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Caring for Transgender and Gender-Nonconforming Youth

  • Adolescent Medicine (M Goldstein and L Johnson, Section Editors)
  • Published:
Current Pediatrics Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We reviewed recently published literature around the care of transgender and gender-nonconforming youth. In this nascent area of medicine, there are few randomized controlled trials, but there are treatment guidelines that include expert opinion and best practices for a more standardized approach to care.

Recent Findings

The most significant article published the past year is the updated standards of care—“Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline”—which establishes a care framework with special emphasis on the importance of interdisciplinary care. However, there are several other important articles that review health-care utilization and outcomes after treatment in the transgender population.

Summary

As gender dysphoria and nonconformity become more visible and prevalent, health-care providers will deliver care for these patients and will need to understand common health concerns and treatment options. The ability to provide culturally competent and appropriate care can improve psychosocial outcomes for these patients.

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References

Papers of particular interest, published recently, have been highlighted as: •Of importance, ••Of major importance

  1. • Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender and gender-nonconforming people, version 7. Int J Transgend. 2012;13(4):165–232. Treatment guidelines from WPATH (World Professional Association for Transgender Health).

    Article  Google Scholar 

  2. •• Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869–903. Most current guidelines for treatment of transgender persons

    Article  PubMed  Google Scholar 

  3. Flores AR, Herman JL, Gates GJ, Brown TNT. How many adults identify as transgender in the United States? The Williams Institute. 2016. Available at: https://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf. Accessed May 8, 2018.

  4. van Beijsterveldt CE, Hudziak JJ, Boomsma DI. Genetic and environmental influences on cross-gender behavior and relation to behavior problems: a study of Dutch twins at ages 7 and 10 years. Arch Sex Behav. 2006;35(6):647–58.

    Article  PubMed  Google Scholar 

  5. Human Rights Campaign. Growing up LGBT in America. In: May; 2012.

    Google Scholar 

  6. Kosciw JG, Greytak EA, Giga NM, Villenas C, Danischewski DJ. The 2015 National School Climate Survey: the experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. New York: GLSEN; 2016.

    Google Scholar 

  7. American Psychiatric Association. (2013). Gender dysphoria. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing, 2013; https://doi.org/10.1176/appi.books.9780890425596.dsm14.

  8. Steensma TD, Biemond R, de Boer F, Cohen-Kettenis PT. Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. Clin Child Psychol Psychiatr. 2011;16(4):499–516.

    Article  Google Scholar 

  9. Hoekzema E, Schagen SE, Kreukels BP, et al. Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain. Psychoneuroendocrinology. 2015 May;55:59–71.

    Article  PubMed  Google Scholar 

  10. Green R. Family co-occurrence of gender dysphoria: ten sibling or parent-child pairs. Arch Sex Behav. 2000;29:499–507.

    Article  PubMed  CAS  Google Scholar 

  11. Bao A-M, Swaab DF. Sexual differentiation of the human brain: relation to gender identity, sexual orientation and neuropsychiatric disorders. Front Neuroendocrinol. 2011;32:214–26.

    Article  PubMed  Google Scholar 

  12. Russell ST, Pollitt AM, Li G, et al. Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicide behavior among transgender youth. J Adolesc Health. 2018; https://doi.org/10.1016/j.jadohealth.2018.02.003.

  13. • Rider GN, BJ MM, Gower AL, et al. Health and care utilization of transgender and gender nonconforming youth: a population-based study. Pediatrics. 2018;141(3):e20171683. This article reviews variability in health care use based on gender identity.

    Article  Google Scholar 

  14. Grant J, Mottet L, Tanis J, et al. Injustice at every turn: a report of the national transgender discrimination survery. Washington DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.

    Google Scholar 

  15. Connolly MD, Zervos MK, Barone CJ, et al. The mental health of transgender youth: advances in understanding. J Adolesc Health. 2016 Nov;59(5):489–95.

    Article  PubMed  Google Scholar 

  16. Reisner SL, Vetters R, Leclerc M, Zaslow S, Wolfrum S, Shumer D, et al. Mental health of transgender youth in care at an adolescent urban community health center; a matched retrospective cohort study. J Adolesc Health. 2015 Mar;56(3):274–9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Haas A, Rodgers P, Herman J. Suicide attempts among transgender and gender non-conforming adults: findings of the National Transgender Discrimination Survey. Los Angeles: UCLA, Williams Institute and American Foundation for Suicide Prevention; 2014.

    Google Scholar 

  18. Olson J, Schrager SM, Belzer M, Simons LK, Clark LF. Baseline physiologic and psychosocial characteristics of transgender youth seeing care for gender dysphoria. J Adolesc Health. 2015 Oct;57(4):374–80.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Singh AA. Transgender youth of color and resilience: negotiating oppression and finding support. Sex Roles. 2013 Jun;68(11):690–702.

    Article  Google Scholar 

  20. Janssen A, Huang H, Duncan C. Gender variance among youth with autism spectrum disorders: a retrospective chart review. Transgend Health. 2016;1:63–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Carswell J, Roberts S. Induction and maintenance of amenorrhea in transmasculine and nonbinary adolescents. Transgend Health. 2017;2(1):195–201.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Committee on Adolescent Health Care. Care for transgender adolescents. Committee Opinion No 685. Obstet Gynecol. 2017;129:e11–6.

    Article  Google Scholar 

  23. Committee on Adolescent Health Care. Committee Opinion No. 668: menstrual manipulation for adolescents with physical and developmental disabilities. Obstet Gynecol. 2016;128:e20–5.

