Management of adolescents with gender dysphoria
Dr Jarin is Fellow, Pediatric and Adolescent Gynecology, Washington Hospital Center, Washington, DC.
Dr Gomez-Lobo is Director, Pediatric and Adolescent Gynecology, Washington Hospital Center, Washington, DC.
Gender dysphoria (GD), formerly “gender identity disorder,” is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition encountered in people whose sex at birth (their “assigned gender”) is contrary to the gender with which they identify (their “affirmed gender”).
The psychiatric focus is on the distress experienced due to the incongruence between assigned and affirmed genders. Current evidence supports that gender-affirming therapy greatly improves outcomes.1 The American Psychiatric Association further states that such individuals should be able to obtain care without fear of discrimination and that treatment options for this condition include counseling, cross-sex hormones, gender reassignment surgery, and social and legal transition to the desired sex.1
In 2009, the Endocrine Society, along with the Pediatric Endocrine Society, World Professional Association for Transgender Health (WPATH), European Society of Endocrinology, and the European Society for Pediatric Endocrinology, published “Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline.”2 Since then, an increasing number of children and adolescents have received treatment for the condition.
It is important for general gynecologists to be aware of the current recommendations as well as long-term management of these adolescents as it is likely that they will encounter these patients in their practice.
For children and adolescents who present with GD, evaluation and management by a mental health provider with experience in child development and gender identity are essential. The mental health provider will assess whether the child indeed qualifies for the diagnosis and for confounding psychological factors and family support, provide psychotherapy, and evaluate the child’s psychological readiness for medical interventions such as puberty blockers and/or cross-sex hormones.