First Amsterdam UMC study: puberty blockers don’t pose a risk for sexual well-being
Taking puberty blockers does not have a negative impact on the sexual well-being of transgender adolescents later in life. This has been demonstrated for the first time by researchers at Amsterdam UMC in an exploratory study. “They can still experience sexual desire, arousal and orgasms.”
In adulthood, transgender youth who have been treated with puberty blockers can experience sexual desire, arousal and orgasms. This is according to a study conducted by Amsterdam UMC among seventy transgender adults.
Puberty blockers pause some of the effects of puberty, such as breast growth in trans boys and facial hair growth and a deepening voice in trans girls. They give transgender young people more time to think about their gender identity without the pressure of a changing body. A possible next step in the medical transition is treatment with sex hormones, which can only be given from the age of 15 or 16.
Puberty blockers have been used in transgender young people in the Netherlands for around 25 years: Amsterdam UMC was one of the first to start offering this treatment. However, puberty blockers are not without controversy. As the long-term effects are still unknown, this medication for transgender young people is limited in Sweden, the United Kingdom, Finland and certain States of the US.
There were also questions about the effects of puberty blockers on sexuality. The Amsterdam UMC regularly received questions from transgender young people and their parents, such as: if my child has used puberty blockers, will they still be able to orgasm later in life?
No additional risk
To answer these and other questions, researchers at Amsterdam UMC asked 70 transgender adults to complete a questionnaire about their sexual experiences. The participants had been treated with puberty blockers before the age of 18 and subsequently with gender-affirming hormones. The majority of them also underwent gender-affirming surgery. They completed the questionnaire at an average age of 29, an average of 14 years after starting puberty blockers.
The questionnaire shows that more than half of trans men and 40 percent of trans women are satisfied with their sex lives. That may not sound very high, but it is comparable to sexual satisfaction among the cisgender population.
Nevertheless, transgender people experience sexual problems more often than cisgender people. Trans men cite finding sexual contact or taking the initiative as the most common sexual problem, while trans women most often mention difficulty reaching orgasm. However, based on this study, the cause does not appear to lie in puberty suppression, as transgender people who started their medical transition without puberty suppression experience the same problems. In other words, treatment with puberty blockers does not appear to pose an additional risk to sexual well-being.
This is an important milestone, says lead author of the study and medical doctor Isabelle van der Meulen. “This is the first study worldwide on sexual satisfaction and problems among transgender people after puberty blockers. However, it is important to remember that this is an initial exploratory study. We invite other researchers to also conduct research into sexual well-being after puberty blockers to see if they find similar results.”
Polarised field
Van der Meulen is cautious about whether the study is also a first step towards dispelling the controversy surrounding puberty blockers. “That was not the aim of the study. Studies on early gender treatment in young people are under scrutiny. It is a highly polarised field, and research alone is unlikely to completely dispel the controversy surrounding puberty blockers. Nevertheless, it is important to continue researching both the short- and long-term effects of our treatments. Our research centre is therefore conducting several studies on sexual well-being and other effects of puberty blockers.”
According to Van der Meulen, this study does help transgender care. “We can now better inform young people about what they can expect in terms of sexuality later in life.”
That said, Van der Meulen adds that there should not only be attention for the physical factors, but also to the psychosocial part. “Many transgender people say they have
difficulty initiating sexual contact, which is not directly related to hormone treatment. Problems with acceptance by potential sexual partners, self-confidence or body image can also play a role. These problems are not a direct result of medical treatment. Guidance from a psychologist or sexologist during and after gender treatment can be useful, because once you have completed your medical transition, not all of these problems will have been resolved.'
