Puberty-Blocking Hormonal Therapy for Adolescents with Gender Identity Disorder: A Descriptive Clinical Study

Abstract

The use of puberty-delaying or blocking hormonal treatment of adolescents with gender identity disorder (GID) has become increasingly common. In the present study, we examined demographic, behavior problem, and psychosexual measures to see if any of them correlated with the clinical decision to recommend, or not recommend, puberty-blocking hormonal therapy in a consecutive series of 109 adolescents (55 females, 54 males) with GID evaluated between 2000 and 2009. Of the 109 adolescents, 66 (60.6%) were recommended for puberty-blocking hormonal therapy and 43 (39.4%) were not. A combination of five (of 15) demographic, behavior problem, and psychosexual measures were identified in a logistic regression analysis to significantly predict this clinical recommendation. The quantitative data were complemented by clinical case descriptions and some follow-up information. We discuss our data in relation to the Dutch model of early biomedical treatment for youth with GID and consider areas that require further clinical and empirical examination.

KEYWORDS:

• gender identity disorder
• adolescents
• hormonal therapy

Notes

1. Two of the patients had a co-occurring disorder of sex development: one patient was a genetic female with congenital adrenal hyperplasia, who had been assigned female shortly after birth; the second patient was a genetic male with penile agenesis, who had also been assigned female shortly after birth (and surgically castrated). Both of these patients are included in our sample as females based on their assigned gender. Two other female patients had co-occurring polycystic ovarian syndrome.

2. For sexual orientation, we arbitrarily selected the EROS measure as the metric of sexual orientation, not the SHQ. These two variables were highly correlated, with a Phi coefficient of .61 (Nunnally, 1978, pp. 132–133).

3. A logistic regression that only included the participants with no missing data on any of the variables (N = 88) yielded very similar findings as the multiple imputation procedure. The results of this logistic regression analysis are available from the corresponding author upon request.

4. There is considerable clinical evidence that some women with a lesbian sexual orientation can “migrate” to a transgendered gender identity and vice-versa. For lesbian women, this is particularly common among those who self-identify as “butch.” One can also make the same clinical observation for men with a gay sexual orientation, particularly those who are behaviorally very feminine. Thus, it is important consider that an adolescent might fluctuate between these two kinds of identity statuses and thus is an appropriate topic for exploration in supportive psychotherapy (see, e.g., Brown, 2010; Devor, 1997; Diamond & Butterworth, 2008; Lee, 2001; McCarthy, 2003; Rosario, 2009).