Background: Paediatric transgender individuals are reported, as adults, to be disproportionately affected by barriers to care, mental health problems, suicide, violence, discrimination, poverty, and HIV compared to the general population possibly due to stigma and discrimination (1). Knowing the denominator of people at risk is necessary for assessing the incidence of diseases, setting medical priorities and goals, and advocating for care programs (1).
Objective: The purpose of this survey is to underline the importance of transgender medicine as a part of paediatric endocrinology.
Materials and Methods: We studied a cohort of 35 paediatric transgender individuals since the opening of our centre in 2014 until 2018.
Results: A total of 35 trans-children and trans-adolescents from 6.9 up to 19 years of age were enrolled in the survey, all recruited at our centre by referral from sexologists, paediatricians and self-referral (Figure 1). 34% of the paediatric transgender patients aged 19.8±2.9 years (SD) were male-to-female (MtF) and 66% female-to-male (FtM) gender dysphoric. 46% of all patients were started on cross-sex hormonal treatment (CHT) within one to three years after initial presentation, 8% in the MtF group and 65% in the FtM group, respectively. Patients not yet started on CHT are intended to do so after indications are fulfilled according to treatment guidelines (2). Hormonal treatment in the MtF group consisted of estradiol and cyproterone acetate (CPA) and in the FtM group of testosterone undecanoate and Leuprorelin (3). In one patient gender-confirming surgery was performed at the age of 20.9 years.
Discussion: The total number of transgender patients in our center equals to 517, 481 adult individuals older than 21 years and 35 patients up to 21 years of age. When relating these numbers to a recent epidemiologic publication from San Francisco (4), we detected less than roughly ¼ of these patients in the city of Hamburg. The difference can partly be explained by additional centers in our metropolitan region. We started cross-sex hormonal treatment as early as possible according to treatment guidelines and national legislation.
Conclusion: Diagnostics, treatment and professional attendance of paediatric patients with gender dysphoria should be in the hands of an experienced team consisting of paediatric endocrinologists, psychologists, psychiatrists, gynaecologists, urologists and paediatric surgeons. Transgender individuals should undergo the transition from adolescence to adulthood best when paediatric endocrinologists are having consultations together with adult endocrinologists.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology