Objectives: To describe the patients with gender non-conforming referred to a pediatric medical center after creation of the multidisciplinary team "APEVAGE" (Ambulatorio Pediatrico per la Varianza di Genere, Pediatric Clinic for Gender Variance) composed by pediatric endocrinologist, psychologist and child psychiatrist at Institute for Maternal and Child Health "Burlo Garofolo" in Trieste. It is one of the 8 centers recognized by ONIG (Osservatorio Nazionale sull'Identità di Genere, National Observatory on Gender Identity) and the only one in the North-East of Italy (1,882,988 inhabitants <18 years of age over a total of 11,640,852 inhabitants).
Methods: Data gathered on 15 consecutive patients <18 years, with initial visits between April 2015 and March 2019, who were referred to APEVAGE for gender nonconformity. Main descriptive measures included gender, age, source of referral, final diagnosis (if available).
Results: Fifteen patients have been evaluated so far. The clinic started in 2015 with the first patient. There was an increase in the following years: in 2016 2 patients, in 2017 4 patients, in 2018 6 patients and 2 patients in the first 3 months of 2019.
Genotypic male:female ratio was 6:9 (2:3). Age of presentation was 10.6 years [10.1-15.5] (median [IQR]) which was higher for female (15.2 [10.4-15.9] vs 10.5 [7.4-10.5], P=0.05). Seven patients (46%) were referred by primary care pediatricians, 4 by psychologist or child psychiatrist (27%), 3 by hospital pediatrician (20%) and 1 by parents self-referral (7%). In 2 patients (median age 14.9 years) a diagnosis of gender dysphoria have been established, but no medical treatments have been started so far (in one case due to disagreement between parents, in one case pending approval); 7 patients were identified as gender variant (median age 8.0 years) and did not require further evaluations; 2 patients had a disorder of sex development (Frasier syndrome and 5-alpha-reductase deficiency); 4 patients are currently under evaluation.
Conclusions: After establishment of a multidisciplinary gender clinic, there was a six-fold increase in referred patients, although the prevalence of children and adolescent referred is still very low (0.79/100.000 minors). Girls are more frequently referred than boys, with a higher age at referral. The majority of patients had been referred by primary care pediatricians. No patients were treated with pubertal suppressive therapy (due to a too advanced pubertal development),nor cross-sex hormone therapy. A greater awareness is needed in this region of Italy.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology