Editor’s note: This article originally appeared as a comment on the study “Mental Health of Youths Who Use Puberty Blockers,” published in JAMA Network Open.
While this study notes that its findings should be interpreted with caution given “unmeasured confounding” and “selection bias,” these limitations are significant and not in isolation. As a retrospective observational study, the underlying claims data “do not allow for determining definitive causes,” limiting the conclusion suggesting that mental-health (MH) benefits are associated with puberty blockers (PBs).
For one, the study does not establish temporal ordering between initiation of PBs and an individual’s MH. The study treats the presence of a PB and that of mood or suicidality ICD-10 codes in sum. Thus, for any attenuation in MH observed among youths receiving PBs, it is impossible to determine whether the PB improved MH outcomes or whether those who received PBs were already a lower risk subgroup. Notably, a recent preprint study found that depression symptoms did not improve over 2 years after PB initiation.
Read the full comment here.