Puberty Suppression Followed by Cross-sex Hormones and Gender Reassignment Surgery: A Prospective Follow-up of Gender Dysphoric Adolescents into Adulthood

Objective: To assess long term outcome of adolescents with a gender identity disorder (GID). Design: Longitudinal cohort study with two assessments: pre-treatment (PreT), shortly after their initial attendance at the gender identity clinic and post-treatment (PostT), at least one year after gender reassignment surgery (GRS). Setting: Gender identity clinic. Participants: Twenty-seven young adults (11 female to males and 16 male to females) with a mean age of 13.5 years (SD 1.8) PreT and 20.9 years (SD1.0) PostT. Intervention: GRS preceded by puberty suppression and cross-sex hormone treatment. Main outcome measures: PreT, gender-dysphoria, behavioral problems, peer relations and intelligence were measured. PostT, gender dysphoria, treatment satisfaction, current life situation and employment or study careers, sexual experiences and romantic relationships, quality of life, satisfaction with life and happiness were assessed. Results: Gender dysphoria resolved and participants were predominantly satisfied with the treatment received. Concerning relationships with family and peers, professional and educational careers and sexual behavior and romantic relationships, the young adults were in many aspects comparable with their non-GID peers. Participants considered their quality of life good. PreT intelligence and peer relations correlated with PostT quality of life. Conclusion: The gender reassignment procedure starting with early puberty suppression seems to have enabled these formerly gender dysphoric adolescents to make important age appropriate develop mental transitions, contributing to a satisfactory qualify of life. Some PreT factors (intelligence, peer-relations) influence PostT quality of life.