Background: Children and adolescents who have a gender identity that does not correlate with their assigned gender (based upon genital anatomy and chromosomes) are described as Gender-Dysphoric/Gender-Incongruent Persons (GD/gender incongruence) based on the ICD-11 classification of the World Health Organization.
Objective: The case of a young teenager with Gender Dysphoria Disorder.
Case presentation: A boy, aged 13 and 4/12 years, was admitted because of marked discomfort with his primary and secondary sex characteristics and a strong feeling that he belongs to the female gender. The patient used to dress up with female clothes since childhood and he was constantly seeking information on the website about medical and surgical treatments for gender congruent boys. Medical history was remarkable for a long-lasting and intense pattern of gender non-conformity, starting at the age of 68 years. On physical examination, he was in early puberty, as evidenced by pubic hair Tanner II and testicular volume of 4 ml. Initial laboratory examination was compatible with pubertal initiation, while karyotype was 46, XY. He was followed by a pediatric psychiatrist who confirmed that the adolescents gender dysphoria worsened following the onset of puberty and that the adolescents situation and functioning were stable enough to start treatment. His parents were informed of the effects and side effects of treatment and they gave informed consent to start treatment with GnRH analogues in order to suppress pubertal hormones and he gave assent.
Results: The patient today is 14 and 9/12 years old. He is regularly monitored by both specialists, Pediatric Psychiatrist and Endocrinologist and he continues therapy with GnRH analogues, in order to have time to confirm the persistence of gender dysphoria and for the adolescent to have adequate mental capacity to give informed consent for treatment with estrogens. His feelings have not changed, he has persistent gender dysphoria and he persistently demands initiation of subsequent sex hormone treatment, being quite angry and emotional dealing with the delay of treatment that the medical team had advised.
Conclusion: Children and adolescents with gender identity disorders should be treated only by trained group of physicians, mental health and endocrinology professionals, who meet the criteria according to International Guidelines, in order to help them make a thorough and informed decision about permanent physical changes.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology