In 2009, the National Health Service of the Basque Country created a Gender Identity Reference Unit (GIU-BC) to cover the health needs of the transsexual population with a multidisciplinary assessment: Psychiatry, psychology, endocrinology, plastic and reconstructive surgery. Pediatric endocrinologists and pediatric psychiatry were included in 2013.
Aim: To know the activity of Pediatric Endocrinology in the GIU-BC since 2013.
Patients and Methods: A retrospective/descriptive study was conducted to evaluate the endocrinological assistance offered to young patients with gender dysphoria/transsexuality in the GIU-BC. Epidemiological and clinical variables were studied. The GIU-BC follows the health care approach recommended by the Endocrine Society 2017(1) and the Working Group of the Basque Government 2016(2). Transgender adolescents were treated with pubertal suppression (using gonadotropin-releasing hormone analogues) in stage 2 of Tanner, if possible, followed by the use of cross-sex hormones (estrogen or testosterone) at the age of 14-16 years. Monthly meetings scheduled to discuss the suitability of the physical and emotional situation of each patient before starting hormonal therapies.
Results: 60 children and adolescents with gender dysphoria or transsexuality were evaluated (55% assigned female sex) with an average age of 11.3±3 years (range 4-15). Pubertal development: 35% prepubertal, 18% Tanner II-III and 47% Tanner IV-V. The number of patients/year over time was: period 2013-2016: 10// 2017: 13// 2018: 37. The 77.3% of the children/adolescents made the social transition before attending the GIU. 6.7% did not continue the follow-up in the unit.
Subgroup of minor transsexuals (n = 53): 57% assigned female sex, average age at first visit 11.2±3 (range 4-15) and distribution of pubertal development: 36% prepubertal, 19% Tanner II-III and 45% Tanner IV-V. Average age in the social transition was 11±3 years (range 4-15). 83% made the social transition before attending the GIU. 51% received analogues of the gonadotropin-releasing hormone that began at 13.7±2.1 years (range 9-16). 21% were on cross-hormone therapy initiated at 15.6±2.1 years (range 14-16). The transsexual girls visited the GIU and made the social transition before the boys [visit by age: 10.1 ± 3.7 vs. 12.5 ± 2.5, P=0.03; Age transition: 9.8±3.6 vs. 12.1±2.8, P=0.01; Mann-Whitney test]
Conclusions: Assistance to transsexual adolescents is progressively increasing. Most of the children/adolescents made the social transition before attending the GIU. The transsexual girls consult and make the social transition earlier than boys. The percentage of children who have left the GIU is low.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology