender-affirming CSHs and chest wall masculinization were associated with improvements in mental health and quality of life in transgender males, the researchers report in The Lancet the Diabetes & Endocrinology, online December 6.

On the other hand, data regarding surgical vaginoplasty in transgender females under age 18 years remains extremely scarce, limiting conclusions that can be drawn regarding its risks and benefits.

"More research is urgently needed to understand long-term outcomes associated with hormonal and surgical interventions in trans adolescents," the research team told Reuters Health. "Funding is desperately needed to determine long-term outcomes associated with hormonal and surgical interventions in trans adolescents."

"This area is in its infancy scientifically, so we need much more data to help guide clinical decision-making and inform best practice," they added. "Establishing cohorts of trans and gender-diverse diverse children will enable us to look at the long-term effects of these interventions on physical safety and mental health outcomes."

"It is important to note that not all trans adolescents will want gender-affirming interventions - but for those that do, there is evidence to suggest that few receive these, despite being eligible," Dr. Zepf and colleagues said. "Training in trans adolescent medicine, where possible, is invaluable for understanding the unique social and medical needs of trans young people, such as eligibility for hormonal interventions."

"Physicians and other health practitioners should always strive to maintain a supportive, gender-affirming environment when seeing trans and gender diverse children and adolescents, which includes using the young person's preferred pronouns (he, she, they)," they said.

SOURCE: https://bit.ly/2QesPqF

Lancet Diabetes Endocrinol 2018.

(c) Copyright Thomson Reuters 2019. Click For Restrictions - https://agency.reuters.com/en/copyright.html