Transgender Healthcare Demands Multispecialty Care

Bruce Jenner's Story Sparks Interest in Gender Issues

Wylie Hembree, MD; Christine Wiebe


May 08, 2015

In This Article

Identifying Gender Dysphoria in Youth

Medscape: Does the patient's age make a big difference in terms of how you approach them?

Dr Hembree: We are treating people of two age groups: the childhood/adolescent age group, and the adult. In the adolescent, we recommend giving medication at the onset of puberty that blocks pubertal development for a period of time until it's appropriate to start giving hormones of the opposite sex.

In those cases, a mental health professional generally will have seen the patient sometime during childhood and would have been the one who says, "Yes, this individual has gender dysphoria, and they are having difficulties with that dysphoria. It's interfering with their life, and they wish strongly to do everything that they can to live in the opposite gender from their natal sex." At that point, we would block puberty in those individuals.

In childhood, there is no hormonal issue.

It's usually the mental health professional who calls up the endocrinologist/pediatric endocrinologist to start the blockade of puberty, and then later to move forward with the sex steroids of the opposite gender.

Medscape: At that stage, are children experiencing hormonal changes, or is it mostly a mental health issue?

Dr Hembree: In childhood, there is no hormonal issue. After about the first 6 months of life, hormone levels in males and females are identical, until they begin to go through puberty. If you took random blood samples, the overwhelming majority of 8-year-olds would have the same hormone levels, regardless of their natal sex.

Medscape: What should pediatricians and other clinicians tell parents of children who are exhibiting or expressing signs of gender dysphoria?

Dr Hembree: According to the best information we have, in no more than 20% of children with gender dysphoria does it persist into puberty. It desists in about 80%, according to the literature.

Now, the data are controversial, and some people don't believe this is the case. But I think the bottom line is that if you're a clinician talking to a parent who believes their child may have gender dysphoria, you could say—conservatively—that more than one half do not continue to experience that into adulthood.

I think in most of those cases, the parent would then seek out a mental health professional who has experience with gender dysphoria. Fortunately, there are several places that are quite good across the country. And I'm quite impressed that school psychologists are very well trained in this and are very sensitive to it.


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