Medical treatment in gender dysphoric adolescents endorsed by SIAMS–SIE–SIEDP–ONIG
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Despite international guidelines being available, not all gender clinics are able to face gender dysphoric (GD) youth population needs specifically. This is particularly true in Italy. Centers offering specialized support are relatively few and a commonly accepted Italian approach to GD youth has still not been defined. The aim of the present Position Statement is to develop and adhere to Italian guidelines for treatment of GD adolescents, in line with the “Dutch Approach”, the Endocrine Society (ES), and the World Professional Association for Transgender Health (WPATH) guidelines.
An in-depth brainstorming on the application of International guidelines in the Italian context was performed by several dedicated professionals.
A staged approach, combining psychological support as well as medical intervention is suggested. In the first phase, individuals requesting medical help will undergo a psycho-diagnostic procedure to assess GD; for eligible adolescents, pubertal suppression should be made available (extended diagnostic phase). Finally, from the age of 16 years, cross-sex hormonal therapy can be added, and from the age of 18 years, surgical sex reassignment can eventually be performed.
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.
KeywordsGender Dysphoria Adolescents Puberty suppression
Società Italiana di Andrologia e Medicina della Sessualità (Italian Society of Andrology and Sexual Medicine)
Società Italiana di Endocrinologia (Italian Society of Endocrinology)
Società Italiana di Endocrinologia e Diabetologia Pediatrica (Italian Society for Paediatric Endocrinology and Diabetes)
Osservatorio Nazionale sull’Identità di Genere (National Observatory of Gender Identity)
Conflict of interest
The authors declare no conflict of interest.
- 1.American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, Fifth Edition: DSM-5 tm. Washington, DCGoogle Scholar
- 2.Dèttore D, Ristori J, Antonelli P, Bandini E, Fisher AD, Villani S, de Vries A, Steensma T, Cohen-Kettenis P (2014) Gender dysphoria in adolescents: the need for a shared assessment protocol and the proposal of the AGIR protocol. J Psychopathol in pressGoogle Scholar
- 10.Fisher AD, Bandini E, Casale H, Ferruccio N, Meriggiola MC, Gualerzi A, Manieri C, Jannini EA, Mannucci E, Monami M, Stomaci N, Delle Rose A, Susini T, Ricca V, Maggi M (2013) Sociodemographic and clinical features of gender identity disorder: an Italian multicentric evaluation. J Sex Med 10:408–419PubMedCrossRefGoogle Scholar
- 11.Bandini E, Fisher Castellini G, Lo Sauro C, Lelli L, Meriggiola MC, Casale H, Benni L, Ferruccio N, Faravelli C, Dèttore D, Maggi M, Ricca V (2013) Gender identity disorder and eating disorders: similarities and differences in terms of body uneasiness. J Sex Med 10:1012–1023PubMedCrossRefGoogle Scholar
- 12.Fisher AD, Castellini G, Bandini E, Casale H, Fanni E, Benni L, Ferruccio N, Meriggiola MC, Manieri C, Gualerzi A, Jannini E, Oppo A, Ricca V, Maggi M, Rellini AH (2013) Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria. J Sex Med. doi: 10.1111/jsm.12413 Google Scholar
- 14.Green R (1974) Sexual identity conflict in children and adults. Basic Books, New YorkGoogle Scholar
- 19.Di Ceglie D, Sturge C, Sutton A (1998) Gender identity disorders in children and adolescents: Guidance for management (Council Report CR63). Royal College of Psychiatrists, LondonGoogle Scholar
- 20.Meyer W, Boockting WO, Cohen-Kettenis P, Coleman E, Di Ceglie D, Devor H, Gooren L, Hage JJ, Kirk S, Kuiper B, Laub D, Lawrence A, Menard Y, Patton J, Schaefer L, Webb A, Wheeler CC (2002) Standards of care of the Harry Benjamin International Gender Dysphoria Association, Sixth Version. J Psychol Hum Sex 13:1–30CrossRefGoogle Scholar
