Caring for Gender Variant youngsters.
Medical care for gender variant young people: Dealing with the practical problems.
Article published in Sexologies Volume 17, Issue 4, October–December 2008, Pages 258–264.
GIRES takes a keen interest in the medical care offered to gender variant young people. Adult transsexual people often express the wish that they had received treatment at this stage of their lives. However, the treatment offered to young trans people in the UK diverges markedly from that offered in some other countries.
Hospitalisation
When admited to hospital gender variant children and young people should be accorded the same respect for their self-defined gender as are trans adults, regardless of their genital sex. Advice on legal and practical aspects can be found here.
Consent FormsConsent forms for download intended to protect both service users and clinicians by ensuring that proper information has been given and fully understood before embarking on treatment. The forms relevant to hormone treatment may be provided at the first appointment, so that service users have the opportunity to take the forms away and consider any gaps in their knowledge while waiting for basic blood tests to be done. Although hormone treatment will almost always follow, this should not be presumed to be an automatic process since tests may reveal serious contra-indications.
At present, there is only one centre that provides treatment for gender variant young people – the Gender Identity Development Service at the Tavistock & Portman NHS Foundation Trust in London. The contrast between the treatment provided by this service and that offered in overseas centres was highlighted by two conferences in London in the Autumn of 2008 at Imperial College and the Royal Society of Medicine (RSM).
The British Society for Paediatric Endocrinology and Diabetes (BSPED) has published its amended statement on caring for children and adolescents with gender identity disorder. It permits flexibility and deviation from “current practice”, without defining what that is. Nonetheless, the statement opens the way for adolescents who experience profound and persistent gender dysphoria to be offered early suspension of puberty. The statement can be found here
Professor Louis Gooren and Professor Peggy Cohen-Kettenis spoke on 17 March 2010 at the British Endocrine Society conference in Manchester. They described the Dutch approach to treating adolescents who experience profound and persistent gender dysphoria and the factual reasoning upon which it is based. There were worthwhile questions from the audience but nobody opposed what the Dutch are offering. Professor Mike Besser in fact supported it.
Professor Ieuan Hughes described pubertal development and the disadvantageous and largely irreversible physical changes that these adolescents would experience without GnRH analogues. He described the variability of this development between individual cases but showed that, in general, the onset of puberty is probably now occurring earlier, especially in girls. He chaired the committee that previously prepared new British guidelines that now are essentially consistent with those published by the Endocrine Society and the World Professional Association for Transgender Health. No date has yet been announced for changing British practice in accordance with the foregoing guidelines.
Dr Leighton Seal described his approach to treating adult transsexual people at the Charing Cross Gender Identity Clinic.
Latest news (May 2010) from the clinicians who provide medical care for youngsters experiencing gender dysphoria at the Gender Identity Development Service (GIDS), in London, which is part of The Tavistock and Portman NHS Foundation Trust. They are now finalizing their research submission to commence a closely monitored programme of suspending the puberty of carefully screened adolescents, in whom the gender dysphoria is profound and highly likely to persist. This is subject to the approval of their research and ethics committees. However, this should not cause delay because these committees meet frequently. Polly Carmichael, who heads the London service is keen to get started.
Importantly it will be possible for the youngsters whose families have taken them to the USA for treatment to enter the GIDS programme as a separately monitored group.
UK Case Studies
- A mother and father's experience with a twelve-year-old gender variant child
- Letters from a 16½ year old trans girl to her two clinicians
Overseas treatment
A number of overseas treatment centres follow the standards of care published by the Harry Benjaman International Gender Dysphoria Association (HBIGDA) (subsequently renamed as the World Professional Association for Transgender Health (WPATH)).
An explicit comparison of the the approachs taken in Britain and the Netherlands can be found here.
Funding provided by the Nuffield Foundation and other charitable donors has enabled GIRES to undertake a highly important project. Its purpose is to improve the treatment offered, in the UK and other countries, to adolescents who experience profound and persistent discomfort with the gender role assigned at birth because it clashes with their innate gender identities. The final report may be found here.
Consensus Report on Symposium in May 2005
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