Trajectories of transgender adolescents referred for endocrine intervention in England

Abstract

ObjectivesSome gender-diverse young people (YP) who experience clinically significant gender-related distress choose to pursue endocrine treatment alongside psychotherapeutic support to suppress pubertal development using gonadotropin-releasing hormone analogues (GnRHa), and then to acquire the secondary sex characteristics of their identified gender using gender affirming hormones (GAH). However, little is known about the demographics of transgender adolescents accessing paediatric endocrinology services while under the specialist Gender Identity Development Service (GIDS) in England.DesignDemographics of referrals from the GIDS to affiliated endocrinology clinics to start GnRHa or GAH between 2017 and 2019 (cohort 1), with further analysis of a subgroup of this cohort referred in 2017–2018 (cohort 2) were assessed.Results668 adolescents (227 assigned male at birth (AMAB) and 441 assigned female at birth (AFAB)) were referred to endocrinology from 2017 to 2019. The mean age of first GIDS appointment for cohort 1 was 14.2 (±2.1) years and mean age of referral to endocrinology postassessment was 15.4 (±1.6) years. Further detailed analysis of the trajectories was conducted in 439 YP in cohort 2 (154 AMAB; 285 AFAB). The most common pathway included a referral to access GnRHa (98.1%), followed by GAH when eligible (42%), and onward referral to adult services when appropriate (64%). The majority (54%) of all adolescents in cohort 2 had a pending or completed referral to adult services.ConclusionsThis study highlights the trajectories adolescents may take when seeking endocrine treatments in child and adolescent clinical services and may be useful for guiding decisions for gender-diverse YP and planning service provision.

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

“…The assessment process prior to referral for paediatric endocrine support in our clinics is comprehensive, and the proportion seeking endocrine support varies by age. 1 A more recent report by Masic et al 9 describes the proportion of young people who are referred to endocrinology from the GIDS and the demographic information matching the appropriate criteria for referral for physical intervention. 9 The GIDS will assess and discharge other young people with gender variance not requesting endocrine support, but they are not known to the paediatric endocrine services and their outcome trajectories are not included here.…”

Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review

“…This makes long-term follow-up of puberty suppression difficult to assess, including any differences between the types of interventions that are offered and when these are initiated, and the few studies reporting long-term outcomes either did not control for this or reported overall effects for both interventions. Although recent studies suggest nearly all adolescents who receive puberty suppression go on to feminising/masculinising hormones,74–76 research is still needed to assess whether suppression will have any lasting effects for those who do not. Aggregation of studies reporting proportions of adolescents who progress to hormones and reasons for discontinuation would also offer useful insights.…”

Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review

“…For adolescents who do not first receive puberty suppression, GnRH-a or another anti-androgenic treatment may be offered at the initiation of hormones although the reasons for this are unclear 79. Although recent studies suggest most adolescents who proceed with hormones will receive puberty suppression before this,9 10 80 research that robustly compares outcomes for adolescents on this treatment pathway versus receiving hormones alone is needed, especially given recent studies suggesting the effect on secondary sex characteristics and fertility may be different 34 39…”

“…In a study of 1766 children and adolescents receiving care at a national gender service in the Netherlands (1997–2018), 202 birth-registered males and 454 birth-registered females received hormones at a median age of 16.0 (IQR 15.5–17.1) and 16.7 (16.0–17.5), respectively 9. In the UK, the mean age of consent for treatment was 17.3 (SD 0.1) 10…”