Care of Gender Nonconforming/Transgender Youth

Chapter

Abstract

In many parts of the world, increasing numbers of gender nonconforming/transgender youth are seeking medical services to enable the development of physical characteristics consistent with their experienced gender. Such medical services include use of agents to block endogenous puberty at Tanner stage 2 with subsequent use of cross-sex hormones and are based on longitudinal studies demonstrating that those individuals who were first identified as gender dysphoric in early or middle childhood and continue to meet the mental health criteria for being transgender at early puberty are likely to be transgender as adults. This chapter addresses terms and definitions applicable to gender nonconforming youth, studies that shed light on the biologic underpinnings of gender identity, outcomes and potential complications of current treatment models, gaps in knowledge, and priorities for research.

Keywords

Gender nonconforming youth Transgender youth Gender identity Gender dysphoria Biology of gender Pubertal blockers Gonadotropin-releasing hormone agonists Cross-sex hormones Estradiol Testosterone 

References

  1. 1.
    Rosenthal SM. Approach to the patient: transgender youth: endocrine considerations. J Clin Endocrinol Metab. 2014;99(12):4379–89.CrossRefGoogle Scholar
  2. 2.
    Vance SR Jr, Ehrensaft D, Rosenthal SM. Psychological and medical care of gender nonconforming youth. Pediatrics. 2014;134(6):1184–92.CrossRefGoogle Scholar
  3. 3.
    American Psychiatric Association and American Psychiatric Association. DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5, vol. xliv. 5th ed. Washington, DC: American Psychiatric Association; 2013. p. 947.CrossRefGoogle Scholar
  4. 4.
    Conron KJ, Scott G, Stowell GS, Landers SJ. Transgender health in Massachusetts: results from a household probability sample of adults. Am J Public Health. 2012;102(1):118–22.CrossRefGoogle Scholar
  5. 5.
    Winter S, Diamond M, Green J, Karasic D, Reed T, Whittle S, Wylie K. Transgender people: health at the margins of society. Lancet. 2016;388(10042):390–400.CrossRefGoogle Scholar
  6. 6.
    Heylens G, De Cuypere G, Zucker KJ, Schelfaut C, Elaut E, et al. Gender identity disorder in twins: a review of the case report literature. J Sex Med. 2012;9(3):751–7.CrossRefGoogle Scholar
  7. 7.
    Dessens AB, Slijper FM, Drop SL. Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Arch Sex Behav. 2005;34(4):389–97.CrossRefGoogle Scholar
  8. 8.
    Pasterski V, Zucker KJ, Hindmarsh PC, Hughes IA, Acerini C, Spencer D, Neufeld S, Hines M. Increased cross-gender identification independent of gender role behavior in girls with congenital adrenal hyperplasia: results from a standardized assessment of 4- to 11-year-old children. Arch Sex Behav. 2015;44(5):1363–75.CrossRefGoogle Scholar
  9. 9.
    Bermudez de la Vega JA, Fernández-Cancio M, Bernal S, Audí L. Complete androgen insensitivity syndrome associated with male gender identity or female precocious puberty in the same family. Sex Dev. 2015;9(2):75–9.CrossRefGoogle Scholar
  10. 10.
    Brunner F, Fliegner M, Krupp K, Rall K, Brucker S, Richter-Appelt H. Gender role, gender identity and sexual orientation in CAIS (“XY-women”) compared with subfertile and infertile 46,XX women. J Sex Res. 2016;53(1):109–24.CrossRefGoogle Scholar
  11. 11.
    Reiner WG, Gearhart JP. Discordant sexual identity in some genetic males with cloacal exstrophy assigned to female sex at birth. N Engl J Med. 2004;350(4):333–41.CrossRefGoogle Scholar
  12. 12.
    Joel D, Berman Z, Tavor I, Wexler N, Gaber O, et al. Sex beyond the genitalia: the human brain mosaic. Proc Natl Acad Sci U S A. 2015;112(50):15468–73.CrossRefGoogle Scholar
  13. 13.
    Berglund H, Lindström P, Dhejne-Helmy C, Savic I. Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids. Cereb Cortex. 2008;18(8):1900–8.CrossRefGoogle Scholar
  14. 14.
    Burke SM, Cohen-Kettenis PT, Veltman DJ, Klink DT, Bakker J. Hypothalamic response to the chemo-signal androstadienone in gender dysphoric children and adolescents. Front Endocrinol (Lausanne). 2014;5:60.Google Scholar
  15. 15.
    Steensma TD, McGuire JK, Kreukels BP, Beekman AJ, Cohen-Kettenis PT. Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. J Am Acad Child Adolesc Psychiatry. 2013;52(6):582–90.CrossRefGoogle Scholar
  16. 16.
    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 Psychiatry. 2011;16(4):499–516.CrossRefGoogle Scholar
  17. 17.
    Hidalgo MA, Ehrensaft D, Tishelman AC, Clark LF, et al. The gender affirmative model: what we know and what we aim to learn. Hum Dev. 2013;56(5):285–90.CrossRefGoogle Scholar
  18. 18.
