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  1. Article ; Online: Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria.

    Brik, Tessa / Vrouenraets, Lieke J J J / de Vries, Martine C / Hannema, Sabine E

    Archives of sexual behavior

    2020  Volume 49, Issue 7, Page(s) 2611–2618

    Abstract: Gonadotropin-releasing hormone analogues (GnRHa) are recommended as initial treatment for adolescents diagnosed with gender dysphoria, providing time to follow gender identity development and consider further treatment wishes without distress caused by ... ...

    Abstract Gonadotropin-releasing hormone analogues (GnRHa) are recommended as initial treatment for adolescents diagnosed with gender dysphoria, providing time to follow gender identity development and consider further treatment wishes without distress caused by unwanted pubertal changes. This has been described as an extended diagnostic phase. However, there are also concerns about the physical, neurocognitive, and psychosocial effects of this treatment. In this retrospective study, we document trajectories after the initiation of GnRHa and explore reasons for extended use and discontinuation of GnRHa. Treatment was considered appropriate in 143 (67%) of the 214 adolescents eligible for GnRHa treatment by virtue of their age/pubertal status, and all started GnRHa (38 transgirls, 105 transboys; median age, 15.0 years [range, 11.1-18.6] and 16.1 years [range, 10.1-17.9]). After a median duration of 0.8 years (0.3-3.8) on GnRHa, 125 (87%) started gender-affirming hormones (GAH). Nine (6%) discontinued GnRHa, five of whom no longer wished gender-affirming treatment. Thirteen had used GnRHa for longer than required by protocol for reasons other than logistics and regularly met with a mental health professional during this time, supporting the use of GnRHa treatment as an extended diagnostic phase. In conclusion, the vast majority who started GnRHa proceeded to GAH, possibly due to eligibility criteria that select those highly likely to pursue further gender-affirming treatment. Due to the observational character of the study, it is not possible to say if GnRHa treatment itself influenced the outcome. Few individuals discontinued GnRHa, and only 3.5% no longer wished gender-affirming treatment.
    MeSH term(s) Adolescent ; Child ; Female ; Gender Dysphoria/drug therapy ; Gonadotropin-Releasing Hormone/pharmacology ; Gonadotropin-Releasing Hormone/therapeutic use ; Humans ; Male ; Retrospective Studies
    Chemical Substances Gonadotropin-Releasing Hormone (33515-09-2)
    Language English
    Publishing date 2020-03-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 184221-3
    ISSN 1573-2800 ; 0004-0002
    ISSN (online) 1573-2800
    ISSN 0004-0002
    DOI 10.1007/s10508-020-01660-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Perceptions on the function of puberty suppression of transgender adolescents who continued or discontinued treatment, their parents, and clinicians.

    Vrouenraets, Lieke J J J / de Vries, Martine C / Hein, Irma M / Arnoldussen, Marijn / Hannema, Sabine E / de Vries, Annelou L C

    International journal of transgender health

    2021  Volume 23, Issue 4, Page(s) 428–441

    Abstract: Purpose: ...

    Abstract Purpose:
    Language English
    Publishing date 2021-11-11
    Publishing country United States
    Document type Journal Article
    ISSN 2689-5277
    ISSN (online) 2689-5277
    DOI 10.1080/26895269.2021.1974324
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  3. Article ; Online: Assessing Medical Decision-Making Competence in Transgender Youth.

    Vrouenraets, Lieke J J J / de Vries, Annelou L C / de Vries, Martine C / van der Miesen, Anna I R / Hein, Irma M

    Pediatrics

    2021  Volume 148, Issue 6

    Abstract: Background: According to international transgender care guidelines, an important prerequisite for puberty suppression (PS) is transgender adolescents' competence to give informed consent (IC). In society, there is doubt whether transgender adolescents ... ...

