University College London Hospitals NHS Foundation Trust, London, UK; St Peter's Andrology Centre, London, UK.
University College London Hospitals NHS Foundation Trust, London, UK; UCL Great Ormond Street Institute of Child Health, London, UK; The Tavistock and Portman NHS Foundation Trust, London, UK.
Eur Urol Focus. 2023 Jan;9(1):35-41. doi: 10.1016/j.euf.2022.11.002. Epub 2022 Nov 14.
Gonadotropin-releasing hormone analogues (GnRHAs) delay the progression of puberty in transgender and nonbinary (TGNB) adolescents and reduce the impact of dysphoria due to ongoing physical development. The intervention remains contentious despite growing evidence to support this practice.
To stimulate discussion on this topical issue in the urological and gynaecological community given potential ramifications for future fertility, physical development, and options for gender affirmation surgery (GAS).
We conducted searches of the MEDLINE (from 1946) and Embase (from 1974) databases for the benefits and potential challenges of hormone blockade in TGNB adolescents on February 1, 2022. Evidence with a primary focus on clinical issues of interest to urologists and gynaecologists was objectively synthesised and reported.
The onset of puberty represents a period of distress for TGNB adolescents as secondary sexual characteristics develop. GnRHAs are prescribed to inhibit sex hormone production, but the decision to treat should be balanced against the known (and unknown) adverse effects. Fertility preservation is more likely to be successful if GnRHA treatment is delayed for as long as possible. Some adolescents may decide to stop GnRHA use to harvest spermatozoa or oocytes before starting gender-affirming hormone treatment. Transfeminine individuals should consider that options for genital GAS may become more limited, as vaginoplasty with penile skin inversion requires an adequate stretched penile length. Transmasculine individuals may no longer require chest reconstruction for breast development.
Offers of GnRHA treatment to TGNB adolescents should be balanced by careful preparation and counselling. Urologists and gynaecologists can complement the expertise of specialist psychosocial and adolescent endocrinology teams, and should be involved early in and throughout the treatment pathway to maximise future functional and surgical outcomes.
Puberty blockers for transgender and nonbinary adolescents have benefits, but timing is important to preserve fertility and surgical options.
促性腺激素释放激素类似物（GnRHAs）可延缓跨性别和非二元性别（TGNB）青少年的青春期进展，并减轻因身体持续发育而引起的不适。尽管有越来越多的证据支持这种做法，但该干预措施仍存在争议。
鉴于 GnRHAs 对未来生育能力、身体发育和性别肯定手术（GAS）选择的潜在影响，在泌尿科和妇科领域就这一热门话题展开讨论。
我们于 2022 年 2 月 1 日在 MEDLINE（始于 1946 年）和 Embase（始于 1974 年）数据库中检索了 GnRHAs 对 TGNB 青少年的益处和潜在挑战方面的证据。客观综合和报告了主要关注泌尿科医生和妇科医生感兴趣的临床问题的证据。
青春期的开始是 TGNB 青少年感到困扰的时期，因为第二性征开始发育。GnRHAs 被开处方以抑制性激素的产生，但治疗的决定应权衡已知（和未知）的不良反应。如果 GnRHAs 治疗尽可能延迟，那么生育力保存更有可能成功。一些青少年可能决定在开始性别肯定激素治疗之前停止 GnRHA 治疗，以收获精子或卵子。 transgender 女性应该考虑到，进行阴道成形术需要足够的伸展阴茎长度时，用于阴道重建的阴茎皮肤翻转术的选择可能会变得更有限。 transgender 男性可能不再需要进行乳房发育的乳房重建。
向 TGNB 青少年提供 GnRHAs 治疗应通过仔细的准备和咨询来平衡。泌尿科医生和妇科医生可以补充专业的心理社会和青少年内分泌学团队的专业知识，并应尽早并贯穿整个治疗过程参与，以最大限度地提高未来的功能和手术结果。
青春期阻滞剂可用于跨性别和非二元性别青少年，但是为了保留生育能力和手术选择，时机很重要。
