Chapter 4 - GnRH Analogs (Mechanism, Past Studies, Drug Options, Use in Precocious Puberty, Use in Gender-Nonconforming Youth)

Abstract

Gonadotropin-releasing hormone analogs (GnRHas) transformed the treatment of central precocious puberty beginning with their advent in the 1980s and have a long-standing track record of efficacy and safety. The use of GnRHas in patients with gender dysphoria represents a newer application of these medications that is associated with improved physical and psychological outcomes. GnRHas are the treatment of choice for pubertal suppression in the gender dysphoric patient and are recommended to be started at Tanner stage 2. This prevents pubertal progression along with the concomitant irreversible secondary sexual characteristics that result in an amplification of emotional distress due to the discrepancy between biological sex and gender identity. The cadre of GnRHa preparations continues to expand, and several extended-release formulations are available. However, large gaps in knowledge pertaining to the use of GnRHas in gender-variant youth exist, and more long-term data are critically needed. Barriers faced by transgender youth and their providers include frequent insurance denial and the high cost of GnRHas, rendering them out of reach for many.