Brignardello-Petersen and Wiercioch, 2022

Effects of gender affirming therapies in people with gender dysphoria: evaluation of the best available evidence


Florida’s Agency for Health Care Administration published this evidence review alongside their recommendations. The review finds that puberty blocking treatment has minor improvements to mental health of low or very low certainty.

Method and Results

The two authors are experts in systematic reviews and clinical guideline creation from McMaster University in Hamilton, Ontario Canada.

The reviewers undertook a comprehensive search for systematic reviews that addressed mental health outcomes, quality of life, suicidal ideation, suicide, and adverse effects from puberty suppression treatment. The review covers cross-sex hormones and surgical interventions as well as puberty blockers.

The reviewers found four systematic reviews that met assessed the effects of puberty blockers and met screening criteria. The reviewers graded these reviews on methodological quality:

Review Methodological Quality
AHRQ 2021 Moderate
NICE, 2020 (2021) Moderate
Ramos, 2020 (2021) Critically Low
Rew, 2020 (2021) Critically Low
The AHRQ Review only reports the protocol of a single review that met the search and screening criteria. This turns out to be Baker et al., 2021 but the in publication the Baker review only deals with puberty blockers in passing. The NICE review is the only review to take a comprehensive review of blockers and a moderate methodological quality rating.

The reviews show blockers may have small effects on decreasing depression and anxiety and slightly increase gender dysphoria. The reviewers rate all outcomes as having a low or very low certainty. Suicidal ideation results relied on Turban et al. and was too uncertain to draw conclusions.

The reviewers also searched for studies that were not included in the systematic reviews and found three more studies that addressed puberty blockers, or puberty blockers in combination with other treatments.

Study Treatment Risk of Bias
Van der Miesen, 2020 GnRHa High
Becker-Hebly, 2021 GnRHa + CSH + Surgery Critical
Tordoff, 2022 GnRHa + CSH Moderate

The results from these studies were not strong or certain enough to change the reviewers conclusions.


In 2022, a decade after puberty suppression was recommended in NZ guidelines, there is no strong evidence that puberty improve mental health or prevent suicide.


mental healthpuberty blockerssystematic review