RESEARCH

Allgayer, Roberta M. C. Moreira, Gustavo da Silva Borba, Ruy Silveira Moraes, Ramon Bossardi Ramos, and Poli Mara Spritzer. “The Effect of Gender-Affirming Hormone Therapy on the Risk of Subclinical Atherosclerosis in the Transgender Population: A Systematic Review.” Endocrine Practice 29, no. 6 (2023): 498–507. https://doi.org/10.1016/j.eprac.2022.12.017. 

Baker, Kellan E., Lisa M. Wilson, Ritu Sharma, Vadim Dukhanin, Kristen McArthur, and Karen A. Robinson. “Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review.” Journal of the Endocrine Society 5, no. 4 (2021): bvab011. https://doi.org/10.1210/jendso/bvab011. 

Ludvigsson, Jonas F., Jan Adolfsson, Malin Höistad, Per-Anders Rydelius, Berit Kriström, and Mikael Landén. “A Systematic Review of Hormone Treatment for Children with Gender Dysphoria and Recommendations for Research.” Acta Paediatrica 112, no. 11 (2023): 2279–92. https://doi.org/10.1111/apa.16791. 

Miroshnychenko, Anna, Sara Ibrahim, Yetiani Roldan, et al. “Gender Affirming Hormone Therapy for Individuals with Gender Dysphoria Aged <26 Years: A Systematic Review and Meta-Analysis.” Original Research. Archives of Disease in Childhood 110, no. 6 (2025): 437–45. https://doi.org/10.1136/archdischild-2024-327921. 

Miroshnychenko, Anna, Yetiani Roldan, Sara Ibrahim, et al. “Puberty Blockers for Gender Dysphoria in Youth: A Systematic Review and Meta-Analysis.” Original Research. Archives of Disease in Childhood 110, no. 6 (2025): 429–36. https://doi.org/10.1136/archdischild-2024-327909. 

Miroshnychenko, Anna, Yetiani M. Roldan, Sara Ibrahim, et al. “Mastectomy for Individuals with Gender Dysphoria Younger Than 26 Years: A Systematic Review and Meta-Analysis.” Plastic and Reconstructive Surgery 155, no. 6 (2025): 915. https://doi.org/10.1097/PRS.0000000000011734. 

NICE. Evidence Review: Gonadotrophin Releasing Hormone Analogues for Children and Adolescents with Gender Dysphoria. 2021. https://www.engage.england.nhs.uk/consultation/puberty-suppressing-hormones/user_uploads/nice-evidence-review-gnrh-analogues-for-children-and-adolescents-with-gender-dysphoria-october-2020.pdf. 

Pang, Kenneth. “Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review.” Yearbook of Paediatric Endocrinology 141, no. 4 (2018). https://doi.org/10.1530/EY.15.6.6. 

Taylor, Jo, Alex Mitchell, Ruth Hall, et al. “Interventions to Suppress Puberty in Adolescents Experiencing Gender Dysphoria or Incongruence: A Systematic Review.” Original Research. Archives of Disease in Childhood 109, no. Suppl 2 (2024): s33–47. https://doi.org/10.1136/archdischild-2023-326669. 

Taylor, Jo, Alex Mitchell, Ruth Hall, Trilby Langton, Lorna Fraser, and Catherine Elizabeth Hewitt. “Masculinising and Feminising Hormone Interventions for Adolescents Experiencing Gender Dysphoria or Incongruence: A Systematic Review.” Original Research. Archives of Disease in Childhood 109, no. Suppl 2 (2024): s48–56. https://doi.org/10.1136/archdischild-2023-326670. 

Thompson, Lucy, Darko Sarovic, Philip Wilson, et al. “A PRISMA Systematic Review of Adolescent Gender Dysphoria Literature: 3) Treatment.” PLOS Global Public Health 3, no. 8 (2023): e0001478. https://doi.org/10.1371/journal.pgph.0001478. 

