Management of juvenile gender dysphoria

Hembree, Wylie C.

doi:10.1097/01.med.0000436193.33470.1f

Cited by 8 publications

(2 citation statements)

References 27 publications

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“…At the onset of puberty, the reaction of the adolescent to the first bodily changes, under the form of increasing aversion of their biological sex which will enhance GD, often provides additional diagnostic evidence [ 7 ]. If GD persists, the child will be eligible for medical treatment aimed at suppressing puberty and/or attenuating its physical symptoms [ 5 , 8 ], a decision which is to be made by an experienced multidisciplinary team. However, delaying puberty is controversial.…”

Section: Introductionmentioning

confidence: 99%

Consecutive lynestrenol and cross-sex hormone treatment in biological female adolescents with gender dysphoria: a retrospective analysis

et al. 2016

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BackgroundPrior to the start of cross-sex hormone therapy (CSH), androgenic progestins are often used to induce amenorrhea in female to male (FtM) pubertal adolescents with gender dysphoria (GD). The aim of this single-center study is to report changes in anthropometry, side effects, safety parameters, and hormone levels in a relatively large cohort of FtM adolescents with a diagnosis of GD at Tanner stage B4 or further, who were treated with lynestrenol (Orgametril®) monotherapy and in combination with testosterone esters (Sustanon®).MethodsA retrospective analysis of clinical and biochemical data obtained during at least 6 months of hormonal treatment in FtM adolescents followed at our adolescent gender clinic since 2010 (n = 45) was conducted. McNemar’s test to analyze reported side effects over time was performed. A paired Student’s t test or a Wilcoxon signed-ranks test was performed, as appropriate, on anthropometric and biochemical data. For biochemical analyses, all statistical tests were done in comparison with baseline parameters. Patients who were using oral contraceptives (OC) at intake were excluded if a Mann-Whitney U test indicated influence of OC.ResultsMetrorrhagia and acne were most pronounced during the first months of monotherapy and combination therapy respectively and decreased thereafter. Headaches, hot flushes, and fatigue were the most reported side effects. Over the course of treatment, an increase in musculature, hemoglobin, hematocrit, creatinine, and liver enzymes was seen, progressively sliding into male reference ranges. Lipid metabolism shifted to an unfavorable high-density lipoprotein (HDL)/low-density lipoprotein (LDL) ratio; glucose metabolism was not affected. Sex hormone-binding globulin (SHBG), total testosterone, and estradiol levels decreased, and free testosterone slightly increased during monotherapy; total and free testosterone increased significantly during combination therapy. Gonadotropins were only fully suppressed during combination therapy. Anti-Müllerian hormone (AMH) remained stable throughout the treatment. Changes occurred in the first 6 months of treatment and remained mostly stable thereafter.ConclusionsTreatment of FtM gender dysphoric adolescents with lynestrenol monotherapy and in combination with testosterone esters is effective, safe, and inexpensive; however, suppression of gonadotropins is incomplete. Regular blood controls allow screening for unphysiological changes in safety parameters or hormonal levels and for medication abuse.

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Section: Introductionmentioning

confidence: 99%

Consecutive lynestrenol and cross-sex hormone treatment in biological female adolescents with gender dysphoria: a retrospective analysis

et al. 2016

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“…GnRHa has been used in the treatment of gender dysphoria since the mid 1990s, and their efficacy in delaying puberty in adolescents is documented by numerous studies and scientific publications (Cohen-Kettenis, Schagen et al, 2011;De Vries & Cohen-Kettenis, 2012;Coleman et al, 2012;Desforges et al, 1991;Costa et al, 2015;Delemarre-van de Waal & Cohen-Kettenis, 2006;Kreukels & Cohen-Kettenis, 2011;De Vries et al, 2011Edwards-Leeper & Spack, 2012;Hembree et al, 2009;Hembree, 2013;Hewitt et al, 2012;Khatchadourian et al, 2014;Nakatsuka, 2012;Shumer & Spack, 2013;Spack, 2013;Vrouenraets et al, 2015Vrouenraets et al, , 2016Wylie et al, 2016).…”

Section: The Problems Of Off Label Usementioning

confidence: 99%