Masic Una, Butler Gary, Carruthers Paul, Carmichael Polly
Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK
Department of Paediatrics and Adolescents, University College London Hospital, London, UK.
Arch Dis Child. 2022 Oct 19;107(11):1012-1017. doi: 10.1136/archdischild-2022-324283.
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.
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.
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.
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.
一些经历了临床上显著的性别相关困扰的性别多样化年轻人（YP）选择在心理治疗支持的同时接受内分泌治疗，使用促性腺激素释放激素类似物（GnRHa）抑制青春期发育，然后使用性别肯定激素（GAH）获得他们所认定性别的第二性征。然而，对于在英国专科性别认同发展服务（GIDS）下接受儿科内分泌服务的跨性别青少年的人口统计学特征知之甚少。
评估了2017年至2019年期间从GIDS转介至附属内分泌诊所开始使用GnRHa或GAH的转诊患者的人口统计学特征（队列1），并对该队列中2017 - 2018年转诊的一个亚组（队列2）进行了进一步分析。
2017年至2019年期间，有668名青少年（227名出生时被指定为男性（AMAB），441名出生时被指定为女性（AFAB））被转介至内分泌科。队列1首次在GIDS就诊的平均年龄为14.2（±2.1）岁，评估后转介至内分泌科的平均年龄为15.4（±1.6）岁。对队列2中的439名YP（154名AMAB；285名AFAB）进行了轨迹的进一步详细分析。最常见的途径包括转介以获取GnRHa（98.1%），符合条件时使用GAH（42%），以及在适当时转介至成人服务（64%）。队列2中所有青少年的大多数（54%）有等待或已完成转介至成人服务的情况。
本研究突出了青少年在儿童和青少年临床服务中寻求内分泌治疗时可能采取的轨迹，可能有助于指导性别多样化YP的决策和规划服务提供。
