Studies › 2011 · Last reviewed 2026-05-16

de Vries et al. (2011)

Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011;8(8):2276–83.

Summary

Prospective follow-up of 70 Dutch adolescents who received GnRHa to suppress puberty. After at least 2 years of suppression, behavioural and emotional problems and depressive symptoms decreased, while general functioning improved. Gender dysphoria and body image remained unchanged. None of the participants discontinued GnRHa.

1. Design

Type	Prospective cohort study
Sample	n = 70 (32 MtF / 38 FtM)
Age at start	Mean 13.6 years
Follow-up	≥ 2 years GnRHa
Outcome measures	CBCL, YSR, BDI, TAI, Body Image Scale, UGDS

2. Findings

Decrease in behavioural and emotional problems (CBCL).
Decrease in depressive symptoms.
Improved general functioning.
No change in dysphoria or body image — interpretation: dysphoria is suspended, not resolved.
0% attrition from the GnRHa phase.

3. Limitations

No control group.
Possible selection bias (only suitable candidates).
No blinding.
Short follow-up (2 years).

Critical note

The reported "improvement" concerns outcome measures with a natural course that cannot be ruled out — behavioural and emotional problems decrease in many adolescents over the course of a few years, even without intervention. Without a control group the effect of GnRHa cannot be isolated. The UK replication study by Costa et al. (2015) showed, on comparison with a waiting-list group, that psychological improvement in treated patients was no greater than in untreated patients.¹