Gender affirming medical care of transgender youth

Abstract

The number of gender diverse and transgender youth presenting for treatment are increasing. This is a vulnerable population with unique medical needs; it is essential that all pediatricians attain an adequate level of knowledge and comfort caring for these youth so that their health outcomes may be improved. There are several organizations which provide clinical practice guidelines for the treatment of transgender youth including the WPATH and the Endocrine Society and they recommend that certain eligibility criteria should be met prior to initiation of gender affirming hormones. Medical intervention for transgender youth can be broken down into stages based on pubertal development: pre-pubertal, pubertal and post-pubertal. Pre-pubertally no medical intervention is recommended. Once puberty has commenced, youth are eligible for puberty blockers; and post-pubertally, youth are eligible for feminizing and masculinizing hormone regimens. Treatment with gonadotropin releasing hormone agonists are used to block puberty. Their function is many-fold: to pause puberty so that the youth may explore their gender identity, to delay the development of (irreversible) secondary sex characteristics, and to obviate the need for future gender affirmation surgeries. Masculinizing hormone regimens consists of testosterone and feminizing hormone regimens consist of both estradiol as well as spironolactone. In short term studies gender affirming hormone treatment with both estradiol and testosterone has been found to be safe and improve mental health and quality of life outcomes; additional long term studies are needed to further elucidate the implications of gender affirming hormones on physical and mental health in transgender patients. There are a variety of surgeries that transgender individuals may desire in order to affirm their gender identity; it is important for providers to understand that desire for medical interventions is variable among persons and that a discussion about individual desires for surgical options is recommended.

Navigating Human Immunodeficiency Virus and Primary Care Concerns Specific to the Transgender and Gender-Nonbinary Population

“…Providers should also be cognizant of inadvertent disclosure via parental insurance claims when discussing PrEP. Currently, all GAHT, including the use of gonadotropin-releasing hormone (GnRH) receptor agonists for puberty suppression, requires parental or legal guardian consent if a youth is under age 18 [ 29 , 30 ].…”

Headache in transgender and gender‐diverse patients: A narrative review

“…This in turn prevents increased gender dysphoria related to these changes. If patients then elect to receive masculinizing or feminizing hormone therapy, prior treatment with pubertal blockade can prevent the need for gender‐affirming surgeries such as thyroid chondroplasty in transgender women 19–21 . Puberty blockade is usually achieved through the use of gonadotropin‐releasing hormone agonists such as goserelin, leuprolide, or histrelin in the form of monthly or quarterly subcutaneous injections 21 …”

“…If patients then elect to receive masculinizing or feminizing hormone therapy, prior treatment with pubertal blockade can prevent the need for gender-affirming surgeries such as thyroid chondroplasty in transgender women. [19][20][21] Puberty blockade is usually achieved through the use of gonadotropin-releasing hormone agonists such as goserelin, leuprolide, or histrelin in the form of monthly or quarterly subcutaneous injections. 21 These therapies are generally well tolerated and help to suppress pituitary production of luteinizing hormone and follicle-stimulating hormone.…”

Ethical and culturally competent care of transgender patients: A scoping review

“…Neira 39 noted that care professionals should also learn effective and sensitive approaches to communication entailing respectful verbal and non-verbal skills that do not threaten the dignity of transgender individuals. Salas-Humara et al 40 stressed the need to continue acquiring knowledge and teaching competence until the care professionals are confident that they can provide ethical and culturally sensitive care. It was evident from the articles that the provision of ethically and culturally sensitive care is contingent upon the care professionals’ ability to discern personal limitations in knowledge, competence, and consistent endeavors to overcome their limitations.…”

“…However, many studies suggested that the collaborative role of the healthcare team and the organization cannot be neglected. 27,32 –35,40,44,50,52 Grossman 27 emphasized that organizational leaders must develop policies and encourage their staff to provide ethical and sensitive care. Karasic and Fraser 31 noted that the team leaders should lead from the front to offer positive experiences to transgender individuals.…”