Effect of 12 Months of Pubertal Suppression on Psychological Parameters in Transgender Youth and their Caregivers

ABSTRACT

Objectives Data regarding the effects of pubertal suppression on mental health parameters in transgender (TG) youth are limited. Even less is known about the psychological well-being of caregivers during the time that their child's puberty is paused. We describe the impact of pubertal suppression on mental health in TG youth and their caregivers during the first 12 months of gonadotropin-releasing hormone analog (GnRHa) therapy. Methods TG youth who met clinical criteria for a puberty blocker were recruited from the gender health program at our institution. Subjects were treatment naive and anticipated to be on a blocker alone for >= 1 year. Psychological measures were obtained at baseline, 6 months, and 12 months using short-form validated questionnaires from the NIH's Patient Reported Outcomes Measurement Information System (PROMIS). Self-reports of anger, anxiety, depression, stress, and life satisfaction were obtained in TG youth. Their primary caregiver completed self-reports of anxiety, depression, and stress, while also providing proxy-reports of their child's anxiety, depression, and life satisfaction. Results Twenty-eight subjects (mean age 12.3 years +/-1.35, range 8.42-13.95) were enrolled of whom 20 were assigned female at birth (AFAB) and 8 were assigned male at birth (AMAB). To date, 12- month measures have been collected for 14/20 AFAB and 6/8 AMAB subjects. At 12-month follow up, the median time since blocker initiation was 13.6 months (range 10.7-20.6). Breast Tanner stage in subjects AFAB and testicular volume in subjects AMAB remained stable or slightly decreased over the course of the study. At 12 months, estradiol levels ranged from <15- 27 pg/mL in subjects AFAB and all values were <20 pg/mL in subjects AMAB. Testosterone values ranged from <10-49 ng/dL in subjects AFAB and 10-23 ng/dL in subjects AMAB. Using one-way repeated-measures ANOVA, no significant main effect of time on any measure of psychological functioning for TG youth or their caregivers (p>0.05) was found. Conclusions All measures of psychological well-being remained stable in TG youth and their caregivers during 12 months of pubertal suppression with a GnRHa. As puberty progresses, an increase in gender dysphoria is anticipated, and it is possible that pubertal suppression prevents a deterioration in behavioral health indices during this time period. The lack of an improvement in psychological measures may have been related to a negative impact of the COVID-19 pandemic on the mental health of our cohort.