Young people largely remain committed to endocrine transgender treatment

medwireNews: Most young people treated within a paediatric gender identity development service remain committed to pursuing hormonal treatment in line with their perceived gender, research shows.

“The trajectories identified were predominantly consistent with identifying with a gender other than assigned gender”, write the researchers in the Archives of Disease in Childhood.

They say this indicates that “those pursuing treatment comprise a highly selective group whose identity is consistent with treatment”.

The overall study population comprised 668 young people who were aged between 10.1 and 18.7 years (average 15.4 years) at referral to endocrinology between January 2017 and December 2019.

“These adolescent years have been noted as a particularly difficult time for [young people] owing to advancing pubertal changes, distress over potential romantic relationships and greater shifts in social expectations”, say Una Masic (Tavistock and Portman NHS Foundation Trust, London, UK) and study co-authors.

They also highlight the long wait times for young people to access gender identity development services in the UK, leading to many patients “enduring distress with the advancement of puberty while waiting to access services.”

The young people referred to endocrinology represented 21% of all 3165 who attended their first appointment at the gender identity development service within this time period. They were predominantly assigned female at birth (66%), which the researchers say is in line with studies from other countries.

Looking in detail at the 439 young people referred to endocrinology in 2017–2018, the team found that 431 consented to receive a gonadotropin-releasing hormone analogue (GnRHa), at an average age of 15.8 years, and eight consented to gender-affirming hormones (GAHs) only.

Of the 431 young people who consented to GnRHa, 97 were still accessing this within the paediatric service at the time of analysis, and 183 (42%) had subsequently consented to GAH treatment, at an average age of 17.3 years. The researchers note that the ages at consent reflect the service’s policy of not offering GAH until around the age of 16 years or after approximately 1 year of GnRHa treatment.

A further 121 study participants were referred on to adult gender identity services, and 30 had either stopped GnRHa or did not start on it after consenting. The reasons for this were not known for 13 young people, but five had physical health problems, four had paused to preserve fertility, four had transferred to a private health provider, three felt unsure and one had mental health issues.

All of the 56 young people who started on GAH within the paediatric service commenced and continued the treatment, although the researchers stress the short timeframe for assessing this outcome.

Overall, most of the 2017–2018 cohort either continued treatment within the paediatric service or were referred onwards to the adult service.

“While some may argue that this may reflect an unwillingness to explore gender once GnRHa is accessed, there may be more plausible hypotheses”, say Masic and colleagues.

Noting that all the young people received psychosocial assessment prior to referral and ongoing support during treatment, they suggest the high commitment to treatment “may instead be indicative of this group being a highly selective sample of [young people] whose deeply held sense of gender identity remains consistent”.

By Eleanor McDermid

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Arch Dis Child 2022; doi:10.1136/archdischild-2022-324283
Martin Savage
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