ESPE Abstracts

Background: Lately, pediatric gender services have been confronted with a steep and unexplained increase of transgender and gender diverse (TGD) youngsters seeking psychological support and eventually medical care. We report on the evolution of referrals to our clinic for first psychological assessment and the rates of medical transition.

Methods: The whole cohort of youngsters undergoing a first psychological intake between 2007 and 2023 was included. Subgroups were analyzed based on sex at birth, year of intake, age at first intake (below or above 10).

Results: During 2007-2023, 890 youngsters (65.5% RFAB) accessed our services. The ratio RFAB/RMAB (registered female/male at birth) increased across the years, with RFAB aged>10 at first intake being the greatest proportion. The time between psychological intake and start of PS/GAH has progressively decreased. The median age at start of PS is 12 for RFAB and 14 for RMAB starting GnRHa, and 16.4 and 16.7 respectively when progestins or cyproterone acetate (CPA) are started instead of GnRHa. For both RFAB and RMAB, median age at start of GAH is 17.1. 28.1% of RFAB and 47.2% of RMAB did not start any medical treatment. Of the 67% RFAB and the 52.8% RMAB starting puberty suppression, 74.6% RFAB and 86.4% RMAB started GAH. To date, 91.6% RFAB and 90.7% RMAB are still using GAH; 5.3% RFAB and 9.3% RMAB are lost at follow-up in our clinic. Of all RFAB who started GAH and over 18 years, 97.8% underwent mastectomy, 54.6% hysterectomy, 19.3% phalloplasty, 7.4% metaoidioplasty, 8.2% testicular prostheses, and 5.9% penile implant. Of all RMAB on GAH and over 18 years, 59.5% underwent vaginoplasty, 6.6% orchidectomy without vaginal reconstruction, 35.5% breast prosthesis implantation, 3.3% facial feminizing surgery, 2.5% Adam’s apple surgery, 8.3% voice feminizing surgery. Unfortunately, 5 RFAB committed suicide, while under medical transition. Two RMAB and three RFAB did not initiate any medical step and reverted their social transition. Two RMAB stopped the transition after starting CPA. One RFAB underwent full medical transition, mastectomy and hysterectomy without gonadectomy before stopping GAH because of a non-binary identity, without any regret for the undertaken steps. One RFAB decided to stop GAH, after mastectomy and hysteron-ovariectomy also occurred and is now assuming synthetic estrogens.

Conclusion: In last years referrals have increased, mainly for RFAB older than 10. Most of referred RFAB started and still continue medical transition, while 47% RMAB did not initiate any medical step.