- 21.Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfäfflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K (2011) Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism 13:165–232CrossRefGoogle Scholar
- 26.Giordano S (2012) Children with gender identity disorder, a clinical, ethical and legal analysis. Routledge, London and New YorkGoogle Scholar
- 32.Di Ceglie D, Freedman D, McPherson S, Richardson P (2002) Children and adolescents referred to a specialist gender identity developmental service: clinical features and demographic characteristics. Int J Transgenderism 6:1Google Scholar
- 33.Istituto Nazionale di Statistica (ISTAT) (2013). http://noi-italia.istat.it. Accessed 24 Oct 2013
- 34.Achenbach TM, Rescorla LA (2001) Manual for the ASEBA school-age forms and profiles. Burlington: VT: University of Vermont, Research Centre for Children, Youth and FamiliesGoogle Scholar
- 36.Di Ceglie D (2012) Internalising and externalising behaviours in a group of young people with gender dysphoria. Unpublished manuscript, Gender Identity Development Service, The Tavistock and Portman NHS Foundation Trust, Tavistock Centre, London, EnglandGoogle Scholar
- 41.Lev AI (2004) Transgender emergence-therapeutic guidelines for working with gender-variant people and their families. The Haworth Clinical Practice Press, New York-London-OxfordGoogle Scholar
- 42.Ratifica ed esecuzione della convenzione sui diritti del fanciullo, L.27 maggio 1991 n.176. http://www.camera.it/_bicamerali/infanzia/leggi/l176.htm. Accessed 24 Oct 2013
- 45.Feuillan PP, Jones JV, Barnes K, Oerter-Klein K, Cutler GB Jr (1999) Reproductive axis after discontinuation of gonadotropin-releasing hormone analog treatment of girls with precocious puberty: long-term follow-up comparing girls with hypothalamic hamartoma to those with idiopathic precocious puberty. J Clin Endocrinol Metabol 84:44–49CrossRefGoogle Scholar
- 46.Heger S, Partsch CJ, Sippell WG (1999) Long-term outcome after depot gonadotropin-releasing hormone agonist treatment of central precocious puberty: final height, body proportions, body composition, bone mineral density, and reproductive function. J Clin Endocrinol Metabol 84:4583–4590Google Scholar
- 47.De Sutter P (2007) Reproduction and fertility issues for transpeople. In: Ettner R, Monstrey S, Eyler AE (eds) Principles of transgender medicine and surgery. Haworth Press, New York, pp 209–221Google Scholar
- 53.Delemarre-van de Waal HA (2013) Early Medical Intervention in Adolescents with Gender Dysphoria. In: Kreukels BPC, Steensma TD, de Vries ALC (eds.) Gender Dysphoria and Disorders of Sex Development. Springer New York Heidelberg Dordrecht London, pp 193–203Google Scholar
- 58.Cohen-Kettenis PT, Pfäfflin F (2003) Transgenderism and intersexuality in childhood and adolescence. Sage Publications, Making Choices. LondonGoogle Scholar
- 59.de Vries AL (2010) Gender dysphoria in adolescents: mental health and treatment evaluation. Doctoral dissertation, VU University, AmsterdamGoogle Scholar
- 70.Yigit S, Onyirimba M, Gendreau P, Lerer T, Rubin K (2004) Effect of transdermal versus oral estradiol on growth factors and markers of bone turn-over in young adults with Turner Syndrome: a pilot study. J Bone Miner Res 19:S320Google Scholar
- 72.Vehkavaara S, Silveira A, Hakala-Ala-Pietilä T, Virkamäki A, Hovatta O, Hamsten A, Taskinen MR, Yki-Järvinen H (2001) Effects of oral and transdermal estrogen replacement therapy on markers of coagulation, fibrinolysis, inflammation and serum lipids and lipoproteins in postmenopausal women. Thromb Haemost 85:619–625PubMedGoogle Scholar
- 74.Spack N (2008) An endocrine perspective on the care of transgender adolescents. Presented at the 55th annual meeting of the American Academy of Child and Adolescent Psychiatry, 28 October–2 November 2008Google Scholar