ESPE Abstracts

Gender dysphoria indicates a psychological distress due to any incongruence between biological sex and gender identity, while transgender identity refers to an individual, whose gender identity is the opposite of the biological sex. The number of gender dysphoric youth seeking hormonal care seems to rise worldwide. Therefore, numerous bioethical and medical controversies are raising about possible side effects of hormonal therapies, including interference with brain development, growth, fertility and bone health. In this retrospective observational study, we collected data between January 2012 and September 2021 of the gender dysphoric children and adolescent referred to our tertiary care center at the University Children’s Hospital Bern, Switzerland. The aims of the study were to assess the number of the referred subjects, describing the persons’ characteristics, the hormonal treatments and their effects. Over the past 9 years, 57 subjects with gender dysphoria were referred to our center. Of these, 45 had a diagnosis of transgender, and among these 28 received a hormonal therapy in-house. Over all, we found a significant increase in the number of referred subjects (P=0.001), aligned with the literature’s results. However, for subjects with a confirmed diagnosis of transgender this increase was less significant (P=0.05), and the number of hormonally-treated transgenders did not rise significantly (P=0.15). The age at referral was mostly over 10 years and after puberty onset, however, 7 of the 57 children were referred earlier. Co-existing psychiatric comorbidities were diagnosed in 42% of the subjects. Among the 28 in-house hormonally-treated transgenders, the median age at start of pubertal suppression therapy step 1 was 15.0 years (range 10.3-17.2y) and of the gender-affirming therapy (n = 18) was 16.4 years (range 14-17.6y). In our cohort, height, weight and BMI were within normal ranges for biological sex, with no significant changes after the hormonal therapies. There were two regrets after short course of step 1 therapy; none of them reported irreversible physical changed. Data about bone health and fertility preservation were scarce, with bone densitometry performed in only 15 individuals. However, there were no reported pathological fractures and no major side effects of the hormonal therapies. Four adolescents opted for an additional surgical therapy immediately after transitioning to adult care. Longitudinal studies are still needed to investigate the possible long-term side effects of the hormonal therapies in transgender individuals in order to provide safe and standardized treatment.