Adolescents with gender dysphoria

MANAGEMENT OF ENDOCRINE DISEASE: Approach to the management of children and adolescents with Gender Dysphoria

“…Development of gender identity (Table 2) is complex, and one's self-awareness as male or female (or other) evolves and may change gradually during life (2,3), under a multifactorial interplay of biological (genetic, hormonal), psychological and environmental (social, cultural) factors (2, 4) (for a detailed review on this subject see (5)). For most children, gender identity is consistent with their birthassigned gender and remains constant across lifespan, but some children may experience an incongruence between their experienced and assigned gender (so-called gender incongruence) and exhibit persistent, consistent nonconforming or nongender stereotypical behaviors at (1).…”

“…According to various studies, the percentage of 'persisters' appears to be between 10 and 39% (10,11). Besides, studies that have been conducted among children and adolescents have shown that GD that persists into adolescence is unlikely to subside (2,10,12,13). Therefore adolescents may be considered for medical treatment when GD persists or intensifies when puberty has started (Tanner breast or genital stage 2) (3).…”

“…Despite the advances, many transgender adolescents report facing barriers to access competent and comprehensive medical and mental health services, including lack of access to trained providers and low rates of insurance coverage for medical therapies (108). Legally speaking, in Anglo-American countries, it seems easier to adopt a new first name, but registration documents are not centralized (as a result, a person can be male according to one and female according to another document) (2).…”

How Should Physicians Help Gender-Transitioning Adolescents Consider Potential Iatrogenic Harms of Hormone Therapy?

“…Treatment to suppress puberty can be initiated if: (1) the criteria for a GD diagnosis are met; (2) puberty has started (Tanner stage 2-3); (3) the adolescent has demonstrated longlasting and intense GD; (4) the GD feelings intensified with the onset of puberty; (5) coexisting medical, psychological, or social problems have been addressed; and (6) both the adolescent and parents have consented (if the adolescent has not reached the age of medical consent) [10]. Puberty suppression using gonadotropin-releasing hormone analogues (GnRHa) prevents the development of undesired secondary sex characteristics (i.e., feminization in birth-assigned girls and masculinization in birth-assigned boys), allowing adolescents to further explore their GD without the distress of a furtherdeveloping body and possibly preventing "risky" (unnecessary) surgical interventions when the patient reaches the age of medical consent [18].…”

Should Mental Health Screening and Psychotherapy Be Required Prior to Body Modification for Gender Expression?

“…WPATH offers a variety of recommendations for the care of gendernonconforming children and adults, and some of these will be exposed to health care professionals early on in their lives; that exposure may help them consolidate their interests in modifying their bodies while still relatively young. For example, clinicians now routinely treat certain minors to suppress the onset of puberty and, later in adolescence, to initiate treatments to shape the body in desired ways [9][10][11]. In some instances, clinicians have even surgically modified the bodies of minors, although most professional groups recommend delay until a child reaches the age of 18 [12].…”