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Trajectories of transgender adolescents referred for endocrine intervention in England
  1. Una Masic1,
  2. Gary Butler2,
  3. Paul Carruthers3,
  4. Polly Carmichael1
  1. 1Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK
  2. 2Department of Paediatrics and Adolescents, University College London Hospital, London, UK
  3. 3Department of Endocrinology, Leeds Children's Hospital, Leeds, West Yorkshire, UK
  1. Correspondence to Dr Una Masic, Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK; umasic{at}tavi-port.nhs.uk

Abstract

Objectives Some gender-diverse young people (YP) who experience clinically significant gender-related distress choose to pursue endocrine treatment alongside psychotherapeutic support to suppress pubertal development using gonadotropin-releasing hormone analogues (GnRHa), and then to acquire the secondary sex characteristics of their identified gender using gender affirming hormones (GAH). However, little is known about the demographics of transgender adolescents accessing paediatric endocrinology services while under the specialist Gender Identity Development Service (GIDS) in England.

Design Demographics of referrals from the GIDS to affiliated endocrinology clinics to start GnRHa or GAH between 2017 and 2019 (cohort 1), with further analysis of a subgroup of this cohort referred in 2017–2018 (cohort 2) were assessed.

Results 668 adolescents (227 assigned male at birth (AMAB) and 441 assigned female at birth (AFAB)) were referred to endocrinology from 2017 to 2019. The mean age of first GIDS appointment for cohort 1 was 14.2 (±2.1) years and mean age of referral to endocrinology postassessment was 15.4 (±1.6) years. Further detailed analysis of the trajectories was conducted in 439 YP in cohort 2 (154 AMAB; 285 AFAB). The most common pathway included a referral to access GnRHa (98.1%), followed by GAH when eligible (42%), and onward referral to adult services when appropriate (64%). The majority (54%) of all adolescents in cohort 2 had a pending or completed referral to adult services.

Conclusions This study highlights the trajectories adolescents may take when seeking endocrine treatments in child and adolescent clinical services and may be useful for guiding decisions for gender-diverse YP and planning service provision.

  • endocrinology
  • adolescent health
  • child health
  • child health services
  • child development

Data availability statement

No data are available. Owing to the sensitive nature of this patient data, and to ensure anonymity, data are not available to share.

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Data availability statement

No data are available. Owing to the sensitive nature of this patient data, and to ensure anonymity, data are not available to share.

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Footnotes

  • Contributors UM conceptualised the research and methodology, carried out the screening and selection processes, analysed the data, drafted the manuscript and was responsible for overall content as the guarantor. PC critically reviewed the manuscript for important intellectual content, confirmed the data and contributed to manuscript revisions. GB confirmed the data and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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