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Treating transsexual kids: wait for, then delay puberty to treat

September 17, 2009 |  1:33 pm

The nation's oldest and largest organization of endocrinologists has recommended that physicians treating children with gender identity disorder intervene to delay puberty at its first signs and wait until a child is at least 16 before offering hormonal therapy that would begin his or her gender transition.

In a new clinical practice guideline unveiled today, the Endocrine Society tackled some of the most ethically sensitive decisions endocrinologists face in the treatment of those who are born of one gender, but identify themselves strongly with the opposite gender. Indeed, the society urges that its physicians rely on a mental health professional to render a diagnosis of transsexualism, which is termed gender identity disorder in the psychiatric profession's current diagnostic manual.

The new practice guidelines also recommend that no action be taken to intervene in the hormonal balance of a young child who identifies as the opposite gender of his or her birth. "A diagnosis of transsexualism in a child who has not gone through puberty cannot be made with certainty," the group concluded. 

At the first signs of puberty, however, the new guidelines recommend that physicians use hormone therapy strictly for the purpose of suppressing pubertal changes until an adolescent has reached the age of 16. At that point, the group concluded, "cross-sex hormones may be given."

Those guidelines come at a time when many of those with "gender dysphoria"--persistent distress over one's gender at birth--are asking to begin gender reassignment hormonal therapy and/or surgery at an earlier and earlier age. While surgeons have been reluctant to do gender reassignment surgery on a patient under 18, endocrinologists often face pressure from would-be transsexuals to offer earlier, interim treatment. The new guidelines are likely to set a standard that many endocrinologists will follow in such cases.

"Transsexual persons experiencing the confusion and stress associated with feeling 'trapped' in the wrong body look to endocrinologists for treatment that can bring relief and resolution to their profound discomfort," said Dr. Wylie Hembree, a Columbia University endocrinologist who chaired the committee drafting the guidelines. The new guidelines, he added in a news release, are intended to provide "science-based recommendations" for practitioners to provide "safe and effective treatment" to those diagnosed with Gender Identity Disorder.

The transgender community has advocated for changes in the psychiatry's approach to the diagnosis of gender identity disorder, which is now being revisited in drafting sessions for the profession's diagnostic manual. Among the transgender community's concerns: that current definitions of Gender Identity Disorder lump the diagnosis under "paraphilias," contribute to stigmatization, and fail to support the goals of gender transition and access to surgical and hormonal therapies in treatment of GID.

The new practice guidelines are published in the September issue of the Endocrine Society's Journal of Clinical Endocrinology & Metabolism. For a somewhat dated discussion of the ethical issues involved, check out this article from Salon. And if you feel you were born into a body of the wrong gender, here's a place to seek help and support.

-- Melissa Healy

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