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(141) The Role of C-L Psychiatry in Puberty Suppression Treatment of Transgender Youth


Authors:

Michael T. Ingram, Jr., MD – C-L Fellow, University of California, Los Angeles

Jose Aguilar, Jr, MD – Assistant Clinical Professor, University of California, Riverside School of Medicine


Co-Authors:

Presenting Author: Michael Ingram, Jr., MD, University of California, Los Angeles
Co-Author: Jose Aguilar, Jr, MD, University of California, Riverside School of Medicine

Abstract:

Background: An increasing number of transgender children and adolescents are seeking gender-affirming medical interventions in recent years. One treatment option involves the use of Gonadotropin-releasing hormone (GnRH) agonists to reversibly inhibit puberty and allow transgender adolescents to experience puberty as their identified gender with cross sex hormone therapy (CSHT). Effective treatment requires a multidisciplinary team to address the unique medical and physical health needs of this marginalized population. Unfortunately, many psychiatrists are inexperienced or uncomfortable managing transgender patients and some outright refuse treatment. The increasing prevalence of depression, anxiety, trauma, self-harm, suicide, and substance use disorders in transgender youth highlights an emerging role for C-L Psychiatry in advocating for this underserved population.


Methods:
We searched PubMed and PsychINFO databases for citations in English reviewing the most updated guidelines for treating transgender youth. We then searched the same databases for studies reporting on psychological outcomes of puberty-suppression treatment. In addition, we consulted experts at a major academic medical center with a dedicated transgender youth clinic for guidance on developing a collaborative care model that can be implemented at any hospital or clinic setting.


Results:
The World Professional Association for Transgender Health (WPATH) and Endocrinology Society (ES) guidelines on treating transgender people are the most internationally recognized guidelines. Both guidelines recommend a mental health evaluation prior to initiating puberty suppression treatment at Tanner stage 2. Puberty suppression should continue until age sixteen when adolescents are eligible for CSHT (WPATH SOC, 2012). Only four published cohort studies were found addressing the psychological outcomes of puberty suppression treatment, but each study showed significant improvements in general functioning, decreased behavioral and emotional problems, and alleviation of depressive symptoms after puberty suppression treatment.


Discussion:
The dearth of evidence informing current guidelines on the treatment of transgender youth underscores the need for further research. Nevertheless, preliminary studies on psychological outcomes are showing promising results. As more children and adolescents seek gender affirming medical and psychological care it will be imperative for physicians from all specialties to collaborate, advocate, and become educated on current issues in Transgender health care delivery. C-L psychiatrists are in a unique position to help manage and advocate for the complex medical and psychological needs of this diverse population.

References:




  1. 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 Oct;134(4):696-704.

  2. Costa R, Dunsford M, Skagerberg E, Holt V, Carmichael P, Colizzi M. Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria. J Sex Med. 2015 Nov;12(11):2206-14. doi: 10.1111/jsm.13034


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