Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline

Hembree, Wylie C.; Cohen‐Kettenis, Peggy T.; Gooren, Louis; Hannema, Sabine E.; Meyer, Walter J.; Murad, M. Hassan; Rosenthal, Stephen M.; Safer, Joshua D.; Tangpricha, Vin; T’Sjoen, Guy

doi:10.1210/jc.2017-01658

Cited by 1,703 publications

(1,778 citation statements)

References 222 publications

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“…Mental health comorbidities, including suicide risk, were common among the youth in our clinic, reinforcing the need for comprehensive screening during the evaluation of transgender youth. If corroborated, our data have additional clinical implications; namely that AFAB youth, who now represent the majority of youth in clinic, may have higher rates of mental health comorbidities and that laboratory testing can likely be streamlined even further than the recent Endocrine Society guidelines indicated [25]. …”

Section: Discussionmentioning

confidence: 68%

“…The Endocrine Society recently published their updated 2017 guidelines regarding the treatment of persons with gender dysphoria [25]. As with the original 2009 guidelines, the Endocrine Society continues to support the option of using “puberty-blockers” or gonadotropin-releasing hormone agonists (GnRH agonists) in transgender youth as a means to decrease their gender dysphoria [25, 26].…”

Section: Introductionmentioning

confidence: 99%

“…As with the original 2009 guidelines, the Endocrine Society continues to support the option of using “puberty-blockers” or gonadotropin-releasing hormone agonists (GnRH agonists) in transgender youth as a means to decrease their gender dysphoria [25, 26]. Despite this recommendation, there are few studies examining the baseline physiological parameters outlined by the Endocrine Society or the hormonal and biochemical impact of such treatment [20, 27, 28].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of Adolescents Referred to a Gender Clinic: Are Youth Seen Now Different from Those in Initial Reports?

2018

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Background/Aims: To examine characteristics, including mental health comorbidities, among adolescents presenting to a transgender clinic and to compare these data to previous reports. Methods: Retrospective chart review among youth seen at The Hospital for Sick Children between January 2014 and June 2016. Demographic data, clinical characteristics, and mental health comorbidities were assessed. Baseline and repeat blood work were also examined. Results: Charts from 203 adolescents aged 12–18 years were reviewed (156 assigned female at birth [AFAB] (77%) aged 16.3 ± 1.63 years, 47 assigned male at birth [AMAB] aged 16.1 ± 1.70 years). There was no statistically significant difference between gender groups except for Tanner stage (AFAB, mean 4.42 ± 0.8 and AMAB, mean 4.03 ± 1.1, p = 0.040). Individuals from racial/ethnic minority populations were under-represented compared to the background population. Self-report and baseline psychological questionnaires showed high levels of gender dysphoria, mood disorders, and suicidal ideation, with higher levels of anxiety detected on questionnaires among AFAB (p = 0.03). Laboratory abnormalities identified on baseline and repeat testing were minor; on cross-sex hormones, hemoglobin levels increased slightly in AFAB (p = 0.002, highest = 166 g/L) and decreased among AMAB (p = 0.02, lowest = 132 g/L). Conclusion: Our study supports an evolving demographic trend with more AFAB than AMAB youth now presenting to gender clinics. The data also corroborate studies indicating that extensive laboratory testing may not be a necessary part of caring for these youths. Why more AFAB are now presenting to clinic and racial/ethnic minorities are underrepresented is not clear, but these trends have important implications for clinical care and warrant further study.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characteristics of Adolescents Referred to a Gender Clinic: Are Youth Seen Now Different from Those in Initial Reports?

