Approach to the Patient: Pharmacological Management of Trans and Gender-Diverse Adolescents

Abstract

Internationally, increasing numbers of children and adolescents with gender dysphoria are presenting for care. In response, gender affirming therapeutic interventions that seek to align bodily characteristics with an individual’s gender identity are more commonly being employed. Depending on a young person’s circumstances and goals, hormonal interventions may aim to achieve full pubertal suppression, modulation of endogenous pubertal sex hormone effects and/or development of secondary sex characteristics congruent with their affirmed gender. This is a relatively novel therapeutic area and, while short-term outcomes are encouraging, longer-term data from prospective longitudinal adolescent cohorts are still lacking, which may create clinical and ethical decision-making challenges. Here we review current treatment options, reported outcomes, and clinical challenges in the pharmacological management of trans and gender diverse adolescents.

Transgeneridade: caso de disforia de gênero grave com quadro de mutismo e retraimento social

“…A terapia hormonal é uma destas alternativas e é dividida em duas etapas, conhecidas como supressão puberal e hormonioterapia para reafirmação de gênero [5]. A supressão, também chamada de bloqueio puberal, pode ser feita a partir do estágio 2 de Tanner e é considerada temporária e reversível, tornandose ideal para que o indivíduo possa conhecer o corpo sem influências da puberdade e decidir, mais tarde, por descontinuação ou substituição para reposição com hormônios masculinizantes ou feminilizantes [3][4][5]10]. O bloqueio puberal deve ser realizado e acompanhado por endocrinologista especializado e feito com análogos de GnRH, como Triptorelina ou Leuprolide, os quais agem na redução da secreção de estrógenos e testosterona, produzidos nos ovários e testículos, respectivamente [5,10].…”

“…A terapia de bloqueio puberal é considerada segura, porém não é isenta do risco de eventos adversos, dentre eles infertilidade, diminuição da densidade mineral óssea, mudanças de humor, dor de cabeça, instabilidade vasomotora e ondas de calor [4,10,11]. Dito isto, se trata de uma intervenção que ainda causa dúvidas quanto à sua segurança.…”

Gender affirming hormonal treatment in Danish transgender persons: A nationwide register‐based study

“…The adherence to GAHT was high, and we found no indication of higher risk of discontinuation of GAHT despite shorter duration from the index date to first prescription of GAHT. Recently, gender affirming treatment of young individuals is debated, 17 and some CGI centers have stopped gender affirming treatment in persons below 25 years of age. Our data did not suggest a higher rate of GAHT discontinuation in persons <25 years, and the highest rate of discontinuation was found in AMAB ≥ 25 years.…”

Gender identity services for children and young people in England

“…However, many young people in this situation will already be in late puberty or have finished their pubertal development, by which time the main potential benefits of puberty suppression have been lost 11. Moreover, using puberty blockers in such individuals is more likely to induce unwanted menopausal symptoms such as fatigue and disturbed mood 14. For these reasons, puberty suppression outside the UK is typically reserved for gender diverse young people who are in early or middle puberty, when there is a physiological reason for prescribing blockers.…”