ESPE Abstracts

In many parts of the world, increasing numbers of transgender/gender diverse (TGD) youth are seeking medical care to bring their physical sex characteristics into alignment with their gender identity—their inner sense of self as male, female, or somewhere on the gender spectrum. Compelling studies in the last decade have produced evidence supporting the concept that gender identity is not simply a psychosocial construct but likely reflects a complex interplay of biological, environmental, and cultural factors. In addition, while there are uncertainties in the care of TGD youth and a need for long-term safety and efficacy research, several studies have demonstrated the clear mental health benefits of gender-affirming medical care (including pubertal blockers and gender-affirming sex hormones) first pioneered by the Dutch, which have informed the current Endocrine Society’s Clinical Practice Guideline (CPG) for Gender-Dysphoric/Gender-Incongruent Persons, cosponsored by ESPE and numerous other professional associations. Despite the above-noted advances in the care of TGD youth, significant barriers have recently emerged that would greatly restrict access to gender-affirming medical care. In the United Kingdom a high court has issued a ruling that would prevent youth under the age of 16 from receiving pubertal blockers without a court order. In the United States, pending legislation in several states would prohibit gender-affirming medical care to those under 18 years of age and would criminalize providers who follow the currently existing Endocrine Society’s Clinical Practice Guidelines. This presentation will review advances in our understanding of the prevalence of TGD youth, the mental health impact of gender-affirming medical care, potential adverse effects of such care, gaps in knowledge, priorities for research, and an overview of ethical dilemmas and barriers to care.