Clinical Policy: Puberty suppressing hormones – Puberty suppressing hormones (PSH) are not available as a routine commissioning treatment option for treatment of children and young people who have gender incongruence / gender dysphoria.

Jennifer Thetford-Kay
03/14/2024
Articles & Blogs, Featured Posts, Health & Social Care

https://www.england.nhs.uk/publication/clinical-policy-puberty-suppressing-hormones/

These documents may not be fully accessible to all users. If you require the information in a different format please email england.scengagement@nhs.net.

https://www.england.nhs.uk/wp-content/uploads/2024/03/clinical-commissioning-policy-gender-affirming-hormones-v2.docx

clinical-commissioning-policy-gender-affirming-hormones-v2-1 Download

https://www.england.nhs.uk/wp-content/uploads/2024/03/evidence-review-gnrh-analogues-october-2020.pdf

evidence-review-gnrh-analogues-october-2020 Download

https://www.england.nhs.uk/wp-content/uploads/2024/03/psh-clinical-panel-report.pdf

The results of the studies that reported impact on the critical outcomes of gender dysphoria
and mental health (depression, anger and anxiety), and the important outcomes of body image
and psychosocial impact (global and psychosocial functioning) in children and adolescents
with gender dysphoria are of very low certainty using modified GRADE. They suggest little
change with GnRH analogues from baseline to follow-up.
Studies that found differences in outcomes could represent changes that are either of
questionable clinical value, or the studies themselves are not reliable and changes could be
due to confounding, bias or chance. It is plausible, however, that a lack of difference in scores
from baseline to follow-up is the effect of GnRH analogues in children and adolescents with
gender dysphoria, in whom the development of secondary sexual characteristics might be
expected to be associated with an increased impact on gender dysphoria, depression, anxiety,
anger and distress over time without treatment. One study reported statistically significant
reductions in the Child Behaviour Checklist/Youth Self-Report (CBCL/YSR) scores from
baseline to follow up, and given that the purpose of GnRH analogues is to reduce distress
caused by the development of secondary sexual characteristics and the CBCL/YSR in part
measures distress, this could be an important finding. However, as the studies all lack
reasonable controls not receiving GnRH analogues, the natural history of the outcomes
measured in the studies is not known and any positive changes could be a regression to mean.
This document was prepared in October 2020 Page 46 of 131
The results of the studies that reported bone density outcomes suggest that GnRH analogues
may reduce the increase in bone density which is expected during puberty. However, as the
studies themselves are not reliable, the results could be due to confounding, bias or chance.
While controlled trials may not be possible, comparative studies are needed to understand
this association and whether the effects of GnRH analogues on bone density are seen after
treatment is stopped. All the studies that reported safety outcomes provided very low certainty
evidence.
No cost-effectiveness evidence was found to determine whether or not GnRH analogues are
cost-effective for children and adolescents with gender dysphoria.
The results of the studies that reported outcomes for subgroups of children and adolescents
with gender dysphoria, suggest there may be differences between sex assigned at birth
males (transfemales) and sex assigned at birth females (transmales).