Transgender youth treatment options

A Look at What’s Available for the Young

The medical treatment options for transgender youth include both psychological and social therapies, in addition to measures taken to better align an individual’s physical exterior with their gender identity.

And, while countless individuals from varying age groups have benefited from gender-affirming medical treatments, it is important to note that the umbrella-term transgender encompasses an array of gender identities; including but not limited to transexual, genderqueer, gender-variant, gender-expressive, and gender-expansive.

In 1979, the World Professional Association for Transgender Health (WPATH) published one of the earliest sets of clinical guidelines, “The Standards of Care for the Health of Transexual, Transgender, and Gender Nonconforming People” (WPATH-SOC), which provide clinical guidance outlining the recommended medical protocol intended to meet the healthcare needs of transexual, transgender, and gender non-conforming individuals.

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WPATH said they drafted these guidelines to “ensure lasting personal comfort with the gendered self in order to maximize the overall psychological well-being and self-fulfillment” of the transgender population. As the medical discipline that is transgender care advances, WPATH-SOC is periodically updated and revised.

In his article, “Gender Affirming Medical Care of Transgender Youth,” Stephen M. Rosenthal, M.D. said there has been a rising number of transgender and gender non-conforming youth seeking medical treatments in both the U.S., as well as other countries.

“The prevalence of transgender youth is not known,” said Rosenthal. “However, multidisciplinary clinics for transgender youth and adolescents in Europe and North America and some parts of Asia have seen a steadily increasing demand for services in recent years,” he added.

Stemming from the influx of transgender youth seeking medical treatments, suggested medical-treatment protocol for transgender youth has become an ever-growing area of study. With a number of medical providers who specialize in this type of care conducting case studies and chronicling their research through the publication of medical journals, as well as various LGBTQ advocacy groups publishing literature on the subject. It provides a broader and more in-depth understanding of how to provide better, more informed care to transgender youth.

Social transitioning, the primary treatment commonly recommended for prepubescent youth, is a type of affirmative-care intervention for transgender youth that encourages them to present themselves in a way that feels most genuine to them. It may also include the use of a different name or pronouns aligned with their gender identity.

“Allow transgender youth to express their gender identity through their chosen attire, hairstyles, names, mannerisms and other physical presentations without punishment or ridicule,” said LGBTQ American civil rights organization Lambda Legal in their guide, “Working With Transgender Youth.” “Don’t assume that transgender youth are acting out when they express their gender identity. The clothing and personal style that an individual chooses are important aspects of self-expression. Support transgender youth in these choices and challenge restrictive policies that may not allow such freedom.”

As transgender youth approach puberty, they begin developing more pronounced features of a gender that feels foreign to them. This often results in the onset of a condition known as gender dysphoria, involving a conflict between an individual’s assigned gender-at-birth with the gender with which they identify with. This disorder typically leads to the development of a host of mental health issues that can potentially become life-threatening if not addressed. And while transgender youth may experience gender dysphoria prior to becoming pubescent, the symptoms tend to become much worse as an individual enters this stage of physical development.

In her article, “The Impact of Early Medical Treatment for Transgender Youth: Protocol for the Longitudinal, Observational Trans Youth Care Study,” Johanna Olson-Kennedy, M.D. said the medical guidelines for transgender youth most commonly used today are aimed at treating the symptoms associated with gender dysphoria.

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“Pharmacologic treatment recommendations vary depending on the age and developmental stage of youth with gender dysphoria,” said Olson-Kennedy. “For youth in the earliest stages of pubertal development, treatment with gonadotropin-releasing hormone agonist (a type of hormone blocker) is recommended to suppress endogenous puberty and avoid the development of undesired sex characteristics,” she added.

“Pubertal suppression, commonly known as puberty blockers, is used to delay the onset of puberty, and hormone therapy is used to promote gender-affirming physical changes,” The Trevor Project says.

Rosenthal said he credits the Dutch for the development of puberty blockers.

“The Dutch pioneered the use of what we call pubertal blockers, hormones that selectively, temporarily and reversibly turn off the hormones in the pituitary gland, whose role is to turn on the ovaries and testicles,” Rosenthal said. “Once these are secreting testosterone and estrogen, that’s what leads to all the physical changes,” he added.

The American Psychiatric Association says many transgender people who take feminizing or masculinizing hormones report improvement of emotions as their gender dysphoria lessens or resolves.

“Some adolescents seek help for further gender identity exploration, while others have an already established desire for physical-sex characteristics of the experienced gender,” said Anna van der Miesen, M.D. in her article, “Special Issues in Treating Adolescents With Gender Dysphoria.”

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