ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: J Sex Med. 2020, Apr; 17: 570–84. doi: https://www.ncbi.nlm.nih.gov/pubmed/32111534

This position statement provides an update for health-care professionals on recommended basic principles for care of transgender people, including male, female and nonbinary. It uses a developmental approach to describe the best care for prepubescent, pubescent and adolescent gender diverse people and emphasizes the importance of expertise of health-care providers, especially also in gender-affirming psychological aspects.

The recommendations are from a task force of the European Society for Sexual Medicine based on current available literature (including latest guidelines) and experience. They add important aspects to current guidelines in the prospect of an upcoming change in the diagnostic classification system that most European services will adapt. In this new ICD-11 classification, the diagnosis “gender incongruence” (GIC) has been moved out of the mental health chapter to depathologize transgender people. A total of 32 statements summarize and provide evidence for: general aspects, the assessment of gender diverse children, adolescents and adults, hormone therapies and aspects of sexual functioning and satisfaction in relation to surgical treatment.

For many topics, evidence is limited, and more studies are necessary, especially regarding long-term follow-up. Important statements related to healthcare of gender incongruent children and adolescents include the following: Overall 20–36% of transgender people identify beyond a binary gender. In prepubescent children, in contrast to adolescents and adults, gender incongruence may remit before puberty, but all age groups have much higher frequencies of emotional and behavioral problems than the general population, highlighting the need for mental health support. In children, support from the social network is essential, and this includes parents, school representatives and peers. Hormonal therapies should be clinically and biochemically monitored in an individual developmental context. It is key to inform transgender persons comprehensively about effects, side effects and possible adverse short-term and long-term outcomes for any type of offered hormonal or surgical treatment.