Transition memories: experiences of trans adult women with hormone therapy and their beliefs on the usage of hormone blockers to suppress puberty

  • G. GiovanardiEmail author
  • P. Morales
  • M. Mirabella
  • A. Fortunato
  • L. Chianura
  • A. M. Speranza
  • V. Lingiardi
Original Article



In recent years, an increasing number of specialized gender clinics have been prescribing gonadotropin-releasing hormone (GnRH) analogs to adolescents diagnosed with gender dysphoria (GD) to suppress puberty. This paper presents qualitative research on the hormone therapy (HT) experiences of older trans-people and their views on puberty suppression. The main aim of this research was to explore the psychological aspects of hormonal treatments for gender non-conforming adults, including the controversial use of puberty suppression treatments.


Using a semi-structured interview format, ten adult trans-women were interviewed (mean age: 37.4) to explore their personal histories regarding GD onset and development, their HT experiences, and their views on the use of GnRH analogs to suppress puberty in trans-children and adolescents. Results: the interview transcripts were analyzed using the consensual qualitative research method from which several themes emerged: the onset of GD, childhood experiences, experiences with puberty and HT, views on the puberty suspension procedure, and the effects of this suspension on gender identity and sexuality.


The interviews showed that overall, the participants valued the new treatment protocol due to the opportunity to prevent the severe body dysphoria and social phobia trans-people experience with puberty. It seems that the risk of social isolation and psychological suffering is increased by the general lack of acceptance and stigma toward trans-identities in the Italian society. However, during gender transitions, they highlight the need to focus more on internal and psychological aspects, rather than over-emphasize physical appearance. This study gives a voice to an under-represented group regarding the use of GnRH analogs to suppress puberty in trans-individuals, and collected firsthand insights on this controversial treatment and its recommendations in professional international guidelines.


Transgender Hormone blockers Hormone therapy Puberty suppression Gender dysphoria 



The authors wish to thank the staff at the Service for the Adaptation of Physical Identity to Psychological Identity Clinical Center (SAIFIP) in Rome for their availability for this study and for their enduring work on the health and well-being of trans-people.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

The study was approved by the Institutional Ethics Committee and all procedures involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from patients.

Supplementary material

40618_2019_1045_MOESM1_ESM.pdf (191 kb)
Supplementary material 1 (PDF 191 kb)