2018

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“…Of course, it does not include those being cared for under other independent clinical pathways, nor does it help directly determine the rules for intervention or the qualifications or experience of those directing care. The major centers responding here do use the international guidelines [3, 4] to provide medical care, but as yet there is virtually nothing published about long-term outcomes, which may skew the intervention pathways towards a more conservative, lower-risk decision-making process. However, a slower approach to starting intervention may better concord with adolescent developmental stages [3].…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines on the treatment of GD adolescents have been issued by the World Professional Association for Transgender Health (WPATH) and by the Endocrine Society [3, 4]. They recommend multidisciplinary assessment and treatment by specialist teams.…”

Section: Introductionmentioning

confidence: 99%

ESPE and PES International Survey of Centers and Clinicians Delivering Specialist Care for Children and Adolescents with Gender Dysphoria

Skordis¹,

Butler

Vries

et al. 2018

Horm Res Paediatr

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Background/Aims: Increasing numbers of children and adolescents seek medical care because they experience incongruence between their physical sex and their gender identity. Methods: The ESPE working group on gender dysphoria (GD) undertook a survey to investigate the structure and the type of medical care in centers that offer specialist care for transgender adolescents. Results: The personnel of each center varied from country to country, and a nationally organized network or plan for managing GD did not exist in all centers. The majority of young people were transitioning from female to male, and the number of new referrals increased remarkably during the past 3 years. Almost all centers follow the guidelines issued by the Endocrine Society and World Professional Association for Transgender Health. GnRH analogues were used as the initial treatment in the majority of the centers. The age from which adolescents are treated with gender-affirming hormones varied between centers. Several legal restrictions that concern or influence the treatment of children and adolescents with GD were finally addressed. Conclusion: This first international survey examining the variations in availability and provisions of services for children and adolescents with GD serves as a starting block for further dialogue and future studies.

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How Should Decision-Sharing Roles Be Considered in Adolescent Gender Surgeries?

Grimstad

Boskey

2020

AMA Journal of Ethics

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The nascent field of gender-affirming surgery (GAS) for binary and nonbinary transgender adolescents is growing rapidly, and the optimal use of shared decision making (SDM)-including who should be involved, to what extent, and for which parts of the decision-is still evolving. Participants include the adolescent (whose goals might center on aesthetics and functionality), the surgeon (who might focus more on minimizing complications), the referring clinician (whose participation is mandated by present standards of care), and the caregiver (whose participation is required for patients below the age of consent). This article argues that effective, ethical SDM in adolescent GAS care requires a different conceptualization of roles than might be expected in other situations and should be a longitudinal experience rather than a singular event. To claim one AMA PRA Category 1 Credit TM for the CME activity associated with this article, you must do the following: (1) read this article in its entirety, (2) answer at least 80 percent of the quiz questions correctly, and (3) complete an evaluation. The quiz, evaluation, and form for claiming AMA PRA Category 1 Credit TM are available through the AMA Ed Hub TM. Adolescent Gender Surgery Decisions Gender affirmation is, fundamentally, the use of social, medical, and surgical processes to reify individuals' sense of themselves as a gendered being. The nascent field of gender-affirming surgery (GAS) is growing rapidly, particularly in its understanding of optimal techniques and outcomes. This is especially true for adolescent surgeries, as the existing literature predominantly focuses on adults, 1 which is in line with clinical practice guidelines that presently recommend gender-affirming genital surgeries be deferred until the age of majority. 2,3 However, both the World Professional Association for Transgender Health's Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People and the Endocrine Society's clinical practice guidelines, Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons, state that chest surgery may be performed prior to the age of majority depending on the individual, 2,3 and a number of surgeons acknowledge performing genital surgeries prior to age of majority. 4 In addition, many individuals seek GAS shortly after reaching the age of majority, which suggests that most counseling has already occurred.

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Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline

Cited by 1,703 publications

References 222 publications

Characteristics of Adolescents Referred to a Gender Clinic: Are Youth Seen Now Different from Those in Initial Reports?

Characteristics of Adolescents Referred to a Gender Clinic: Are Youth Seen Now Different from Those in Initial Reports?

ESPE and PES International Survey of Centers and Clinicians Delivering Specialist Care for Children and Adolescents with Gender Dysphoria

How Should Decision-Sharing Roles Be Considered in Adolescent Gender Surgeries?

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