Figure 1.

Study design and analysis flow diagram

Terminology: cis-woman: a person who identifies as female and was also assigned female at birth. This may have been based on genitals and/or having two X chromosomes (XX); cis-man: a person who identifies as male and was also assigned male at birth. This may have been based on genitals and/or having one X and one Y chromosome (XY); trans-woman: a person who identifies as female but was assigned male at birth, on the basis of their genitals and/or having one X and one Y chromosome (XY). Sometimes known as MTF, male-to-female; trans-man: a person who identifies as male but was assigned female at birth, on the basis of their genitals and/or having two X chromosomes (XX). Sometimes known as FTM, female-to-male; puberty blocker: medication that blocks the production of the hormones estrogen and testosterone, which cause female or male puberty, respectively. These are given to young people before they begin taking cross-sex hormones to begin their transition. In this case, GnRHa (gonadotrophin-releasing hormone agonists).