  1. 1.
    Shields JP, Cohen R, Glassman JR, Whitaker K, Franks H, Bertolini I (2013) Estimating population size and demographic characteristics of lesbian, gay, bisexual, and transgender youth in middle school. J Adolesc Health 52:248–250CrossRefGoogle Scholar
  2. 2.
    Clark TC, Lucassen MF, Bullen P, Denny SJ, Fleming TM, Robinson EM, Rossen FV (2014) The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth’12). J Adolesc Health 55:93–99CrossRefGoogle Scholar
  3. 3.
    Eisenberg ME, Gower AL, McMorris BJ, Rider GN, Shea G, Coleman E (2017) Risk and protective factors in the lives of transgender/gender nonconforming adolescents. J Adolesc Health 61:521–526CrossRefGoogle Scholar
  4. 4.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, WashingtonCrossRefGoogle Scholar
  5. 5.
    World Health Organization (2018) International statistical classification of diseases and related health problems (11th revision). Accessed 12 March 2019
  6. 6.
    Drescher J, Cohen-Kettenis PT, Reed GM (2016) Gender incongruence of childhood in the ICD-11: controversies, proposal, and rationale. Lancet Psychiatry 3:297–304. CrossRefGoogle Scholar
  7. 7.
    Lingiardi V, McWilliams N (2015) The psychodynamic diagnostic manual–2nd ed. (PDM-2). World Psychiatry 14:237–239. CrossRefGoogle Scholar
  8. 8.
    Foreman M, Hare L, York K et al (2019) Genetic Link between gender dysphoria and sex hormone signaling. J Clin Endocrinol Metab 104:390–396. CrossRefGoogle Scholar
  9. 9.
    Lombardo F, Toselli L, Grassetti D et al (2013) Hormone and genetic study in male to female transsexual patients. J Endocrinol Invest 36:550–557Google Scholar
  10. 10.
    Ciocca G, Limoncin E, Cellerino A et al (2014) Gender identity rather than sexual orientation impacts on facial preferences. J Sex Med 11:2500–2507. CrossRefGoogle Scholar
  11. 11.
    de Vries ALC, Kreukels BPC, Steensma TD, McGuire JK (2014) Gender identity development: a biopsychosocial perspective. In: Kreukels B, Steensma T, de Vries A (eds) Gender dysphoria and disorders of sex development. Springer, Boston, pp 53–82CrossRefGoogle Scholar
  12. 12.
    Clements-Nolle K, Marx R, Katz M (2006) Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J Homosex 51:53–69CrossRefGoogle Scholar
  13. 13.
    Grossman AH, D’Augelli R (2007) Transgender youth and life-threatening behaviors. Suicide Life Threat Behav 37:527–537CrossRefGoogle Scholar
  14. 14.
    Cohen-Kettenis PT, Owen A, Kaijser VG, Bradley SJ, Zucker KJ (2003) Demographic characteristics, social competence and behaviour problems in children with gender identity disorder: a cross-national, cross-clinic comparative analysis. J Abnorm Child Psychol 31:41–53CrossRefGoogle Scholar
  15. 15.
    Ristori J, Steensma TD (2016) Gender dysphoria in childhood. Int Rev Psychiatry 28:13–20CrossRefGoogle Scholar
  16. 16.
    Fisher AD, Ristori J, Castellini G et al (2017) Psychological characteristics of Italian gender dysphoric adolescents: a case–control study. J Endocrinol Invest 40:953–965. CrossRefGoogle Scholar
  17. 17.
    Steensma TD, Zucker KJ, Kreukels BPC et al (2014) Behavioral and emotional problems on the Teacher’s Report Form: a cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents. J Abnorm Child Psychol 42:635. CrossRefGoogle Scholar
  18. 18.
    Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ (2008) The treatment of adolescent transsexuals: changing insights. J Sex Med 5:1892–1897CrossRefGoogle Scholar
  19. 19.
    Spack N (2005) Transgenderism. Med Ethics 12:12Google Scholar
  20. 20.
    Reisner SL, Vetters R, Leclerc M, Zaslow S, Wolfrum S, Shumer D, Mimiaga MJ (2015) Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. J Adolesc Health 56:274–279CrossRefGoogle Scholar
  21. 21.
