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expert reaction to Dutch study looking at sexual function in transgender adults who had had puberty blockers in adolescence and then cross-sex hormones

A study published in the Journal of Sexual Medicine & Research looks at sexual function of transgender adults who had taken puberty blockers during adolescence. 

 

Prof Kevin McConway, Emeritus Professor of Applied Statistics, Open University, said:

“I should start by saying that I’m no expert in sexual medicine, and certainly not in the sexual problems and issues faced by trans people.  It does seem to me, as a non-expert, that much of the information in this new study will be useful to those who do work with trans people on these matters (and to trans people themselves).

“I do, however, have expertise in the design and interpretation of research studies, and because of that I have some doubts about the interpretation of some of the findings, including how they are described in the press release.  (The press release does generally match what is said in the research paper.)

“The research paper tells us that, of their group who had been treated with puberty blockers and later with gender-affirming hormones, 58% of the trans men and 50% of the trans women reported at least one sexual dysfunction.  52% of the trans men and 40% of the trans women said they were satisfied with their sex lives.  My doubts are mostly about some comparisons within these groups in the study, and particularly about comparisons with other groups that weren’t in the study (trans people who did not have puberty blockers, and cis people).

“The first issue to note is that the number of participants was pretty small for trans men (50 of them) and very small for trans women (just 20).  This in itself limits how far the findings can be generalized beyond people attending the clinic where the research was done.

“But how do these rates of sexual dysfunction compare to other groups?  Are those percentages large or small?  Some comparisons between groups are made in the research paper and reported in the press release, and here I have some doubts.

“Some comparisons are made within the participants in the study.  For instance, a quote in the release says, “There was also no difference between people who started puberty blockers early or later in puberty.”  That does generally match what the research paper says.  However, this was an observational study.  In observational studies, there are always doubts about what is causing what.  That’s because there will be differences between the groups being compared in terms of other factors, and perhaps the other factors are causing any observed differences in the outcomes.  This extends to doubts about whether a lack of difference between people who got puberty blockers at different stages is because the stage of starting the blockers has no real effect – maybe it does have an effect but that is masked by some other factors.

“Typically in this kind of study, the researchers would make statistical adjustments to try to allow for the effects of other factors that differed between subgroups of the participants.  But in this study, that could not be done because the number of participants was too small.  So there must remain some doubt about whether the puberty stage when puberty blockers began does affect the level of sexual problems later.  It might not, or it might.

“However, the researchers make comparison with other groups too, groups on which this study did not itself collect any data.  It’s always very awkward to make comparisons between findings from different studies that might use different measurement methods – different questionnaires in this case – and possibly very different populations of participants, where differences in other factors may be very important.

“In the research paper, the researchers make informal comparisons about the level of sexual problems between the people in their own study, who all had puberty blockers and then, later, gender-affirming hormones, with people in a different study who had gender-affirming treatment that started in adulthood, and so had no puberty blockers.  They report that the other study (reference 26 in the new paper) found that 54% of sexually active trans men and 69% of sexually active trans women reported at least one sexual difficulty.  Those rates are higher than the rates in the new study, but (as the paper points out) there are several differences between the new study and the one used for comparison.  But nevertheless the press release says, “The frequency of sexual problems was consistent with previous studies among transgender adults who did not start hormone therapy until adulthood.”  Given the small numbers of participants, and the fact that there are reasonably substantial differences between the two studies in terms of sexual difficulties, I think that’s going a bit too far.

“Also, part of a quote in the press release says, “This [the level of satisfaction with their sex lives of the participants in the new study] corresponds to the sexual satisfaction of the cisgender population.”  I think that’s going too far as well: The research article quotes rates of sexual dysfunction in cis women in young women in the Netherlands and adult women in the US as 42% and 43% respectively, and in the new study, 50% of the trans women reported at least one sexual dysfunction.  (But remember there were only 20 trans women in the new research.)  For adult cis men in the US and England, the researchers quote that 31% and 34% reported sexual dysfunction.  In the new study, 58% of the trans men reported at least one sexual dysfunction.

“I think the best we can say is that all these percentages are in roughly the same ballpark.  But does it make sense to say that they ‘correspond’?  How far does it make sense at all to compare data on adults, on average much older than the people in the new study, and to compare recent data (in the new study) with data going back to1998 and 2000 for the UK and US results?  And anyway, to what extent might all these figures represent what participants want to tell researchers, rather than what they truly think about their own sex lives?”

 

Dr Channa Jayasena, Associate Professor in Reproductive Endocrinology, Imperial College London, said:

“Puberty blockers ‘switch off’ a hormone signal from the brain which tells the body to develop male or female adult characteristics.  Puberty blockers are approved in many countries to stop puberty in children with gender dysphoria who do not want to go through puberty aligned with their birth sex.  In the UK, puberty blockers cannot be given, and a clinical trial is planned to investigate how well they treat symptoms in children with gender dysphoria.

“The current study used questionnaires to investigate rates of sexual problems in patients who had been treated with puberty blockers starting from the ages of 11-18 years.  The size and design of the study is like other studies investigating sexual symptoms in patients.  The authors found that about half of transgender individuals who were given puberty blockers between ages 11 and 18 years reported sexual satisfaction as adults; the authors state that levels of sexual satisfaction reported in their study were similar to levels of satisfaction reported previously for individuals starting treatment for gender dysphoria as adults.  It would have been helpful to have included another group of young people without gender dysphoria, to judge how much gender dysphoria affects sexual satisfaction.  In addition, we currently do not know whether puberty blockade alters sexual satisfaction for young people with gender dysphoria if given < 18 years of age.  As the study doesn’t use any comparison groups – e.g. either those without gender dysphoria, or those with gender dysphoria but who weren’t given puberty blockers – then this study itself isn’t able to directly answer that question.”

 

 

 

‘Sexual satisfaction and dysfunction in transgender adults following puberty suppression treatment during adolescence’ by Isabelle S. van der Meulen et al. was published in the Journal of Sexual Medicine & Research at 01:01 UK time on Wednesday 18 June 2025. 

 

 

Declared interests

Prof Kevin McConway: “No conflicts.”

Dr Channa Jayasena: “None.”

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