ESPE Abstracts

Background: Gender incongruence (GI) is a topic of interest with major impacts on both the individual and society. In recent years, the small group of gender non-conforming children with an early GI history that persists through adolescence has been accompanied by a substantial rise in the proportion of adolescents reporting their gender doubts. The onset of gender dysphoria in this group is rapid. In the Czech Republic, multidisciplinary teams strive for high quality individual care to minimize overdiagnosis and the risk of detransitioning.

Methods: A systematic data review of four paediatric endocrinology centres within the years 2011 to 2021 was performed. We evaluated data including sex assigned at birth, age of onset of GI symptoms, mental health specialist care (MHS), endocrinology care, age of initiation of GnRH analogue and cross-hormonal therapy, the number of individuals with early termination or cessation of treatment, detransitioning and reasonings behind that.

Results: A total of 56, 132 and 484 individuals (2.4; 8.6-fold increase) younger the 18 years with gender dysphoria in 2011, 2016 and 2020 respectively received MHS care. During this period, the proportion of gender incongruent biological girls rose from 62.5 to 79.3 %. In 2011, 2016 and 2020, one, five and 39 (1.7; 3.7; 8 %) adolescents with GI respectively, underwent treatment at paediatric endocrinology outpatient clinics. Summing up to 133 adolescents within 10 years, 111 biological girls and 22 biological boys reported their first symptoms at median age (range) of 10.3 (3 - 14.5) years. MHS referred them for endocrinological care at 15 (11-18) years, i.e. 0.5 to 1.5 years after being diagnosed with GI. When used, GnRH analogue treatment was started at a mean of 14.5 (12-18) years, and cross hormonal therapy at 15.8 (14-18) years. Over the ten-years of follow-up, the drop out rate in our group was 3.7 % (5 biological girls with a complicated psychological history) and 1.5 % (2 biological girls) decided to detransition at the age of 19.5 years.

Conclusions: The growing incidence of gender dysphoria in adolescence and the larger proportion of GI biological girls in the Czech Republic conform with international trends. The age of Czech GI individuals at which MHS and endocrine care were initiated have been stable over the ten-year period. Based on our growing experience in this field, tailor-made individual care is crucial to reduce dropout rate and prevent the need to detransition.