    Zucker JK, Wood H (2012) A developmental, biopsychosocial model for the treatment of children with gender identity disorder. J Homosex 59:369–397CrossRefGoogle Scholar
  22. 22.
    Grant JM, Mottet L, Tanis JE, Harrison J, Herman J, Keisling M (2011) Injustice at every turn: a report of the national transgender discrimination survey. National Center for Transgender Equality and National Gay and Lesbian Task Force, WashingtonGoogle Scholar
  23. 23.
    Gehring D, Knudson G (2005) Prevalence of childhood trauma in a clinical population of transsexual people. Int J Transgender 8:23–30. CrossRefGoogle Scholar
  24. 24.
    Bandini E, Fisher AD, Ricca V et al (2011) Childhood maltreatment in subjects with male-to-female gender identity disorder. Int J Impot Res 23:276. CrossRefGoogle Scholar
  25. 25.
    Giovanardi G, Vitelli R, Vergano CM, Fortunato A, Chianura L, Lingiardi V, Speranza AM (2018) Attachment patterns and complex trauma in a sample of adults diagnosed with gender dysphoria. Front Psychol 9:60. CrossRefGoogle Scholar
  26. 26.
    Lingiardi V, Giovanardi G, Fortunato A, Nassisi V, Speranza AM (2017) Personality and attachment in transsexual adults. Arch Sex Behav 46:1313–1323CrossRefGoogle Scholar
  27. 27.
    Fisher AD, Castellini G, Ristori J et al (2017) Who has the worst attitudes toward sexual minorities? Comparison of transphobia and homophobia levels in gender dysphoric individuals, the general population and health care providers. J Endocrinol Invest 40:263–273CrossRefGoogle Scholar
  28. 28.
    Aitken M, VanderLaan DP, Wasserman L, Stojanovski S, Zucker KJ (2016) Self-harm and suicidality in children referred for gender dysphoria. J Am Acad Child Adolesc Psychiatry 55:513–520CrossRefGoogle Scholar
  29. 29.
    Costa R, Clements-Nolle K, Marx R, Katz M (2016) Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J of Homosexuality 51:53–69Google Scholar
  30. 30.
    Holt V, Skagerberg E, Dunsford M (2016) Young people with features of gender dysphoria: demographics and associated difficulties. Clin Child Psychol Psychiatry 21:108–118CrossRefGoogle Scholar
  31. 31.
    Giordano S (2008) Lives in a chiaroscuro should we suspend the puberty of children with gender identity disorder? J Med Ethics 34:580–584CrossRefGoogle Scholar
  32. 32.
    Olson J, Schrager SM, Belzer M, Simons LK, Clark LF (2015) Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. J Adolesc Health 57:374–380CrossRefGoogle Scholar
  33. 33.
    Wallien MS, Cohen-Kettenis PT (2008) Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47:1413–1423CrossRefGoogle Scholar
  34. 34.
    American Psychological Association (2015) Guidelines for psychological practice with transgender and gender nonconforming people. Am Psychol 70:832–864. CrossRefGoogle Scholar
  35. 35.
    Coleman E, Bockting W, Botzer M et al (2012) Standards of care for the health of transsexual transgender and gender-nonconforming people version 7. Int J Transgender 13:165–232CrossRefGoogle Scholar
  36. 36.
    Hembree WC, Cohen-Kettenis PT, Gooren L et al (2017) Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 102:3869–3903CrossRefGoogle Scholar
  37. 37.
    Edwards-Leeper L, Leibowitz S, Sangganjanavanich VF (2016) Affirmative practice with transgender and gender nonconforming youth: expanding the model. Psychol Sex Orientat Gend Divers 3:165–172CrossRefGoogle Scholar
  38. 38.
    Hidalgo MA, Ehrensaft D, Tishelman AC et al (2013) The gender affirmative model: what we know and what we aim to learn. Hum Dev 56:285–290CrossRefGoogle Scholar
  39. 39.
    de Vries AL, Cohen-Kettenis PT (2012) Clinical management of gender dysphoria in children and adolescents: the Dutch approach. J Homosex 59:301–320CrossRefGoogle Scholar
  40. 40.
