Evidence for puberty blockers and cross-sex hormones for gender dysphoria found to be very low

[janterry]

The National Institute of Health and Care Excellence (NICE) undertook the review to study the use of puberty blockers and cross-sex hormones in young people.
https://www.bbc.com/news/health-56601386
(from article)
The NICE evidence review looked at what impact puberty blockers had on gender dysphoria, mental health - such as depression, anger and anxiety - and quality of life.

NICE, which provides national guidance and advice to improve health and social care, said: "The quality of evidence for these outcomes was assessed as very low certainty."

and

The review found the evidence of clinical effectiveness and safety of gender-affirming hormones was also of "very low" quality.

"Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria," NICE said.

Link to PDF
https://t.co/1oelEMBaGU?amp=1

Conclusion section from report
The results of the studies that reported impact on the critical outcomes ofgender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning),in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up.

Studies that found differences in outcomes could represent changes that are either of questionable clinical value, or the studies themselves are not reliable and changes could be due to confounding, bias or chance. It is plausible, however, that a lack of difference in scores from baseline to follow-up is the effect of GnRH analogues in children and adolescents with gender dysphoria, in whom the development of secondary sexual characteristics might be expected to be associated with an increased impact on gender dysphoria, depression, anxiety, anger and distress over time without treatment. The study by de Vries et al. 2011 reported statistically significant reductions in the Child Behaviour Checklist (CBCL) and Youth Self-Report (YSR) scores from baseline to follow up, which include measures of distress. As the aim of GnRH analogues is to reduce distress caused by the development of secondary sexual characteristics, this maybe an important finding. However, as the studies all lack appropriate controls who were not receiving GnRH analogues, any positive changes could be a regression to mean.

The results of the studies that reported bone density outcomes suggest that GnRH analogues may reduce the expected increase in bone density (which is expected during puberty). However, as the studies themselves are not reliable, the results could be due to confounding, bias or chance. While controlled trials may not be possible, comparative studies are needed to understand this association and whether the effects of GnRH analogues on bone density are seen after they are stopped. All the studies that reported safety outcomes provided very low certainty evidence