Caring for Transgender Kids: Is Clinical Practice Outpacing the Science?

Becky McCall, BSc, MSc; Lisa Nainggolan

Disclosures

August 28, 2018

Evolution of the Endocrinologist's Role in Transgender Medicine

Results of a survey conducted by the Journal of Clinical Endocrinology & Metabolism and reported by Medscape Medical News in 2017 highlighted that nearly 80% of endocrinologists have treated a transgender person but the same percentage (80.6%) have never received formal training on care for these patients.

Findings from two studies presented at the Pediatric Academic Societies 2018 Meeting on the use of transgender care services in the United States reflect a need to train pediatricians to care for this population's unique needs. One survey from the Children's Hospital of Philadelphia found that primary care pediatricians have poor knowledge of existing guidelines and only half were aware of when to prescribe puberty blockers. The other study by the same research group found that between 2010 and 2014 the number of children and adolescents with a gender dysphoria-related claim for a certain insurer increased from 113 to 464.

Commenting on UK healthcare professionals, Stewart from Gendered Intelligence reinforces the need for more education aimed at professionals in addition to other sectors of society. "Many professionals that we work with tell us that they lack confidence in working with trans and gender-diverse people, but they want to do the right thing and be supportive. Education and training go a long way to address this."

More and more research is being presented at international meetings. "It is understandable for endocrinologists to feel uncomfortable if they haven't had relevant training, but within the requirements of continuing medical education, it is the responsibility of endocrinologists to become educated in this respect," Rosenthal asserts.

Managing gender dysphoria remains a hot-button issue in medicine today and promises to be so for years to come, not least because of the paucity of evidence to support the exponential growth in practice.

"The weight of the evidence, some of which is indirect, means there may be compelling adverse consequences of not providing an intervention," Rosenthal says. He adds that "as endocrinologists, we want to be gender-affirming with the provision of mental health support, while minimizing the risk of long-term adverse health outcomes. It's not about following a particular recipe but being thoughtful in approach."

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