Discharge outcome analysis of 1089 transgender young people referred to paediatric endocrine clinics in England 2008–2021

Abstract

IntroductionThe destination of transgender and gender variant young people referred by the National Health Service (NHS) Gender Identity Development Service (GIDS) to, and discharged from the two English paediatric endocrine liaison clinics is not known.Methods1151 young people referred after full assessment by the GIDS; 827 to University College London Hospital since 2008; 324 to Leeds Children’s Hospital since 2013. Discharge categorisation was by agreed criteria. Eleven emigrated and 51 self-discharged. 1089 had known outcomes.Results999/1089 (91.7%) continued identifying as gender variant. 867/999 (86.8%) were discharged to adult gender identity clinics (GICs). 166/867 (19.1%) of these were <16 years and 701/867 (80.9%) ≥16 years at initial endocrine referral. No sex differences were seen. 38/999 (3.8%) opted for non-NHS services.90/1089 ceased identifying as gender variant. In 32/1089 (2.9%), this was subsequent to their first clinic appointment.58/1089 (5.3%) stopped treatment either with the gonadotropin releasing hormone analogue (GnRHa) or gender-affirming hormones (GAH) and reverted to their birth gender: <16 years (20/217; 9.2%); ≥16 years (38/872; 4.4%).Subdividing further, 16/217 (7.4%) <16 years ceased GnRHa and 4/217 (1.8%) after GAH. Of those ≥16 years, 33/872 (3.8%) ceased GnRHa and 5/872 (0.6%) GAH.ConclusionsAt discharge, 91.7% continued as transgender or gender variant, 86.8% sought ongoing care through NHS GICs. 2.9% ceased identifying as transgender after an initial consultation prior to any endocrine intervention and 5.3% stopped treatment either with GnRHa or GAH, a higher proportion in the <16 year compared with the ≥16 year groups.

Trajectories of transgender adolescents referred for endocrine intervention in England

“…It is also important to reiterate the long wait times experienced by YP before accessing services and the older age of accessing treatments noted in cohort 2. When these data are taken alongside the larger cohort of endocrine discharge outcomes presented by Butler et al , and the low rates of stopping treatment noted in this piece,23 considerations around the need for increased service provision, to allow for more timely treatment where indicated is evident.…”

“…The average number of years from consent to GnRHa to consent to GAH was 1.3±0.02 (range: 0.5–2.6; table 2). Further data specifically assessing onward trajectories after discharge from endocrine services for this and wider cohorts of GIDS YP can be found in Butler et al 23…”

“…This analysis represents a snapshot in time. Full details of discharge outcomes are given in Butler et al 23. Qualitative information regarding reasons for decisions not to go onto GICs was not available.…”

“…Stopping treatment data were collected from patient records and information from the endocrinology team. A complementary article specifically assessing all discharge destinations from endocrine clinics of a larger group of YP from 2008 to 2021 was analysed separately (see Butler et al ) 23. The present piece analyses demographics and pathways during YP’s time within the GIDS, with more detail surrounding how services were navigated by a sample of these YP (cohort 2).…”

Sharing decisions amid uncertainties: a qualitative interview study of healthcare professionals’ ethical challenges and norms regarding decision-making in gender-affirming medical care

“…On the other hand, legislation and other efforts aimed at or curbing the provision of GAMC to especially trans youth is on the rise, undergirded, amongst others, by claims that current decision-making practices insufficiently safeguard the principle of non-maleficence [21,22]. The latter often highlight the risk of "detransition" (i.e., discontinuing and/or reversing GAMC) and the more general clinical challenge of accurately identifying for whom treatment is beneficial or harmful [23,24].…”