Does gender affirmation surgery in childhood improve wellbeing and mental health in individuals with gender dysphoria (Gender Identity Disorder)?

From the Guidelines

Gender reassignment surgery in childhood is not a standard practice for improving wellbeing and mental health in individuals with gender dysphoria, and a staged approach with psychological support, social transition, and potentially puberty blockers or cross-sex hormones is typically used instead. The evidence regarding gender reassignment surgery in childhood for improving wellbeing and mental health in individuals with gender dysphoria is limited and inconclusive 1. For prepubertal children, treatment focuses on psychological support and social transition if desired. For adolescents, puberty blockers (such as GnRH agonists like leuprolide) may be considered around Tanner stage 2-3, followed potentially by cross-sex hormones (estrogen or testosterone) in later adolescence. Surgical interventions are rarely considered before age 18, with exceptions sometimes made for chest surgeries in older adolescents after appropriate psychological evaluation and living in the affirmed gender. The approach to gender dysphoria requires individualized care with mental health professionals, endocrinologists, and other specialists working together. Some key points to consider in the management of transgender and gender-diverse patients include:

• Affirming a person’s gender identity and expression is associated with many positive outcomes related to health, well-being, and quality of life 1
• Research has shown that TGD persons in an affirming environment experience less psychological distress and suicidal ideation 1
• The limited research available suggests that for carefully selected adolescents with persistent gender dysphoria, gender-affirming care may improve psychological functioning, but long-term outcome studies specifically on childhood surgical interventions are lacking. Treatment decisions should involve thorough assessment, informed consent discussions with both the young person and their parents/guardians, and ongoing psychological support throughout any transition process. It is essential to prioritize the individual's needs and provide care that is respectful and affirming of their gender identity and expression.

From the Research

Gender Affirmation Surgery in Childhood

• The study by 2 found that gender reassignment surgery in young adulthood can alleviate gender dysphoria and improve psychological functioning, with well-being similar to or better than same-age young adults from the general population.
• The research by 3 showed that the majority of adolescents who started gonadotropin-releasing hormone analogues (GnRHa) proceeded to gender-affirming hormones, suggesting that GnRHa treatment may be an effective step towards gender affirmation.
• However, the editorial perspective by 4 highlighted the limitations of the existing evidence for medical body modification in youth with gender dysphoria, emphasizing the need for further research to inform decision-making.

Psychological Functioning and Well-being

• The study by 2 found that improvements in psychological functioning were positively correlated with postsurgical subjective well-being, suggesting that gender affirmation surgery can have a positive impact on mental health.
• The systematic review by 5 found that the use of GnRHa analogues in adolescents with gender incongruity was associated with a more distinct resemblance to body shape than to the affirmed sex, and may contribute to the mental health of these adolescents.
• The overview by 6 noted that gender reassignment surgery has been demonstrated as the most effective treatment for patients affected by gender dysphoria, and highlighted the importance of eligibility criteria for surgery.

Treatment Options and Outcomes

• The study by 3 found that few individuals discontinued GnRHa treatment, and only a small percentage no longer wished gender-affirming treatment, suggesting that GnRHa treatment may be a effective and acceptable treatment option for many adolescents.
• The systematic review by 5 highlighted the need for further research on the use of GnRHa analogues in adolescents with gender incongruity, particularly in terms of long-term outcomes and potential risks and benefits.
• The editorial perspective by 4 emphasized the importance of considering the potential risks and benefits of medical body modification in youth with gender dysphoria, and highlighted the need for further research to inform decision-making.