Pediatric Endocrine Group
Pubertal blockade can safely be initiated in pediatric patients who
experience gender identity disorder, according to researchers at the Canadian
Pediatric Endocrine Group 2012 Meeting. With exposure to hormones such as
estrogen or testosterone later in their adolescence, these patients will
experience normal metabolic processes.
“If kids are persisting at
puberty [about the need to be the other gender], they will
almost always persist,” said Daniel Metzger, MD, FRCPC, a pediatric
endocrinologist at BC Children’s Hospital in Vancouver, British Columbia,
Canada, and a clinical professor, division of endocrinology in the department
of pediatrics, University of British Columbia in Vancouver.
Metzger spoke about the endocrine management of transgender youth and
said pediatric patients who experience gender identity disorder require
watchful management to reduce the risks for suicidality, depression, drug use
and eating disorders, which are often secondary to gender identity disorder.
“These issues are frequently dealt with if patients can get on the
road to transition,” Metzger said, noting that parental support is key in
making the transition smooth.
Patients will undergo counseling and therapy if they express a desire to
transition from male to female or female to male to ensure they are serious
about their desire, he said.
“The effect of the puberty-blocking drugs is reversible,”
Metzger said. “If they change their mind, they would come off the
(puberty-blocking) drugs and enter puberty.”
Although pubertal blockade, such as gonadotropin-releasing hormone
agonists, puts bone and mineral status on hold, youths can resume the process
once they are exposed to estrogen or testosterone, Metzger said.
In response to Metzger’s presentation, Norman Spack, MD, an
associate in endocrinology and co-director of the Gender Management Service
Clinic at Children’s Hospital Boston, said not treating youths with gender
identity disorder is beginning to be thought of as disregard for the
Hippocratic Oath. Spack co-wrote guidelines on treating gender identity
disorder published by the Endocrine Society in 2009.
“[These patients] often harm themselves if they are not treated
because they are clearly in the wrong body,” Spack said. “The younger
generation (of endocrinologists) who have grown up with gender-variant people
is seeing this as a disregard for a human right.”
In addition, pediatric patients are continually being psychologically
tested to affirm their choice because the administration of sex steroids will
not produce effects that can be reversed, Spack said.
“It is not reversible when you do a hormonal flip and give boys
estrogen and girls
testosterone,” he said. “The Dutch experience has
demonstrated that pubertal blockade does not preclude the ability of youths to
have normal bone density.”
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Disclosure: Drs. Metzger and Spack report no relevant financial