A Lancet-published review of the evidence around the use of gender-affirming hormones and surgery in trans* children and adolescents has found such interventions can lead to a marked improvement in mental health outcomes and quality of life.
However, lead author Simone Mahfouda, a PhD student at The Kids Research Institute Australia, noted that the evidence base was still scarce – particularly around risks and benefits of surgery for trans females under the age of 18 – and more research was urgently needed to understand long term outcomes.
The review, led by Ms Mahfouda and other researchers including Dr Ashleigh Lin – head of Youth Mental Health research at The Kids – was published in The Lancet Diabetes and Endocrinology.
Ms Mahfouda said gender-affirming cross-sex hormones, including oestrogen for trans females and testosterone for trans males, remained the cornerstone of treatment for many individuals who identified as trans.
“Not all people who identify as trans will want this kind of intervention, or be deemed eligible,” Ms Mahfouda said.
“For those who do, it helps to affirm gender identity by inducing masculine or feminine physical characteristics that are congruent with an individual’s gender expression, and improves mental health and quality-of-life outcomes.
“However, more research is desperately needed to inform best clinical practice in this area, particularly in relation to children and adolescents.”
The researchers explored all available published evidence on the effects of gender-affirming cross-sex hormones in eligible trans children and adolescents.
They analysed mental health outcomes, cognitive and physical effects (e.g. body composition and bone parameters, cardiovascular health), side-effects, and safety indices including liver and renal function.
“We also examined whether gender-affirming surgeries, such as breast removal for trans males, was associated with benefits to psychological health,” Ms Mahfouda said.
“The preliminary available data suggests that when clearly indicated, these interventions are associated with marked improvements in mental health outcomes and quality of life.
“Collectively, 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.
“In regard to surgical intervention for transgender females under the age of 18, there is still too little evidence to enable us to draw conclusions about risks and benefits in this age group.
“Further research on an international scale is urgently warranted to clarify long-term outcomes on psychological functioning and safety.”
The review was a collaboration between researchers from The Kids Research Institute Australia, The University of Western Australia, the Gender Diversity Service (Child and Adolescent Mental Health Service, Western Australia), Perth Children’s Hospital, and Jena University Hospital (Germany).
*Trans is an umbrella term used to describe individuals for whom gender identity is incongruent with sex assigned at birth.
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