PDF(Pubmed)
Abstract：
Controversy exists over puberty suppression (PS) in adolescents with gender dysphoria (GD). PS is preferentially achieved with GnRH analogues. By preventing the development of secondary sex characteristics, PS may improve psychological functioning, well-being, quality of life, emotional and behavioral (especially internalizing) problems and depressive symptoms, thus decreasing suicidality. PS can also extend the diagnostic period and give transgender adolescents time to explore their gender identity. GnRHa may also decrease the need for feminization/masculinization surgery. However, 2-year treatment with GnRHa may result in bone mass accrual retardation (decrease in BMD/BMAD z-scores), growth velocity deceleration (decrease in height SDS), increase in fat mass, temporary pause in oocyte/sperm maturation. The most common side effects of GnRHa are hot flashes, mood fluctuations, fatigue and headache. They are usually mild and rarely lead to GnRHa discontinuation. Based on current scientific evidence, PS could be recommended to adolescents who meet the diagnostic criteria of gender incongruence (by DSM-5 and/or ICD-11) and have long-lasting intense GD, which aggravates with puberty onset. Before initiating PS, possible mental issues should be addressed and informed consent (by the adolescent/caregiver) should be given, after counseling on probable reproductive effects of GnRHa. GnRHa can only be started after the adolescent has entered Tanner stage 2. Nevertheless, published studies are inadequate in number, small in size, uncontrolled and relatively short-term, so that it is difficult to draw safe conclusions on efficacy and safety of GnRHa. Large long-term randomized controlled trials are needed to expand knowledge on this controversial issue and elucidate the benefit and risks of PS.
摘要：
在患有性别烦躁不安（GD）的青少年中，青春期抑制（PS）存在争议。PS优选用GnRH类似物实现。通过防止第二性征的发展，PS可以改善心理功能，幸福,生活质量,情绪和行为（尤其是内化）问题和抑郁症状，从而减少自杀。PS还可以延长诊断期，并给跨性别青少年时间来探索他们的性别认同。GnRHa还可以减少女性化/男性化手术的需要。然而,GnRHa治疗2年可能导致骨量累积迟缓（BMD/BMADz评分降低），生长速度减速(高度SDS降低)，脂肪量增加，卵母细胞/精子成熟暂时暂停。GnRHa最常见的副作用是潮热,情绪波动,疲劳和头痛。它们通常是温和的，很少导致GnRHa停药。根据目前的科学证据,PS可以推荐给符合性别不一致诊断标准的青少年（通过DSM-5和/或ICD-11），并且具有持久的强烈GD，随着青春期的发作而加重。在启动PS之前，应解决可能的精神问题，并应（由青少年/照顾者）给予知情同意，在对GnRHa可能的生殖效应进行咨询后。GnRHa只能在青少年进入Tanner阶段2后开始。然而，发表的研究数量不足，尺寸小，不受控制和相对短期的，因此很难得出关于GnRHa疗效和安全性的安全结论。需要大量的长期随机对照试验来扩大对这个有争议的问题的认识，并阐明PS的益处和风险。
