Studies › 1998 · Last reviewed 2026-05-16

Cohen-Kettenis & van Goozen (1998)

Pubertal delay as an aid in diagnosis and treatment of a transsexual adolescent. Eur Child Adolesc Psychiatry. 1998;7(4):246–8.

Summary

This 1998 case report describes a 13-year-old biological female with lifelong gender identity disorder, treated with triptorelin to suppress puberty. The authors argue that puberty suppression can fulfil a diagnostic function by giving the patient and treatment team additional time, while preventing the development of secondary sexual characteristics experienced as distressing. The publication is the empirical anchor of the Dutch Protocol.

1. Design and sample

Type	Single-case report
Sample	n = 1 (13-year-old FtM patient)
Intervention	Triptorelin 3.75 mg / 4 weeks i.m.
Outcome measures	Clinical evaluation, questionnaires
Follow-up	Initially 2 years; further follow-up documented in later publications

2. Findings

According to the authors, puberty suppression provided considerable psychological relief; gender congruence remained unchanged. The authors conclude that hormonal suppression can constitute "a useful diagnostic instrument" in adolescents with persistent cross-gender identification.

3. Limitations

n = 1: no generalisation possible.
No control group.
No blinding or pre/post measurement with standardised instruments.
No long-term outcome measure in this publication.

4. Historical significance

Although methodologically limited, this publication is regarded as the formal introduction of puberty suppression in the treatment of adolescent gender dysphoria. Almost all subsequent clinical guidelines (Endocrine Society, WPATH) refer to this case as the originating source.

Critical note

A single case (n=1) without a control group is, in medical science, normally a reason for caution and follow-up investigation, not for scaling up to standard treatment. The fact that the Dutch Protocol has been built on this single case in the following decades has been cited by Biggs (2023) and Abbruzzese et al. (2023) as a deviation from the usual course of evidence-based medicine.¹