    Article  Google Scholar 

  24. Ahmad S, Leinung M. The response of the menstrual cycle to initiation of hormonal therapy in transgender men. Transgend Health. 2017;2:176–9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. ACOG Committee Opinion No. 701 Summary: Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 129(6):1149–1150.

  26. Kailas M, Lu HMS, Rothman EF, Safer JD. Prevalence and types of gender-affirming surgery among a sample of transgender endocrinology patients prior to state expansion of insurance coverage. Endocr Pract. 2017;23(7):780–6.

    Article  PubMed  Google Scholar 

  27. Buncamper ME, van der Sluis WB, de Vries M, Witte BI, Bouman MB, Mullender MG. Penile inversion vaginoplasty with or without additional full-thickness skin graft: to graft or not to graft? Plast Reconstr Surg. 2017;139(3):649e–56e.

    Article  PubMed  CAS  Google Scholar 

  28. Cizek S, Nguyen N, Lyon L, Zaritsky E, Weiss E. Combined hysterectomy and mastectomy surgery for transgender patients in an integrated health care setting. Int J Transgend. 2017;18:382–8.

    Article  Google Scholar 

  29. Obedin-Maliver J, Light A, de Haan G, Jackson RA. Feasibility of vaginal hysterectomy for female to male transgender men. Obstet Gynecol. 2017;129:457–63.

    Article  PubMed  Google Scholar 

  30. Capitan L, Simon D, Meyer T, et al. Facial feminization surgery: simultaneous hair transplant during forehead reconstruction. Plast Reconsty Surg. 2017;139(3):573–84.

    Article  CAS  Google Scholar 

  31. Papadopulos NA, Zavlin D, Lelle JD, et al. Male to female sex reassignment surgery using the combined technique leads to increased quality of life in a prospective study. Plast Reconstr Surg. 2017;140(2):286–94.

    Article  PubMed  CAS  Google Scholar 

  32. Wiepejes CM, Nota NM, de Blok CJM, et al. The Amsterdam cohort of gender dysphoria study (1972-2015): trends in prevalence, treatment and regrets. J Sex Med. 2018;15(4):582–90.

    Article  Google Scholar 

  33. Milrod C. How young is too young: ethical concerns in genital surgery of the transgender MTF adolescent. J Sex Med. 2014;11(2):338–46.

    Article  PubMed  Google Scholar 

  34. Olson-Kennedy J, Warus J, Okonta V, et al. Chest reconstruction and chest dysphoria in transmasculine minors and young adults—comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatr. 2018; https://doi.org/10.1001/jamapediatrics.2017.5440.

  35. Finlayson C, Johnson E, Chen D, et al. Proceedings of the working group session on fertility preservation for individuals with gender and sex diversity. Transgend Health. 2016;1:99–107.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wierckx K, Caenegem E, Pennings G. Reproductive wish in transsexual men. Hum Reprod. 2012;27:483–7.

    Article  PubMed  Google Scholar 

  37. De Roo C, Tilleman K, T’Sjoen G, et al. Fertility options in transgender people. Int Rev Psychiatry. 2016;28:112–9.

    Article  PubMed  Google Scholar 

  38. Nahata L, Tishelman AC, Caltabellotta NM, Quinn GP. Low fertility preservation utilization among transgender youth. J Adolsc Health. 2017 Jul;61(1):40–4.

    Article  Google Scholar 

  39. Chen D, Simons L, Johnson E, et al. Fertility preservation for transgender adolescents. J Adolesc Health. 2017;6:120–3.

    Article  Google Scholar 

  40. Strang J, Jarin J, Call D, et al. Transgender youth fertility attitudes questionnaire: measure development in nonautistic and autistic transgender youth and their parents. J Adolesc Health. 2018 Feb;62(2):128–35.

    Article  PubMed  Google Scholar 

  41. Chen D, Matson M, Macapagal K, et al. Attitudes toward fertility and reproductive health among transgender and gender-nonconforming adolescents. J Adolesc Health. 2018; https://doi.org/10.1016/j.jadohealth.2017.11.306.

  42. •• Owen-Smith AA, Gerth J, Sineath RC, et al. Association between gender confirmation treatments and perceived gender congruence, body image satisfaction, and mental health in a cohort of transgender individuals. J Sex Med. 2018;15(4):591–600. Larger study of the correlation between medical intervention and outcomes for transgender adults.

    Article  PubMed  Google Scholar 

  43. • de Vries AL, McGuire JK, Steensma TD, et al. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134(4):696–704. First description of transition outcomes for transgender youth

    Article  PubMed  Google Scholar 

  44. • Ryan C, Russell ST, Huebner D, et al. Family acceptance in adolescence and the health of LGBT young adults. J Child Adolesc Psychiatr Nurs. 2010;23(4):205–13. Description of best practices for suicide prevention in sexual minority youth.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC4000, Cincinnati, OH, 45219, USA

    Lee Ann E. Conard

  2. Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC7012, Cincinnati, OH, 45219, USA

    Sarah D. Corathers

  3. Division of Pediatric and Young Women’s Gynecology, Boston Children’s Health Physicians, 40 Sunshine Cottage Road, 1S-B59, Valhalla, NY, 10532, USA

    Gylynthia Trotman

Authors
  1. Lee Ann E. Conard
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  2. Sarah D. Corathers
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Correspondence to Lee Ann E. Conard.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Adolescent Medicine

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Conard, L.A.E., Corathers, S.D. & Trotman, G. Caring for Transgender and Gender-Nonconforming Youth. Curr Pediatr Rep 6, 139–146 (2018). https://doi.org/10.1007/s40124-018-0173-8

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  • DOI: https://doi.org/10.1007/s40124-018-0173-8

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