Also called puberty blockers, gonadotropin-releasing hormone analogues (GnRHas) are medications that can halt estrogen and testosterone production, effectively suppressing the physical changes associated with puberty. This allows transgender and non-binary teens to explore their gender identity without the pressure of puberty, which can exacerbate feelings of dysphoria. GnRHas are administered by implants or injections and their effects are reversible once they are discontinued.
Previous research has shown that transgender people — and trans teens in particular — have higher rates of mental health concerns than their cisgender peers, including anxiety, depression, and suicidal thoughts. One recent large study of transgender teens in the U.S. found that 19 percent had seriously considered suicide, 15 percent had made a plan, 8 percent had made an attempt, and 2.5 percent had been injured by an attempt.
Importance of access to pubertal suppression
Guidelines from the Endocrine Society, American Academy of Pediatrics, and World Professional Association for Transgender Health recommend that transgender adolescents be offered GnRHas as they approach puberty. To better understand the effects of puberty blockers on mental health outcomes, researchers from Massachusetts General Hospital, Boston Children’s Hospital, and the Fenway Institute analyzed data from 20,619 transgender adults between ages 18 and 36.
“We examined the association between access to GnRHas and adult mental health outcomes, including suicidal thoughts,” says Jeremi Carswell, MD, director of Boston Children’s Gender Multispecialty Service and a co-author on the study.
Approximately nine out of 10 transgender adults who had wanted but were denied pubertal suppression reported having suicidal ideation during their lifetime.
The team found that 16.9 percent of people surveyed reported having ever wanted pubertal suppression as part of their gender-related care. Of these, 2.5 percent received puberty blockers. After adjusting for factors such as level of family support, the researchers found that people who had received pubertal suppression as adolescents were less likely to experience suicidal thoughts during their lifetime than those who wanted to receive these medications but did not. All told, approximately nine out of 10 transgender adults who had wanted but were denied pubertal suppression reported having suicidal ideation during their lifetime.
“The respondents who did have access to GnRHas reported less lifetime suicidal ideation compared to those who did not have this option,” explains Carswell. “It’s important to note, however, that this is a study based on a self-report survey and therefore shows an association but not causation.”
This is believed to be the first study of its kind to look possible associations between pubertal suppression of transgender teens and suicidality. “Our findings highlight the importance of ensuring access to puberty blockers and strengthen existing recommendations for this treatment to be made available for those who want it,” adds Carswell. The study appears in Pediatrics.
Learn about the Gender Multispecialty Service.
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