Delaying puberty can give transgenders time to decide about gender identity

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Complications from transgender procedures may be significantly minimized when treatment of a patient with severe gender identity disorder begins prior to puberty, according to expert opinion today at the American Association of Clinical Endocrinologists (AACE) 19th Annual Meeting & Clinical Congress.     

The reason, according to Dr. Norman Spack of Children's Hospital Boston, is that transgender people treated at a younger age often have a much easier time adjusting into society than those who undergo treatment later in life.  A pediatric endocrinologist can administer treatment to delay puberty, giving the patient the time to make a permanent decision later in their teens.    

"The body is in a state of 'pubertal limbo' while the patient undergoes psychological assessment to determine the best course of action," Dr. Spack said.  "Their bodies can't run away from them."

During this window of opportunity patients are subject to psychological evaluation.  With puberty delayed, the patient's medical team has the appropriate amount of time to make the proper diagnosis of the patient.  

"We are no longer rushing to beat the patient's biological clock," Dr. Spack said.  "With time to make the right diagnosis, it's best for the patient."

Dr. Spack, who is an advocate for patients with gender identity disorders, said that he had his own misgivings about this controversial work, but all concerns went away when he saw the devastation extreme gender identity disorder caused in the adult world compared with the successes of treating adolescents in the Netherlands.  He currently treats more than 100 patients at Children's Hospital Boston.

"We are beginning to see great success," Dr. Spack said. "Patients aren't trying to commit suicide, they're bullied less at school, relationships are better, and mammoplastic surgery may not be necessary."  

Despite this, Dr. Spack acknowledged major barriers for treatment still exist.  Few pediatric endocrinologists have clinical experience treating transgender children or have interdisciplinary relationships with psychologists to evaluate gender identity.

"It's a minefield for most pediatric endocrinologists," Dr. Spack said.  "After all the recent criticism about sex assignment/surgery in newborns, they're terrified of being wrong."  

But Dr. Spack hopes these obstacles can soon be overcome:

"By identifying and treating appropriate transgender patients early, they no longer have to deal with the difficulty of adjusting to incorrect sex attribution based on their physical appearance," Dr. Spack. "They are no longer a hostage to their bodies."    

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