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: Purpose: 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. Methods: An in-depth brainstorming on the application of International guidelines in the Italian context was performed by several dedicated professionals. Results: 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. Conclusions: 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. © 2014 Italian Society of Endocrinology (SIE).Journal of endocrinological investigation 07/2014; 37(7):675-687. · 1.55 Impact Factor
Article: Gender Dysphoria and Children.[Show abstract] [Hide abstract]
ABSTRACT: The age at which gender dysphoria can be diagnosed with enough certainty to justify medical intervention is controversial. The aim of this article is to explore current literature as it relates to the gender reassignment process and diagnostic indicators supporting an appropriate age for intervention. The timing of diagnosis and treatment of gender dysphoria remains the center of debate between the long-term effects of early intervention versus delay of treatment. Limited research is available on gender dysphoria treatment protocols for children. However, preliminary studies suggest that early intervention improves the quality of life in individuals who are transgender. Ongoing research suggests that it may be possible to confirm gender dysphoria at an earlier age. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].Journal of Psychosocial Nursing and Mental Health Services 06/2014; · 0.87 Impact Factor
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. · 0.83 Impact Factor