Zepf, F. D., Konig, L., Kaiser, A. “Beyond NICE: Updated Systematic Review on the Current Evidence for Using Puberty Blockers and Cross-Sex Hormones in Minors with Gender Dysphoria.” Department of Child and Adolescent Psychiatry, Psychosomatic Medicine & Psychotherapy of Jena University Hospital, n.d. https://econtent.hogrefe.com/doi/suppl/10.1024/1422-4917/a000972/suppl_file/1422-4917_a000972_esm1.pdf. 

Alzahrani, Talal, Tran Nguyen, Angela Ryan, et al. “Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population.” Circulation: Cardiovascular Quality and Outcomes 12, no. 4 (2019): e005597. https://doi.org/10.1161/CIRCOUTCOMES.119.005597. 

Antun, Ana, Qi Zhang, Shalender Bhasin, et al. “Longitudinal Changes in Hematologic Parameters Among Transgender People Receiving Hormone Therapy.” Journal of the Endocrine Society 4, no. 11 (2020): bvaa119. https://doi.org/10.1210/jendso/bvaa119. 

Bailie, Emily, Mila Maidarti, Robert Hawthorn, et al. “The Ovaries of Transgender Men Indicate Effects of High Dose Testosterone on the Primordial and Early Growing Follicle Pool.” Reproduction and Fertility. Reproduction and Fertility 4, no. 2 (2023). https://doi.org/10.1530/RAF-22-0102. 

Barger, Branden T., Mikhail Pakvasa, Melinda Lem, Aishu Ramamurthi, Shadi Lalezari, and Cathy Tang. “Non-Typhoidal Salmonella Soft-Tissue Infection after Gender Affirming Subcutaneous Mastectomy Case Report.” Case Reports in Plastic Surgery and Hand Surgery 10, no. 1 (2023): 2185621. https://doi.org/10.1080/23320885.2023.2185621. 

Bertelloni, Silvano, Giampiero I. Baroncelli, Marco Ferdeghini, Fabrizio Menchini-Fabris, and Giuseppe Saggese. “Final Height, Gonadal Function and Bone Mineral Density of Adolescent Males with Central Precocious Puberty after Therapy with Gonadotropin-Releasing Hormone Analogues.” European Journal of Pediatrics 159, no. 5 (2000): 369–74. https://doi.org/10.1007/s004310051289. 

Biggs, Michael. “Revisiting the Effect of GnRH Analogue Treatment on Bone Mineral Density in Young Adolescents with Gender Dysphoria.” Journal of Pediatric Endocrinology and Metabolism 34, no. 7 (2021): 937–39. https://doi.org/10.1515/jpem-2021-0180. 

Boogers, Lidewij Sophia, Maria Anna Theodora Catharina van der Loos, Chantal Maria Wiepjes, Adrianus Sarinus Paulus van Trotsenburg, Martin den Heijer, and Sabine Elisabeth Hannema. “The Dose-Dependent Effect of Estrogen on Bone Mineral Density in Trans Girls.” European Journal of Endocrinology 189, no. 2 (2023): 290–96. https://doi.org/10.1093/ejendo/lvad116. 

Bos, Peter A., Dennis Hofman, Erno J. Hermans, Estrella R. Montoya, Simon Baron-Cohen, and Jack van Honk. “Testosterone Reduces Functional Connectivity during the ‘Reading the Mind in the Eyes’ Test.” Psychoneuroendocrinology 68 (June 2016): 194–201. https://doi.org/10.1016/j.psyneuen.2016.03.006. 

Braun, Hayley, Qi Zhang, Darios Getahun, et al. “Moderate-to-Severe Acne and Mental Health Symptoms in Transmasculine Persons Who Have Received Testosterone.” JAMA Dermatology 157, no. 3 (2021): 344–46. https://doi.org/10.1001/jamadermatol.2020.5353. 

