Endocrine Treatment of Transsexual Persons:An Endocrine Society Clinical Practice Guideline

Hembree, Wylie C.; Cohen‐Kettenis, Peggy T.; Waal, Henriëtte A. Delemarre-van de; Gooren, Louis; Meyer, Walter J.; Spack, Norman P.; Tangpricha, Vin; Montori, Víctor M.

doi:10.1210/jc.2009-0345

Cited by 933 publications

(1,130 citation statements)

References 124 publications

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“…The standard for treatment in the clinic follows the Standards of Care of the World Professional Association for Transgender Health (WPATH, Coleman et al, 2011), a professional organization in the field of transgender care, and the Clinical Practice Guidelines of the Endocrine Society published in 2009 (Hembree et al, 2009), comprising puberty suppression with gonadotrophin releasing hormone (GnRH) analogues once adolescents start to display the first physical and endocrine changes of puberty (Tanner stage 2-3), followed by cross-sex hormone therapy after the age of 16. From 18 years of age onward, individuals with GD can be referred for sex reassignment surgery.…”

Section: Subjectsmentioning

confidence: 99%

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Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain

Hoekzema

Schagen

Kreukels

et al. 2015

Psychoneuroendocrinology

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The sexual differentiation of the brain is primarily driven by gonadal hormones during fetal development. Leading theories on the etiology of gender dysphoria (GD) involve deviations herein. To examine whether there are signs of a sex-atypical brain development in GD, we quantified regional neural gray matter (GM) volumes in 55 female-to-male and 38 male-to-female adolescents, 44 boys and 52 girls without GD and applied both univariate and multivariate analyses. In girls, more GM volume was observed in the left superior medial frontal cortex, while boys had more volume in the bilateral superior posterior hemispheres of the cerebellum and the hypothalamus. Regarding the GD groups, at whole-brain level they differed only from individuals sharing their gender identity but not from their natal sex. Accordingly, using multivariate pattern recognition analyses, the GD groups could more accurately be automatically discriminated from individuals sharing their gender identity than those sharing their natal sex based on spatially distributed GM patterns. However, region of interest analyses indicated less GM volume in the right cerebellum and more volume in the medial frontal cortex in female-to-males in comparison to girls without GD, while male-to-females had less volume in * Corresponding author. the bilateral cerebellum and hypothalamus than natal boys. Deviations from the natal sex within sexually dimorphic structures were also observed in the untreated subsamples. Our findings thus indicate that GM distribution and regional volumes in GD adolescents are largely in accordance with their respective natal sex. However, there are subtle deviations from the natal sex in sexually dimorphic structures, which can represent signs of a partial sex-atypical differentiation of the brain.

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Section: Subjectsmentioning

confidence: 99%

“…Treatment with cross-sex hormones is continued after sex reassignment surgery. For additional information regarding the standards for diagnostics and treatment of adolescents with GD, see (Hembree et al, 2009;Kreukels and Cohen-Kettenis, 2011). Please see Table 1 for demographic and clinical details of the sample.…”

Section: Subjectsmentioning

confidence: 99%

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain

Hoekzema

Schagen

Kreukels

et al. 2015

Psychoneuroendocrinology

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“…In fact, puberty brings relief for the vast majority of children receiving therapy for GID, because hormone surges propel the development of their brains as well as their bodies and they come to identify with their biological sex. 4,5 Science and ethics trump the current recommendations of the AAP and APA, which amount to conducting an ideology-driven social experiment on vulnerable children and their families. All physicians must work for the reinstatement of the diagnosis and sound treatment of childhood GID.…”

mentioning

confidence: 99%

“…4 It is also striking that the respondents claim that pubertal blockers can lead to stunted growth when the reference they cite actually notes that any slowdown in growth is remedied once puberty ensues, either through discontinuation of blockers or through the addition of cross-sex hormones appropriate for the affirmed gender. 5 Any compromise of fertility would also be reversed should pubertal blockers be stopped with resumption of endogenous puberty. 5 The respondents also raise concern for malignancies with synthetic (cross-sex) hormones; yet, the reference they cite shows no increased risk of cancer during an observation period of up to 30 years and points to the need for long-term studies.…”

mentioning

confidence: 99%

“…5 Any compromise of fertility would also be reversed should pubertal blockers be stopped with resumption of endogenous puberty. 5 The respondents also raise concern for malignancies with synthetic (cross-sex) hormones; yet, the reference they cite shows no increased risk of cancer during an observation period of up to 30 years and points to the need for long-term studies. 5 Finally, the respondents reject the value of pubertal blockers in gender-dysphoric adolescents because most will not persist as transgender adults.…”

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confidence: 99%

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Author’s Response

Vance

Ehrensaft²,

Rosenthal³

2015

Pediatrics

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Management of the Transgender Adolescent

Olson¹,

Forbes²,

Belzer³

2011

Arch Pediatr Adolesc Med

123

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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.

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Endocrine Treatment of Transsexual Persons:An Endocrine Society Clinical Practice Guideline

Cited by 933 publications

References 124 publications

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain

Author’s Response

Management of the Transgender Adolescent

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