    Abstract Background: According to international transgender care guidelines, an important prerequisite for puberty suppression (PS) is transgender adolescents' competence to give informed consent (IC). In society, there is doubt whether transgender adolescents are capable of this, which in some countries has even led to limited access to this intervention. Therefore, this study examined transgender adolescents' medical decision-making competence (MDC) to give IC for starting PS in a structured, replicable way. Additionally, potential associated variables on MDC, such as age, intelligence, sex, psychological functioning, were investigated.
    Methods: A cross-sectional semistructured interview study with 74 transgender adolescents (aged 10-18 years; 16 birth-assigned boys, 58 birth-assigned girls) within two Dutch specialized gender-identity clinics was performed. To assess MDC, judgements based on the reference standard (clinical assessment) and the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a validated semistructured interview, were used.
    Results: Of the transgender adolescents, 93.2% (reference standard judgements; 69 of 74) and 89.2% (MacCAT-T judgements; 66 of 74) were assessed competent to consent. Intermethod agreement was 87.8% (65 of 74). Interrater agreements of the reference standard and MacCAT-T-based judgements were 89.2% (198 of 222) and 86.5% (192 of 222), respectively. IQ and sex were both significantly related to MacCAT-T total score, whereas age, level of emotional and behavioral challenges, and diagnostic trajectories duration were not.
    Conclusions: By using the MacCAT-T and clinicians' assessments, 93.2% and 89.2%, respectively, of the transgender adolescents in this study were assessed competent to consent for starting PS.
    MeSH term(s) Adolescent ; Adolescent Behavior ; Age Factors ; Child ; Child Behavior ; Clinical Decision-Making/methods ; Cross-Sectional Studies ; Female ; Humans ; Informed Consent By Minors/psychology ; Informed Consent By Minors/statistics & numerical data ; Intelligence ; Judgment ; Male ; Mental Competency/psychology ; Netherlands ; Puberty ; Reference Standards ; Transgender Persons/psychology ; Transgender Persons/statistics & numerical data
    Language English
    Publishing date 2021-11-23
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2020-049643
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Use of Fertility Preservation Among a Cohort of Transgirls in the Netherlands.

    Brik, Tessa / Vrouenraets, Lieke J J J / Schagen, Sebastian E E / Meissner, Andreas / de Vries, Martine C / Hannema, Sabine E

    The Journal of adolescent health : official publication of the Society for Adolescent Medicine

    2019  Volume 64, Issue 5, Page(s) 589–593

    Abstract: Purpose: The primary aims of the study are to examine the rate of attempted fertility preservation (FP) among a Dutch cohort of transgirls who started gonadotropin-releasing hormone analog treatment and the reasons why adolescents did or did not choose ... ...

    Abstract Purpose: The primary aims of the study are to examine the rate of attempted fertility preservation (FP) among a Dutch cohort of transgirls who started gonadotropin-releasing hormone analog treatment and the reasons why adolescents did or did not choose to attempt FP.
    Methods: The study was a single-center retrospective review of medical records of 35 transgirls who started gonadotropin-releasing hormone analog treatment between 2011 and 2017.
    Results: Ninety-one percent of adolescents were counseled on the option of FP. Thirty-eight percent of counseled adolescents attempted FP, and 75% of them were able to cryopreserve sperm suitable for intrauterine insemination or intracytoplasmic sperm injection. Younger and Caucasian transgirls were less likely to attempt FP. No specific reason for declining FP was known in 33% adolescents, 32% of adolescents were not able to produce a semen sample because of early puberty, 17% felt uncomfortable with masturbation, 17% did not want to have children, and 13% wanted to adopt.
    Conclusions: One third of adolescents attempted FP, which is much more than the percentage reported in previous studies from the United States. One third of the transgirls could not make use of FP because they were unable to produce a semen sample because of early pubertal stage. For these adolescents, alternatives need to be explored.
    MeSH term(s) Adolescent ; Age Factors ; Cryopreservation ; Female ; Fertility Preservation ; Humans ; Male ; Netherlands ; Puberty/physiology ; Retrospective Studies ; Spermatozoa/physiology ; Transgender Persons/psychology
    Language English
    Publishing date 2019-01-26
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 1063374-1
    ISSN 1879-1972 ; 1054-139X
    ISSN (online) 1879-1972
    ISSN 1054-139X
    DOI 10.1016/j.jadohealth.2018.11.008
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