ESPE Abstracts

Objectives: The aim of this study is to describe the clinical characteristics of Austrian children and adolescents with gender dysphoria seeking gender affirming medical care, as well as their treatment trajectories.

Methods:In this retrospective study at a large university hospital, a chart review of all patients presenting with gender dysphoria at the pediatric outpatient clinic for differences in sex development between 01.01.2008 and 31.12.2022 was conducted.

Results: Of 309 patients, 229 (74,1%) were transmasculine/assigned female at birth (AFAB), and [RS1] 80 (25,9%) were transfeminine/assigned male at birth (AMAB). The number of referrals increased steeply from 2008 to 2018 whereafter it stabilised at around 50 per year. At the time of initial presentation, the median age of patients was 15,8 years (range 7,1 to 18). AMAB individuals tended to be younger, at a median age of 15 years than AFAB individuals, at a median age of 15,9 years. 35,25% had a BMI > 1 SDS above World Health Organization (WHO) norms, while 11,2% were underweight with a BMI < -1 SDS below the norm. 49,8% reported suffering from depressive symptoms and 28,2% were prescribed antidepressants. Gonadotropin-releasing hormone analogs (GnRHa) were prescribed to 166 (53,7%) individuals at a median age of 16,3 years (range 9,7 to 18,2). Gender affirming (sex steroid) hormone therapy (GAH) was established in 163 (53%) of individuals at a median age of 16,78 years (range 13,2 to 18,4). Chest masculinization surgery was performed in 22 cases, and breast augmentation in two cases between the ages of 16 and 18. Of the 42 AMAB individuals receiving GAH, 5 (11,9%) completed fertility preservation prior to GAH start. Only 1 of the 121 transmasculine adolescents receiving GAH completed fertility preservation.

Conclusion: Our adolescent patient collective showed an overall AFAB/AMAB ratio of 3:1, with a trend towards a lower percentage of AMAB individuals in the past six years. Our findings regarding prevalence of psychiatric co-conditions are consistent with literature published so far. 53% of individuals with gender dysphoria received gender affirming hormone therapy. Regarding fertility preservation, we found very low utilisation of treatment options.