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Meta-Analysis
. 2025 May 16;110(6):429-436.
doi: 10.1136/archdischild-2024-327909.

Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis

Anna Miroshnychenko  1 , Yetiani Roldan  1 , Sara Ibrahim  1 , Chan Kulatunga-Moruzi  2 , Steven Montante  3 , Rachel Couban  4 , Gordon Guyatt  5 , Romina Brignardello-Petersen  6
Affiliations
Meta-Analysis

Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis

Anna Miroshnychenko et al. Arch Dis Child. .

Erratum in

Abstract

Aim: Gender dysphoria (GD) refers to the psychological distress associated with the incongruence between one's sex and one's gender identity. To manage GD, individuals may delay the development of primary and secondary sex characteristics with the use of puberty blockers. In this systematic review, we assess and summarise the certainty of the evidence about the effects of puberty blockers in individuals experiencing GD.

Methods: We searched Medline, Embase, PsychINFO, Social Sciences Abstracts, LGBTQ+ Source and Sociological Abstracts from inception to September 2023. We included observational studies comparing puberty blockers with no puberty blockers in individuals aged <26 years experiencing GD, as well as before-after and case series studies. Outcomes of interest included psychological and physical outcomes. Pairs of reviewers independently screened articles, abstracted data and assessed risk of bias. We performed a meta-analysis and assessed the certainty of a non-zero effect using the grading of recommendations assessment, development and evaluation (GRADE) approach.

Results: We included 10 studies. Comparative observational studies (n=3), comparing puberty blockers versus no puberty blockers, provided very low certainty of evidence on the outcomes of global function and depression. Before-after studies (n=7) provided very low certainty of evidence addressing gender dysphoria, global function, depression, and bone mineral density.

Conclusions: There remains considerable uncertainty regarding the effects of puberty blockers in individuals experiencing GD. Methodologically rigorous prospective studies are needed to understand the effects of this intervention.

Trial registration number: PROSPERO CRD42023452171.

Keywords: Adolescent Health; Epidemiology; Paediatrics.

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Conflict of interest statement

Competing interests: Direct financial conflicts of interest: RB-P and AM provided methodological expertise for the Society for Evidence-based Gender Medicine (SEGM) initiative to summarise and appraise the quality of publications related to gender medicine for the SEGM online platform, and for this work they received financial compensation from SEGM. This work was independent of the systematic review and meta-analysis. Financial conflicts of interest (as reported by the protocol authors who were not part of the evidence synthesis team at the time of their participation in the generation of the question): E Abbruzzese is a contributing author for the SEGM online platform and received financial compensation from SEGM; William Malone’s fee for publishing a research article as 'open access' was compensated by SEGM. Other disclosures (manuscript authors): CKM has expressed opinions on recommendations for gender affirming care for transgender and gender diverse youth in the Journal of Pediatrics and Child Health. This opinion piece was published after this systematic review was submitted for publication, and the content of this systematic review did not change. Other disclosures (as reported by the protocol authors who were not part of the evidence synthesis team at the time of their participation in the generation of the question): William Malone is a board member of SEGM. William Malone has expressed opinions about gender affirmation interventions for adolescents and young adults in Journal of Clinical Endocrinology and Metabolism, The Lancet, Child and Adolescent Health and Medscape.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram for new systematic reviews that included searches of databases and registers only. ΩThis was an umbrella search completed for two related systematic reviews and meta-analyses. Ten studies were included in this systematic review. The studies that were included in another review are part of the studies excluded for wrong intervention. *Twenty-four of 41 studies excluded for wrong intervention were included in another review. Source: Page et al.
See this image and copyright information in PMC

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