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Nat Rev Urol. 2016 Aug;13(8):456-62. doi: 10.1038/nrurol.2016.128. Epub 2016 Jul 19.

To treat or not to treat: puberty suppression in childhood-onset gender dysphoria.

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Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, Tavistock Centre, 120 Belsize Lane, London NW3 5BA, UK.
Department of Psychosis Studies, Institute of Psychiatry, Psychology &Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK.


Puberty suppression using gonadotropin-releasing-hormone analogues (GnRHa) has become increasingly accepted as an intervention during the early stages of puberty (Tanner stage 2-3) in individuals with clear signs of childhood-onset gender dysphoria. However, lowering the age threshold for using medical intervention for children with gender dysphoria is still a matter of contention, and is more controversial than treating the condition in adolescents and adults, as children with gender dysphoria are more likely to express an unstable pattern of gender variance. Furthermore, concerns have been expressed regarding the risks of puberty suppression, which are poorly understood, and the child's ability to make decisions and provide informed consent. However, even if the limited data available mean that it is not possible to make a conclusive treatment recommendation, some safety criteria for puberty suppression can be identified and applied.

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