Departments of Plastic, Reconstructive and Hand Surgery,
Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
Pediatrics. 2020 Nov;146(5). doi: 10.1542/peds.2019-3653.
Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender dysphoria. In this study, we aim to inform prescribing professionals on the long-term effects of PS treatment on the development of sex characteristics and surgical implications.
Participants received PS according to the Endocrine Society guideline at Tanner 2 or higher. Data were collected from adolescents who received PS between 2006 and 2013 and from untreated transgender controls. Data collection pre- and post-PS and before surgery included physical examination and surgical information.
In total, 300 individuals (184 transgender men and 116 transgender women) were included. Of these, 43 individuals started PS treatment at Tanner 2/3, 157 at Tanner 4/5, and 100 used no PS (controls). Breast development was significantly less in transgender men who started PS at Tanner 2/3 compared with those who started at Tanner 4/5 and controls. Mastectomy was more frequently omitted or less invasive after PS. In transgender women, the mean penile length was significantly shorter in the PS groups compared with controls (by 4.8 cm [Tanner 2/3] and 2.1 cm [Tanner 4/5]). As a result, the likelihood of undergoing intestinal vaginoplasty was increased (odds ratio = 84 [Tanner 2/3]; odds ratio = 9.8 [Tanner 4/5]).
PS reduces the development of sex characteristics in transgender adolescents. As a result, transgender men may not need to undergo mastectomy, whereas transgender women may require an alternative to penile inversion vaginoplasty. These surgical implications should inform decision-making when initiating PS.
青春期抑制（PS）是治疗性别焦虑青少年的基石。本研究旨在为处方专业人员提供 PS 治疗对性特征发育和手术影响的长期影响信息。
参与者根据内分泌学会指南在 Tanner 2 或更高阶段接受 PS。数据来自于 2006 年至 2013 年间接受 PS 的青少年和未经治疗的跨性别对照组。PS 前后和手术前收集了体格检查和手术信息。
共纳入 300 名个体（184 名跨性别男性和 116 名跨性别女性）。其中，43 人在 Tanner 2/3 开始 PS 治疗，157 人在 Tanner 4/5 开始 PS 治疗，100 人未使用 PS（对照组）。与 Tanner 4/5 和对照组相比，在 Tanner 2/3 开始 PS 治疗的跨性别男性的乳房发育明显较少。PS 后，乳房切除术更常被省略或采用较少的侵入性方法。在跨性别女性中，PS 组的平均阴茎长度明显短于对照组（Tanner 2/3 为 4.8cm，Tanner 4/5 为 2.1cm）。因此，接受肠阴道成形术的可能性增加（Tanner 2/3 为 84 倍；Tanner 4/5 为 9.8 倍）。
PS 减少了跨性别青少年性特征的发育。因此，跨性别男性可能不需要进行乳房切除术，而跨性别女性可能需要替代阴茎反转阴道成形术。这些手术影响因素应在开始 PS 时为决策提供信息。