Cheng, Philip J., Alexander W. Pastuszak, Jeremy B. Myers, Isak A. Goodwin, and James M. Hotaling. “Fertility Concerns of the Transgender Patient.” Translational Andrology and Urology 8, no. 3 (2019): 20918–20218. https://doi.org/10.21037/tau.2019.05.09. 

Ciancia, Silvia, Vanessa Dubois, and Martine Cools. “Impact of Gender-Affirming Treatment on Bone Health in Transgender and Gender Diverse Youth.” Endocrine Connections. Endocrine Connections 11, no. 11 (2022). https://doi.org/10.1530/EC-22-0280. 

Delgado-Ruiz, Rafael, Patricia Swanson, and Georgios Romanos. “Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy.” Journal of Clinical Medicine 8, no. 6 (2019). https://doi.org/10.3390/jcm8060784. 

Dobrolińska, Magdalena, Karin van der Tuuk, Patti Vink, et al. “Bone Mineral Density in Transgender Individuals After Gonadectomy and Long-Term Gender-Affirming Hormonal Treatment.” The Journal of Sexual Medicine 16, no. 9 (2019): 1469–77. https://doi.org/10.1016/j.jsxm.2019.06.006. 

Dulohery, Kate, Matthias Trottmann, Susanne Bour, et al. “How Do Elevated Levels of Testosterone Affect the Function of the Human Fallopian Tube and Fertility?—New Insights.” Molecular Reproduction and Development 87, no. 1 (2020): 30–44. https://doi.org/10.1002/mrd.23291. 

Getahun, Darios, Rebecca Nash, Dana Flanders, et al. “Cross-Sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study: Annals of Internal Medicine: Vol 169, No 4.” Annals of Internal Medicine 169, no. 4 (2019). https://doi.org/10.7326/M17-2785. 

Irwig, Michael S. “Cardiovascular Health in Transgender People.” Reviews in Endocrine and Metabolic Disorders 19, no. 3 (2018): 243–51. https://doi.org/10.1007/s11154-018-9454-3. 

Islam, Noreen, Rebecca Nash, Qi Zhang, et al. “Is There a Link Between Hormone Use and Diabetes Incidence in Transgender People? Data From the STRONG Cohort.” The Journal of Clinical Endocrinology & Metabolism 107, no. 4 (2022): e1549–57. https://doi.org/10.1210/clinem/dgab832. 

Joseph, Tobin, Joanna Ting, and Gary Butler. “The Effect of GnRH Analogue Treatment on Bone Mineral Density in Young Adolescents with Gender Dysphoria: Findings from a Large National Cohort.” Journal of Pediatric Endocrinology and Metabolism 32, no. 10 (2019): 1077–81. https://doi.org/10.1515/jpem-2019-0046. 

Kerckhof, Mauro E., Baudewijntje P. C. Kreukels, Timo O. Nieder, et al. “Prevalence of Sexual Dysfunctions in Transgender Persons: Results from the ENIGI Follow-Up Study.” The Journal of Sexual Medicine 16, no. 12 (2019): 2018–29. https://doi.org/10.1016/j.jsxm.2019.09.003. 

Klink, Daniel, Martine Caris, Annemieke Heijboer, Michael van Trotsenburg, and Joost Rotteveel. “Bone Mass in Young Adulthood Following Gonadotropin-Releasing Hormone Analog Treatment and Cross-Sex Hormone Treatment in Adolescents With Gender Dysphoria.” The Journal of Clinical Endocrinology & Metabolism 100, no. 2 (2015): E270–75. https://doi.org/10.1210/jc.2014-2439. 

Kranz, Georg S., Andreas Hahn, Ulrike Kaufmann, et al. “Effects of Testosterone Treatment on Hypothalamic Neuroplasticity in Female-to-Male Transgender Individuals.” Brain Structure and Function 223, no. 1 (2018): 321–28. https://doi.org/10.1007/s00429-017-1494-z. 

