Medical treatment in gender dysphoric adolescents endorsed by SIAMS–SIE–SIEDP–ONIG

Abstract

The current inadequacy of Italian services offering specialized support for GD youth may lead to negative consequences. Omitting or delaying treatment is not a neutral option. In fact, some GD adolescents may develop psychiatric problems, suicidality, and social marginalization. With access to specialized GD services, emotional problems, as well as self-harming behavior, may decrease and general functioning may significantly improve. In particular, puberty suppression seems to be beneficial for GD adolescents by relieving their acute suffering and distress and thus improving their quality of life.

Gender identity, gender assignment and reassignment in individuals with disorders of sex development: a major of dilemma

“…A similar exhaustive psychosocial and medical assessment can guide team decisions about gender reassignment, timing of surgery, and sex hormone replacement [72]. In particular-when gonads are still present and possibly functioning-if eligibility criteria are fulfilled (see Table 2) [51,89,90], puberty may be temporary suspended by using gonadotropin-releasing hormone analogues (GnRHa). This treatment leads to a gradual regression of sex characteristic development, aiding in prolonging the diagnostic phase, whereas the body remains in a neutral early pubertal state.…”

“…This option may be particularly relevant in case of GD in DSD conditions where no clear gender identity outcome can be predicted (see Table 1). In line with the Standards of Care of the World Professional Association for Transgender Health [89], it is recommended starting GnRHa when adolescents have experienced puberty to at least Tanner stage 2, because of the important diagnostic value of the negative emotional effects related to the first pubertal changes [51,89,90]. In particular conditions (such as in case of a gender assignment at birth different from the recommended one), an earlier treatment with GnRHa may be also considered.…”

“…In case of GD persistence and if eligibility criteria are met (see Table 2), puberty induction in accordance with the adolescent gender identity should be considered [51,89,90].…”

“…Adverse effects of androgen pubertal induction include erythrocytosis, weight gain, and irreversible development of male secondary sex characteristics, which may be distressing in case of GD. Intramuscular testosterone esters can be started at a dose of 50 mg monthly, increasing by 50-mg intervals every 6-12 months to a dose of 250 mg monthly, at which point a long-acting adult testosterone formulation can be commenced (testosterone undecanoate 1000 mg every 12 weeks, [51,91]). Otherwise, oral testosterone undecanoate 40 mg daily can be given with the evening meal and gradually titrated upward every 6 months to an adult dose of 160-240 mg per day, or to other testosterone formulations [51,91].…”

“…Moreover, the overlap existing between DSD and GD is linked to the possibility in both conditions of discomfort or distress caused by a discrepancy between gender identity and gender assigned at birth [51,52]. Furthermore, in both groups, such distress could lead to a possible gender reassignment request.…”