Young adult psychological outcome after puberty suppression and gender reassignment

Pediatrics. 2014 Oct;134(4):696-704. doi: 10.1542/peds.2013-2958. Epub 2014 Sep 8.


Background: In recent years, puberty suppression by means of gonadotropin-releasing hormone analogs has become accepted in clinical management of adolescents who have gender dysphoria (GD). The current study is the first longer-term longitudinal evaluation of the effectiveness of this approach.

Methods: A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years). Psychological functioning (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness) well-being were investigated.

Results: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being.

Conclusions: A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.

Keywords: adolescents; gender dysphoria; longitudinal outcomes; psychological functioning; puberty suppression; transgenderism.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Body Image / psychology*
  • Cohort Studies
  • Female
  • Hormone Antagonists / administration & dosage
  • Humans
  • Male
  • Puberty / drug effects
  • Puberty / psychology*
  • Sex Reassignment Procedures / methods
  • Sex Reassignment Procedures / psychology*
  • Sex Reassignment Procedures / trends
  • Transgender Persons / psychology*
  • Transsexualism / diagnosis
  • Transsexualism / psychology*
  • Transsexualism / therapy*
  • Treatment Outcome
  • Young Adult


  • Hormone Antagonists