Gender-affirming hormones and surgery in transgender children and adolescents

Simone Mahfouda, Julia K Moore, Aris Siafarikas, Timothy Hewitt, Uma Ganti, Ashleigh Lin, Florian Daniel Zepf

Research output: Contribution to journalReview articlepeer-review

39 Citations (Web of Science)


The Endocrine Society Clinical Practice Guidelines on the treatment of gender incongruent people recommend the use of gender-affirming cross-sex hormone (CSH) interventions in transgender children and adolescents who request this treatment, who have undergone psychiatric assessment, and have maintained a persistent transgender identity. The intervention can help to affirm gender identity by inducing masculine or feminine physical characteristics that are congruent with an individual's gender expression, while aiming to improve mental health and quality-of-life outcomes. Some transgender individuals might also wish to access gender-affirming surgeries during adolescence; however, research to inform best clinical practice for surgeons and other medical professionals is scarce. This Review explores the available published evidence on gender-affirming CSH and surgical interventions in transgender children and adolescents, amalgamating findings on mental health outcomes, cognitive and physical effects, side-effects, and safety variables. The small amount of available data suggest that when clearly indicated in accordance with international guidelines, gender-affirming CSHs and chest wall masculinisation in transgender males are associated with improvements in mental health and quality of life. Evidence regarding surgical vaginoplasty in transgender females younger than age 18 years remains extremely scarce and conclusions cannot yet be drawn regarding its risks and benefits in this age group. Further research on an international scale is urgently warranted to clarify long-term outcomes on psychological functioning and safety.

Original languageEnglish
Pages (from-to)484-498
JournalThe Lancet Diabetes and Endocrinology
Issue number6
Early online date6 Dec 2018
Publication statusPublished - 1 Jun 2019


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