Kyinn, M., K. Banks, S. Y. Leemaqz, E. Sarkodie, D. Goldstein, and M. S. Irwig. “Weight Gain and Obesity Rates in Transgender and Gender-Diverse Adults before and during Hormone Therapy.” International Journal of Obesity 45, no. 12 (2021): 2562–69. https://doi.org/10.1038/s41366-021-00935-x. 

Laidlaw, Michael K., Jennifer Lahl, and Angela Thompson. “Fertility Preservation: Is There a Model for Gender-Dysphoric Youth?” Frontiers in Endocrinology 16 (April 2025). https://doi.org/10.3389/fendo.2025.1386716. 

Lee, Janet Y., Courtney Finlayson, Johanna Olson-Kennedy, et al. “Low Bone Mineral Density in Early Pubertal Transgender/Gender Diverse Youth: Findings From the Trans Youth Care Study.” Journal of the Endocrine Society 4, no. 9 (2020): bvaa065. https://doi.org/10.1210/jendso/bvaa065. 

Maraka, Spyridoula, Naykky Singh Ospina, Rene Rodriguez-Gutierrez, et al. “Sex Steroids and Cardiovascular Outcomes in Transgender Individuals: A Systematic Review and Meta-Analysis.” The Journal of Clinical Endocrinology & Metabolism 102, no. 11 (2017): 3914–23. https://doi.org/10.1210/jc.2017-01643. 

Meece, Matthew S., Lee E. Weber, Alexandra E. Hernandez, Sara J. Danker, and Nivedh V. Paluvoi. “Major Complications of Sigmoid Vaginoplasty: A Case Series.” Journal of Surgical Case Reports 2023, no. 6 (2023): rjad333. https://doi.org/10.1093/jscr/rjad333. 

Nasomyont, Nat, Andrea R. Meisman, Kirsten Ecklund, et al. “Changes in Bone Marrow Adipose Tissue in Transgender and Gender Non-Conforming Youth Undergoing Pubertal Suppression: A Pilot Study.” Journal of Clinical Densitometry 25, no. 4 (2022): 485–89. https://doi.org/10.1016/j.jocd.2022.06.006. 

Nokoff, Natalie J., Sharon L. Scarbro, Kerrie L. Moreau, et al. “Body Composition and Markers of Cardiometabolic Health in Transgender Youth on Gonadotropin-Releasing Hormone Agonists.” Transgender Health 6, no. 2 (2021): 111–19. https://doi.org/10.1089/trgh.2020.0029. 

Nota, Nienke M., Chantal M. Wiepjes, Christel J. M. de Blok, et al. “The Occurrence of Benign Brain Tumours in Transgender Individuals during Cross-Sex Hormone Treatment.” Brain 141, no. 7 (2018): 2047–54. https://doi.org/10.1093/brain/awy108. 

Nota, Nienke M., Chantal M. Wiepjes, Christel J. M. de Blok, Louis J. G. Gooren, Baudewijntje P. C. Kreukels, and Martin den Heijer. “Occurrence of Acute Cardiovascular Events in Transgender Individuals Receiving Hormone Therapy.” Circulation 139, no. 11 (2019): 1461–62. https://doi.org/10.1161/CIRCULATIONAHA.118.038584. 

Rosenthal, Stephen M. “Challenges in the Care of Transgender and Gender-Diverse Youth: An Endocrinologist’s View.” Nature Reviews Endocrinology 17, no. 10 (2021): 581–91. https://doi.org/10.1038/s41574-021-00535-9. 

Schagen, Sebastian E. E., Femke M. Wouters, Peggy T. Cohen-Kettenis, Louis J. Gooren, and Sabine E. Hannema. “Bone Development in Transgender Adolescents Treated With GnRH Analogues and Subsequent Gender-Affirming Hormones.” The Journal of Clinical Endocrinology & Metabolism 105, no. 12 (2020): e4252–63. https://doi.org/10.1210/clinem/dgaa604. 