    Wylie K, Barrett J, Besser M et al (2014) Good Practice guidelines for the assessment and treatment of adults with gender dysphoria. Sex Relatsh Ther 29:154–214. CrossRefGoogle Scholar
  41. 41.
    Cohen-Kettenis PT, Steensma TD, de Vries AL (2011) Treatment of adolescents with gender dysphoria in the Netherlands. Child Adolesc Psychiatr Clin 20:689–700CrossRefGoogle Scholar
  42. 42.
    Conn PM, Crowley WF Jr (1991) Gonadotropin-releasing hormone and its analogues. N Engl J Med 324:93–103CrossRefGoogle Scholar
  43. 43.
    Costa R, Carmichael P, Colizzi M (2016) To treat or not to treat: puberty suppression in childhood-onset gender dysphoria. Nat Rev Urol 13:456CrossRefGoogle Scholar
  44. 44.
    Giovanardi G (2017) Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents. Porto Biomed J 2:153–156CrossRefGoogle Scholar
  45. 45.
    Sadjadi S (2013) The Endocrinologist’s office-puberty suppression: saving children from a natural disaster? J Med Humanit 34:255–260. CrossRefGoogle Scholar
  46. 46.
    Mahfouda S, Moore JK, Siafarikas A, Zepf FD, Lin A (2017) Puberty suppression in transgender children and adolescents. Lancet Diabetes Endocrinol 5:816–826CrossRefGoogle Scholar
  47. 47.
    Costa R, Dunsford M, Skagerberg E, Holt V, Carmichael P, Colizzi M (2015) Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. J Sex Med 12:2206–2214CrossRefGoogle Scholar
  48. 48.
    de Vries ALC, Steensma TD, Doreleijers TA, Cohen-Kettenis PT (2011) Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 8:2276–2283CrossRefGoogle Scholar
  49. 49.
    Khatchadourian K, Amed S, Metzger DL (2014) Clinical management of youth with gender dysphoria in Vancouver. J Pediatr 164:906–911CrossRefGoogle Scholar
  50. 50.
    Delemarre-van de Waal HA, Cohen-Kettenis PT (2006) Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects. Eur J Endocrinol 155:S131–S137. CrossRefGoogle Scholar
  51. 51.
    Klink D, Caris M, Heijboer A, van Trotsenburg M, Rotteveel J (2015) Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clini Endocrinol Metab 100:E270–E275CrossRefGoogle Scholar
  52. 52.
    Staphorsius AS, Kreukels BPC, Cohen-Kettenis PT et al (2015) Puberty suppression and executive functioning: an fMRI-study in adolescents with gender dysphoria. Psychoneuroendocrinology 56:190–199. CrossRefGoogle Scholar
  53. 53.
    Korte A, Goecker D, Krude H, Lehmkuhl U, Grüters-Kieslich A, Beier KM (2008) Gender identity disorders in childhood and adolescence: currently debated concepts and treatment strategies. Deutsches Ärzteblatt Int 105:834Google Scholar
  54. 54.
    Viner RM, Brain C, Carmichael P, Di Ceglie D (2005) Sex on the brain: dilemmas in the endocrine management of children and adolescents with gender identity disorder. Arch Dis Child 90:A78CrossRefGoogle Scholar
  55. 55.
    Drummond KD, Bradley SJ, Peterson-Badali M, Zucker KJ (2008) A follow-up study of girls with gender identity disorder. Dev Psychol 44:34CrossRefGoogle Scholar
  56. 56.
    Kreukels BP, Cohen-Kettenis PT (2011) Puberty suppression in gender identity disorder: the Amsterdam experience. Nat Rev Endocrinol 7:466–472. CrossRefGoogle Scholar
  57. 57.
    Ristori J, Fisher AD, Castellini G et al (2019) Gender Dysphoria and Anorexia Nervosa Symptoms in Two Adolescents. Arch Sex Behav. Google Scholar
  58. 58.
    Vrouenraets LJJJ, Fredriks AM, Hannema SE et al (2015) Early medical treatment of children and adolescents with gender dysphoria: an empirical ethical study. J Adolesc Health 57:367–373CrossRefGoogle Scholar
  59. 59.
    Vrouenraets LJJJ, Fredriks AM, Hannema SE et al (2016) Perceptions of sex, gender, and puberty suppression: a qualitative analysis of transgender youth. Arch Sex Behav 45:1697–1703CrossRefGoogle Scholar
  60. 60.
    Hill CE, Thompson BJ, Williams EN (1997) A guide to conducting consensual qualitative research. Couns Psychol 25:517–572CrossRefGoogle Scholar
