Psychological evaluation and medical treatment of transgender youth in an interdisciplinary "Gender Management Service" (GeMS) in a major pediatric center.
ABSTRACT In 2007, an interdisciplinary clinic for children and adolescents with disorders of sex development (DSD) or gender identity disorder (GID) opened in a major pediatric center. Psychometric evaluation and endocrine treatment via pubertal suppressive therapy and administration of cross-sex steroid hormones was offered to carefully selected patients according to effective protocols used in Holland. Hembree et al.'s (2009) Guidelines for Endocrine Treatment of Transsexual Persons published by the Endocrine Society endorsed these methods. A description of the clinic's protocol and general patient demographics are provided, along with treatment philosophy and goals.
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ABSTRACT: There is currently no consensus over how best to approach work with gender-nonconforming children and their families. We turn to attachment theory to develop a framework for assessing the impact of two different approaches, suggesting that new understandings of links between shame, shame proneness, depression, and identity might provide key questions to consider in developing services for these children. We outline arguments from both sides of the debate, highlighting the work of 2 leading clinicians. We suggest that supportive approaches are more consistent with an attachment-based framework while approaches aimed at correcting gender-nonconforming behavior risk increasing attachment dysfunction.International Journal of Transgenderism 07/2013; 14(3):113-126. DOI:10.1080/15532739.2013.824845
Article: Sexual Minority Youth[Show abstract] [Hide abstract]
ABSTRACT: This article provides an overview of the medical and mental health needs of the lesbian, gay, bisexual, and transgender (LGBT) youth population. Information is reviewed regarding both primary medical care and the special health risks that these youth face. Providers are introduced to the concept that societal and internalized homophobia lead directly to certain health disparities, including substance use, school and family rejection, depression, and increased sexually transmitted infection acquisition. This article familiarizes the primary care practitioner with the health care needs of the LGBT population and the research behind the various recommendations for caring for these youth.Primary Care Clinics in Office Practice 09/2014; 41(3):651–669. DOI:10.1016/j.pop.2014.05.012 · 0.83 Impact Factor
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ABSTRACT: Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exist to compare the mental health of transgender adolescents and emerging adults to cisgender youth accessing community-based clinical services; the present study aimed to fill this gap. A retrospective cohort study of electronic health record data from 180 transgender patients aged 12-29 years seen between 2002 and 2011 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM with MTF youth on mental health outcomes. The sample (N = 360) had a mean age of 19.6 years (standard deviation, 3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared with cisgender matched controls, transgender youth had a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p < .05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use. Transgender youth were found to have a disparity in negative mental health outcomes compared with cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.Journal of Adolescent Health 01/2015; 56(3). DOI:10.1016/j.jadohealth.2014.10.264 · 2.75 Impact Factor