Management of the Transgender Adolescent

Abstract

ransgender individuals are people whose self-identification as male, female, both, or neither (gender identity) does not match their assigned gender (identification by others as male or female based on natal sex). The phenomenon of transgender is uncommon, but as more media attention is directed toward the subject, more adolescents and young adults are "coming out" at an earlier age. Transgender adolescents are an underserved and poorly researched population that has very specific medical and mental health needs. Primary care physicians are in a unique and powerful position to promote health and positive outcomes for transgender youth. While not all transgender adolescents desire phenotypic transition to match their gender and physical body, most do. The process of transitioning is complex and requires the involvement of both a mental health therapist specializing in gender and a physician. Finding comprehensive medical and mental health services is extremely difficult for these youth, who are at risk for multiple psychosocial problems including family and peer rejection, harassment, trauma, abuse, inadequate housing, legal problems, lack of financial support, and educational problems. This review supports and describes timely medical intervention to achieve gender/body congruence paired with affirmative mental health therapy as an appropriate approach to minimize negative health outcomes and maximize positive futures for transgender adolescents.

Psychological and Medical Care of Gender Nonconforming Youth

“…2 With the creation of an increasing number of multidisciplinary clinics dedicated to the care of the GN youth, there seems to be an increasing number of such youth and their families presenting for care. [4][5][6][7][8] Important tasks are to determine the safest and most efficacious mental and medical approaches for this population. There are many unanswered questions: the impact of pubertal suppression and cross-sex hormone therapy on long-term brain development and on bone health; risks of developing chronic medical conditions, such as diabetes, hypertension, and dyslipidemia; and mental health consequences of recommended interventions.…”

“…3 In recent years, an increasing number of multidisciplinary clinics have emerged in the United States that are dedicated to providing care to this population. [4][5][6][7][8] A challenge to all of these programs is that even with published clinical guidelines and standards of care, management of GN youth remains controversial, with a key factor being that these documents are based primarily on expert opinion rather than scientific data, given the paucity of outcomes data on the effects of mental health and medical interventions. An increasing number of GN youth are presenting for gendersensitive health services.…”

Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment

“…1 Fifteen years ago, pubertal delay was introduced as an aid in the treatment of a gender dysphoric adolescent. 2 Although not without debate, blocking pubertal development has rapidly become more widely available [3][4][5][6][7] and is now part of the clinical management guidelines for GD. [8][9][10][11][12] Gonadotropin-releasing hormone analogs (GnRHa) are a putatively fully reversible 13 medical intervention intended to relieve distress that gender dysphoric adolescents experience when their secondary sex characteristics develop.…”

Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth

“…6,7 Transgender people are often also identified by the natal gender and transition to the desired gender; MTF refers to males transitioning to females and FTM are females transitioning to males. 1,5,[7][8][9] Many adolescents who self-report as lesbian will still occasionally have sex with males, and many males who self-report as gay may have sex with females; behaviors do not equal identity. 1,10 This range of sexuality may be reflected in the higher rate of teenage pregnancies experienced by WSW compared with their exclusively heterosexual peers.…”