Shadid, Samyah, Kessewa Abosi-Appeadu, Anne-Sophie De Maertelaere, et al. “Effects of Gender-Affirming Hormone Therapy on Insulin Sensitivity and Incretin Responses in Transgender People.” Diabetes Care 43, no. 2 (2019): 411–17. https://doi.org/10.2337/dc19-1061. 

Silva, Lyvia Maria Bezerra da, Silvana Neves Dias Freire, Eduarda Moretti, and Leila Barbosa. “Pelvic Floor Dysfunction in Transgender Men on Gender-Affirming Hormone Therapy: A Descriptive Cross-Sectional Study.” International Urogynecology Journal 35, no. 5 (2024): 1077–84. https://doi.org/10.1007/s00192-024-05779-3. 

Stoffers, Iris E., Martine C. de Vries, and Sabine E. Hannema. “Physical Changes, Laboratory Parameters, and Bone Mineral Density During Testosterone Treatment in Adolescents with Gender Dysphoria.” The Journal of Sexual Medicine 16, no. 9 (2019): 1459–68. https://doi.org/10.1016/j.jsxm.2019.06.014. 

Tordoff, Diana M., Mitchell R. Lunn, Bertha Chen, et al. “Testosterone Use and Sexual Function among Transgender Men and Gender Diverse People Assigned Female at Birth.” American Journal of Obstetrics & Gynecology 229, no. 6 (2023): 669.e1-669.e17. https://doi.org/10.1016/j.ajog.2023.08.035. 

Vlot, Mariska C., Daniel T. Klink, Martin den Heijer, Marinus A. Blankenstein, Joost Rotteveel, and Annemieke C. Heijboer. “Effect of Pubertal Suppression and Cross-Sex Hormone Therapy on Bone Turnover Markers and Bone Mineral Apparent Density (BMAD) in Transgender Adolescents.” Bone 95 (February 2017): 11–19. https://doi.org/10.1016/j.bone.2016.11.008. 

Thomas D. Steensma and Peggy T. Cohen-Kettenis, “A Critical Commentary on ‘A Critical Commentary on Follow-up Studies and “Desistence” Theories about Transgender and Gender Non-Conforming Children,’” International Journal of Transgenderism 19, no. 2 (April 3, 2018): 225–30, https://doi.org/10.1080/15532739.2018.1468292 

Thomas Steensma and Peggy Cohen-Kettenis, “Gender Transitioning before Puberty?,” Archives of Sexual Behavior 40 (March 1, 2011): 649–50, https://doi.org/10.1007/s10508-011-9752-2 

Thomas D. Steensma et al., “Desisting and Persisting Gender Dysphoria after Childhood: A Qualitative Follow-up Study,” Clinical Child Psychology and Psychiatry 16, no. 4 (October 1, 2011): 499–516, https://doi.org/10.1177/1359104510378303 

Kelley D. Drummond et al., “A Follow-up Study of Girls with Gender Identity Disorder,” Developmental Psychology 44 (2008): 34–45, https://doi.org/10.1037/0012-1649.44.1.34 

Madeleine S. C. Wallien and Peggy T. Cohen-Kettenis, “Psychosexual Outcome of Gender-Dysphoric Children,” Journal of the American Academy of Child and Adolescent Psychiatry 47, no. 12 (December 2008): 1413–23, https://doi.org/10.1097/CHI.0b013e31818956b9 

Susan J. Bradley and Kenneth J. Zucker, “Gender Identity Disorder and Psychosexual Problems in Children and Adolescents,” The Canadian Journal of Psychiatry 35, no. 6 (August 1, 1990): 477–86, https://doi.org/10.1177/070674379003500603 

Jiska Ristori and Thomas D. Steensma, “Gender Dysphoria in Childhood,” International Review of Psychiatry 28, no. 1 (2016): 13–20, https://doi.org/10.3109/09540261.2015.1115754 

Devita Singh, Susan J. Bradley, and Kenneth J. Zucker, “A Follow-Up Study of Boys With Gender Identity Disorder,” Frontiers in Psychiatry 12 (2021), https://www.frontiersin.org/articles/10.3389/fpsyt.2021.632784 

Barnes, Hannah. Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children. Great Britain: Swift Press, 2023. 

