Reacción a "Reactions: Discontinuation of hormone treatment in people who started transition during adolescence is rare"

The management of gender incongruence in adolescence is a highly complex situation and until a few years ago we did not have robust evidence on some issues such as Rapid Onset Gender Dysphoria (ROGD) (description of trans minors as a consequence of social contagion, which is not a medical diagnosis), the safety of hormone treatments initiated at puberty and desistance (which consists of changing the initially manifested sense of identity) or detransition (consisting of reversing the changes made in the gender reassignment process, whether medical, social or administrative). 

Regarding the DGIR, Bauer published a study in April 2022 that attempted to test the hypothesis of social contagion in transgender minors and that they are "adolescents with comorbid mental health problems". Their results did not confirm the existence of DGIR and did confirm a positive impact on the mental health of adolescents on gender affirming hormone treatment.  

In relation to puberty blockers (GnRH analogues - aGnRH), for more than fifteen years there has been knowledge of their efficacy and the absence of serious adverse effects in their use in children with central precocious puberty. Experience in trans children is more limited, but appears to be similar. Recent work has suggested that growth patterns of trans children with puberty blockers are similar to those reported for prepubertal cisgender children. The use of aGnRH in trans children has also been shown to mitigate the risk of depression, anxiety and suicidal tendencies. 

Van der Loos' study published today in The Lancet Child & Adolescent Health adds further scientific evidence to the question of how many trans adolescents who started hormone treatment in adolescence continue treatment into adulthood. 

The Gender Identity Unit (GIDU) of the Amsterdam UMC is a world leader in all aspects of transgender medicine and is governed by protocolised actions. It has one of the best registries related to the biopsychosocial approach to transgender people. This is reflected in the quality of the data and methodology of the study, and therefore of its conclusions. 

In 2022, Butler answered the question for the first time and found that 95% of trans children who started hormone treatment in adolescence continued it into adulthood.   

In the WBU IGU study, 98% of trans adolescents who started hormone treatment in adolescence continued it into adulthood.  

A limitation of this study is the fact that the prescription of hormone treatment does not necessarily translate into continuation of hormones. This is a limitation of all registry-based studies and may overestimate the results.  

Another limitation of the study was the failure to find the reasons why 2% stopped hormone treatment. Regarding the 2% of transgender people who were untreated, the researchers reflected that it cannot be concluded that these people dropped out or became untransitioned. These individuals could have stopped hormone treatment for a number of plausible reasons for treatment discontinuation, such as lack of knowledge about the importance of continued hormone treatment after gonadectomy (following gender confirmation surgery) or adverse effects of medication, or that they have non-binary identities. 

In any case, the results of van der Loos' work are in line with the results of previous studies and provide evidence in this field that supports the current approach to transgender children. Thus, the results of the Amsterdam UMC IGU study confirm that the initiation of hormone treatment in trans adolescents has a high rate of continuation into adulthood (98%), providing health professionals with evidence to reassure them about the results of the current approach. 

These findings can and should help and guide the current public and legal debate on the initiation of medical treatment in transgender minors.