ESPE Yearbook of Paediatric Endocrinology

Eur J Endocrinol. 2018 Oct 12;179(5):R219–R237.

doi: 10.1530/EJE-18-0227. PubMed ID: 30049812

The rapidly increasing number of adolescents with gender dysphoria represents a challenge for psychiatric assessments and the endocrine management of those who are considered to warrant gender change. The diagnostics are more than complicated and the clinical management from the endocrine viewpoint is still a developing field. This review covers both of these issues and gives a broad update of the current situation.

The importance of correct rather than fast diagnosis is emphasized, especially for prepubertal children due to the high rate of desistance (in up to 80% of cases), coupled with our current inability to predict with any certainty those who will persist or desist. Currently, GnRH analog therapy is often started at Tanner stage 2 (B2 or G2), and gender affirming treatment from 16 years or older. The authors warn that, even when started at this stage or later, up to 4% of those who start GnRHa therapy will desist. The ethical dilemma of deciding the age at which the child/adolescent is mature enough to take decisions on own treatment is discussed.

Different effects of treatment options regarding efficacy and some aspects of side effects are described. Cancer and fertility issues are mentioned. The authors advocate regular 3–6 monthly follow-up with measurements of height, weight, sitting height, blood pressure and pubertal development.

In conclusion, firm evidence for many of the recommendations are lacking and there is much need for further research regarding the diagnostics and the right timing for hormonal treatment or surgery, but also concerning the effects and long-term consequences of treatments. The authors call for future studies, and that all teams caring for individuals with gender dysphoria should participate in follow-up studies.