Jamie Reed, “I Thought I Was Saving Trans Kids. Now I’m Blowing the Whistle.,” The Free Press, February 9, 2023, https://www.thefp.com/p/i-thought-i-was-saving-trans-kids 

Joost à Campo, et al., “Psychiatric Comorbidity of Gender Identity Disorders: A Survey Among Dutch Psychiatrists” The American Journal of Psychiatry (July 2003) 

U. Hepp, et al., “Psychiatric comorbidity in gender identity disorder” Journal of Psychosomatic Research, (March 2005) 

Littman, Lisa. “Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners.” Archives of Sexual Behavior 50, no. 8 (November 1, 2021): 3353–69. https://doi.org/10.1007/s10508-021-02163-w 

Shrier, Abigail. Irreversible Damage. New Jersey: Regnery Publishing, 2020. 

Michael Smith, “Referrals to the Gender Identity Development Service (GIDS) Level off in 2018-19,” June 28, 2019, http://tavistockandportman.nhs.uk/about-us/news/stories/referrals-gender-identity-development-service-gids-level-2018-19/ 

Chad Terhune, Robin Respaut, and Michelle Conlin, “As Children Line up at Gender Clinics, Families Confront Many Unknowns,” Reuters, October 6, 2022, https://www.reuters.com/investigates/special-report/usa-transyouth-care/ 

Canadian Gender Report, “10x Growth in Referrals to Gender Clinics in Canada and Our ‘Consent’ Based Model,” Canadian Gender Report (blog), May 18, 2021, https://genderreport.ca/10x-growth-in-referrals-to-gender-clinics-in-canada-and-our-consent-based-model/ 

Society for Evidence Based Gender Medicine, “Sweden’s Karolinska Ends All Use of Puberty Blockers and Cross-Sex Hormones for Minors Outside of Clinical Studies,” May 5, 2021, https://segm.org/Sweden_ends_use_of_Dutch_protocol 

Society for Evidence Based Gender Medicine, “Summary of Key Recommendations from the Swedish National Board of Health and Welfare,” February 27, 2022, https://segm.org/segm-summary-sweden-prioritizes-therapy-curbs-hormones-for-gender-dysphoric-youth 

National Commission of Inquiry for the Health and Care Service, “Patient Safety for Children and Young People with Gender Incongruence,” Ukom, March 9, 2023, https://ukom.no/rapporter/pasientsikkerhet-for-barn-og-unge-med-kjonnsinkongruens/sammendrag 

Hilary Cass, “The Cass Review: Independent review of gender identity services for children and young people,” April 2024, https://cass.independent-review.uk/home/publications/final-report/  

UK Department of Health and Social Care, “Ban on puberty blockers to be made indefinite on experts’ advice,” December 11, 2024, https://www.gov.uk/government/news/ban-on-puberty-blockers-to-be-made-indefinite-on-experts-advice  

Australian Broadcasting Corporation, “Federal government orders review of treatment guidelines for trans and gender diverse children,” January 30, 2025, https://www.abc.net.au/news/2025-01-31/federal-review-treatment-guidelines-trans-gender-diverse-kids/104882406  

Government of New Zealand, “New safeguards for puberty blocker prescribing,” November 19, 2025, https://www.beehive.govt.nz/release/new-safeguards-puberty-blocker-prescribing  

Australian Broadcasting Corporation, “Queensland government to continue pause on puberty blockers for new adolescent trans patients in public system,” December 18, 2025, https://www.abc.net.au/news/2025-12-19/qld-puberty-blockers-pause-trans-teenagers-to-continue/106161908  

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