Puberty suppression and sexual well-being in transgender and gender-diverse individuals: evidence- and experience-based counselling and future research directions.

Despite its increasing clinical use, evidence regarding the effects of puberty suppression using gonadotropin-releasing hormone analogues on sexual development and well-being in transgender and gender-diverse (TGD) adolescents remains limited. Thus, expert recommendations integrating available evidence and clinical experience are essential to guide multidisciplinary care. Targeted literature review coupled with expert opinion - including endocrine, urological, psychological, sexological and gynaecological perspectives - and input from a round table session at the European Professional Association for Transgender Health Conference in 2025, generated recommendations around providing developmentally appropriate information on puberty, puberty suppression and sexual development. These include attention to psychosocial factors such as stigma; individualized decision making regarding fertility and surgical options; and promotion of positive communication about sexuality. Remaining knowledge gaps emphasize the need for longitudinal and interdisciplinary research, combining qualitative and quantitative approaches to advance our understanding of sexual development during puberty suppression, and how it affects sexual pleasure and genital sensitivity. The first exploratory studies have shown similar sexual well-being in young adults who received puberty suppression and those who received gender-affirming hormone treatment without puberty suppression. Another priority is the development of TGD-specific tools to assess sexual development, functioning and satisfaction, that capture the diversity and intersectionality of sexual experiences of TGD individuals. These recommendations aim to support individuals considering puberty suppression and their families and clinicians to optimize their care and well-being.