  61. 61.
    Hill CE (2012) Consensual qualitative research: a practical resource for investigating social science phenomena. Am Psychol Assoc, WashingtonGoogle Scholar
  62. 62.
    Miles MB, Huberman AM, Huberman MA, Huberman M (1994) Qualitative data analysis: an expanded sourcebook. Sage, LondonGoogle Scholar
  63. 63.
    Lingiardi V, Giovanardi G (2017) Challenges in assessing personality of individuals with Gender Dysphoria with the SWAP-200. J Endocrinol Invest 40:693–703. CrossRefGoogle Scholar
  64. 64.
    de Vries AL, Doreleijers TA, Steensma TD, Cohen-Kettenis PT (2011) Psychiatric comorbidity in gender dysphoric adolescents. J Child Psychol Psychiatry 52:1195–1202CrossRefGoogle Scholar
  65. 65.
    de Vries AL, Kreukels BP, Steensma TD, Doreleijers TA, Cohen-Kettenis PT (2011) Comparing adult and adolescent transsexuals: an MMPI-2 and MMPI-A study. Psychiatry 186:414–418Google Scholar
  66. 66.
    Skagerberg E, Parkinson R, Carmichael P (2013) Self-harming thoughts and behaviors in a group of children and adolescents with gender dysphoria. Int J Transgender 14:86–92CrossRefGoogle Scholar
  67. 67.
    Gooren LJ, Giltay EJ, Bunck MC (2008) Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab 93:9–25CrossRefGoogle Scholar
  68. 68.
    Lapauw B, Taes Y, Simoens S, Van Caenegem E, Weyers S, Goemaere S, Toye S, Kaufman JM, T’Sjoen GG (2008) Body composition, volumetric and areal bone parameters in male-to-female transsexual persons. Bone 43:1016–1021CrossRefGoogle Scholar
  69. 69.
    Meyer WJ III, Webb A, Stuart CA, Finkelstein JW, Lawrence B, Walker PA (1986) Physical and hormonal evaluation of transsexual patients: a longitudinal study. Arch Sex Behav 15:121–138CrossRefGoogle Scholar
  70. 70.
    Moore E, Wisniewski A, Dobs A (2003) Endocrine treatment of transsexual people: a review of treatment regimens outcomes and adverse effects. J Clin Endocrinol Metab 88:3467–3473CrossRefGoogle Scholar
  71. 71.
    Colizzi M, Costa R, Todarello O (2014) Transsexual patients’ psychiatric comor- bidity and positive effect of cross-sex hormonal treatment on mental health: results from a longitudinal study. Psychoneuroendocrinology 39:65–73CrossRefGoogle Scholar
  72. 72.
    Manieri C, Castellano E, Crespi C et al (2014) Medical treatment of subjects with gender identity disorder: the experience in an Italian public health center. Int J Transgender 15:53–65CrossRefGoogle Scholar
  73. 73.
    Heylens G, Verroken C, De Cock S et al (2014) Effects of different steps in gender reassignment therapy on psychopathology: a prospective study of persons with a gender identity disorder. J Sex Med 11:119–126. CrossRefGoogle Scholar
  74. 74.
    White Hughto JM, Reisner SL (2016) A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgend Health 1:21–31CrossRefGoogle Scholar
  75. 75.
    Richards C, Bouman WP, Seal L, Barker MJ, Nieder TO, T’Sjoen G (2016) Non-binary or genderqueer genders. Int Rev Psychiatry 28:95–102CrossRefGoogle Scholar
  76. 76.
    Twist J, de Graaf NM (2018) Gender diversity and non-binary presentations in young people attending the United Kingdom’s National Gender Identity Development Service. Clin Child Psychol Psychiatry. Google Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  • G. Giovanardi
    • 1
    • 2
    Email author
  • P. Morales
    • 1
  • M. Mirabella
    • 1
  • A. Fortunato
    • 1
  • L. Chianura
    • 3
  • A. M. Speranza
    • 1
  • V. Lingiardi
    • 1
  1. 1.Department of Dynamic and Clinical PsychologySapienza University of RomeRomeItaly
  2. 2.Department of PsychologyUniversity of Campania “Luigi Vanvitelli”CasertaItaly
  3. 3.San Camillo HospitalRomeItaly

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