Psychological, Cardiovascular, and Skeletal Long-term Outcomes of Hormone Treatment Among Transgender Adolescents: A Systematic Review

Purpose: Research examining the psychological and physical outcomes of hormone treatment in transgender adolescents have yielded inconsistent findings. Given these uncertainties and potential for adverse health events, it is critical to evaluate the long-term outcomes among this population. This systematic review aimed to summarize available evidence from the published literature investigating the long-term effects of hormone treatment of psychological (i.e., anxiety, depression, and gender dysphoria [GD]) and physical (i.e., cardiovascular and skeletal) outcomes within transgender adolescents. Methods: A total of 1,239 longitudinal clinical articles published in English between 2015 and 2024 were retrieved from PubMed, SCOPUS, EBSCOHost, and Science Direct. After extensive screening, 17 longitudinal studies were included in the systematic review ( N = 12,090) with the treatment follow-up period ranging from six months to 15 years. Results: Hormone therapy was associated with improvements in anxiety, depression, and GD, but results were mixed among studies. In addition, changes were observed in cardiovascular measures (i.e., blood pressure, hemoglobin, hematocrit, and cholesterol) and skeletal measures (i.e., bone mineral density [BMD]). However, there was insufficient evidence to conclude whether these changes from hormone treatment increased the risk of developing pathogenesis, particularly adverse cardiovascular events, and osteoporosis. Conclusion: Hormone therapy may improve psychological outcomes, but study conclusions should be interpreted with caution, given the short treatment duration, limited controls, and homogenous samples. Future studies should investigate the psychological benefits and physical changes as transgender individuals progress from adolescence into later adulthood and include control groups.