    Olson J, Garofalo R. The peripubertal gender-dysphoric child: puberty suppression and treatment paradigms. Pediatr Ann. 2014;43(6):e132–7.CrossRefGoogle Scholar
  19. 19.
    Reisner SL, Vetters R, Leclerc M, Zaslow S, Wolfrum S, Shumer D, Mimiaga MJ. Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. J Adolesc Health. 2015;56(3):274–9.CrossRefGoogle Scholar
  20. 20.
    de Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA. Autism spectrum disorders in gender dysphoric children and adolescents. J Autism Dev Disord. 2010;40(8):930–6.CrossRefGoogle Scholar
  21. 21.
    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.CrossRefGoogle Scholar
  22. 22.
    Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–54.CrossRefGoogle Scholar
  23. 23.
    Cohen-Kettenis PT, Steensma TD, de Vries AL. Treatment of adolescents with gender dysphoria in the Netherlands. Child Adolesc Psychiatr Clin N Am. 2011;20(4):689–700.CrossRefGoogle Scholar
  24. 24.
    de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2011;8(8):2276–83.CrossRefGoogle Scholar
  25. 25.
    de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134(4):696–704.CrossRefGoogle Scholar
  26. 26.
    Olson KR, Durwood L, DeMeules M, McLaughlin KA. Mental health of transgender children who are supported in their identities. Pediatrics. 2016;137(3):e20153223.CrossRefGoogle Scholar
  27. 27.
    Bauer GR, Scheim AI, Pyne J, Travers R, Hammond R. Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health. 2015;15:525.CrossRefGoogle Scholar
  28. 28.
    Travers R, Bauer G, Pyne J, Bradley K, for the Trans PULSE Project, Gale L, Papadimitriou M. Impacts of strong parental support for trans youth: a report prepared for Children’s Aid Society of Toronto and Delisle Youth Services. Trans Pulse. 2012:1–5.Google Scholar
  29. 29.
    Sperling MA. Pediatric endocrinology. Philadelphia: Saunders; 2008.Google Scholar
  30. 30.
    Gilsanz V, Chalfant J, Kalkwarf H, Zemel B, et al. Age at onset of puberty predicts bone mass in young adulthood. J Pediatr. 2011;158(1):100–5, 105 e1–2.CrossRefGoogle Scholar
  31. 31.
    Guaraldi F, Beccuti G, Gori D, Ghizzoni L. Management of Endocrine Disease: long-term outcomes of the treatment of central precocious puberty. Eur J Endocrinol. 2016;174(3):R79–87.CrossRefGoogle Scholar
  32. 32.
    Haraldsen IR, Haug E, Falch J, Egeland T, Opjordsmoen S. Cross-sex pattern of bone mineral density in early onset gender identity disorder. Horm Behav. 2007;52(3):334–43.CrossRefGoogle Scholar
  33. 33.
    Van Caenegem E, Taes Y, Wierckx K, Vandewalle S, et al. Low bone mass is prevalent in male-to-female transsexual persons before the start of cross-sex hormonal therapy and gonadectomy. Bone. 2013;54(1):92–7.CrossRefGoogle Scholar
  34. 34.
    Klink D, Caris M, Heijboer A, van Trotsenburg M, Rotteveel J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab. 2015;100(2):E270–5.CrossRefGoogle Scholar
  35. 35.
    Vlot MC, Klink DT, den Heijer M, Blankenstein MA, Rotteveel J, Heijboer AC. Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents. Bone. 2016;95:11–9.CrossRefGoogle Scholar
  36. 36.
    Long CJ, Ginsberg JP, Kolon TF. Fertility preservation in children and adolescents with cancer. Urology. 2016;91:190–6.CrossRefGoogle Scholar
  37. 37.
    Wallace WH, Kelsey TW, Anderson RA. Fertility preservation in pre-pubertal girls with cancer: the role of ovarian tissue cryopreservation. Fertil Steril. 2016;105(1):6–12.CrossRefGoogle Scholar
  38. 38.
    De Roo C, Tilleman K, T’Sjoen G, De Sutter P. Fertility options in transgender people. Int Rev Psychiatry. 2016;28(1):112–9.CrossRefGoogle Scholar
  39. 39.
    Brännström M, Johannesson L, Bokström H, Kvarnström N, et al. Livebirth after uterus transplantation. Lancet. 2015;385(9968):607–16.CrossRefGoogle Scholar
  40. 40.
    Murphy TF. Assisted gestation and transgender women. Bioethics. 2015;29(6):389–97.CrossRefGoogle Scholar
  41. 41.
    Staphorsius AS, Kreukels BP, Cohen-Kettenis PT, Veltman DJ, et al. Puberty suppression and executive functioning: an fMRI-study in adolescents with gender dysphoria. Psychoneuroendocrinology. 2015;56:90–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Janet Y. Lee
    • 1
  • Liat Perl
    • 2
  • Stephen M. Rosenthal
    • 3
  1. 1.Adult and Pediatric Endocrinology, Internal Medicine and PediatricsUniversity of California, San Francisco, Benioff Children’s HospitalSan FranciscoUSA
  2. 2.Pediatric Endocrinology, PediatricsUniversity of California, San Francisco, Benioff Children’s HospitalSan FranciscoUSA
  3. 3.Pediatric Endocrinology, Pediatrics, Child and Adolescent Gender CenterUniversity of California, San Francisco, Benioff Children’s HospitalSan FranciscoUSA

Personalised recommendations