Public health

What endocrinologists need to know about treating transgender youth

Australia now has its first guidelines for the management and treatment of transgender and gender diverse young people.

An estimated 1.2% of adolescents Australia now identify as transgender, and in recent years there has been a sharp rise in demand for medical services for this group, leading to creation of specialised multidiscliplinary services.

Responding to this, the Royal Children’s Hospital (RCH) in Melbourne developed the standards of care and treatment guidelines this month, which recommend best practice models of care for the core group of clinicians who care for this group, including paediatric endocrinologists, paediatricians, adolescent physicians, psychologists and other clinicians caring for this group.

A summary of the document was published in the MJA this month.

Lead author Associate Professor Michelle Telfer, director of RCH’s Gender Service, said there were two international guidelines but one is out of date and the other – by the Endocrine Society – only covered endocrine management.

The new guidelines emphasise the collaborative relationship needed between the paediatric endocrinologist and mental health clinician, who should work together ongoing monitoring of mental health, noting trans teenagers are at much greater risk of psychiatric comorbidity and Autism Spectrum Disorder is associated with gender diversity and dysphoria, which can make assessment more complex.

The primary physician and mental health professional should also collaborate when considering obtaining informed consent for gender affirming medical interventions, the document noting authorisation by a court is no longer required to commence hormone treatment after a 2017 court ruling.

Physicians are also reminded of the importance of talking to patients about the long-term impact of any medical intervention on sexuality and fertility – noting referral for fertility preservation may necessary and to think about bone density when considering Stage 1 treatment, because the long-term impact of puberty suppression on bone density is currently unknown.

Paediatric endocrinologists may also be called upon to provide documentation to help the young person change identification documents, to reflect their preferred name and gender, and the importance of using respectful and affirming language when talking to patients is also highlighted.

The document also offers best practice guidelines for assessments, investigations and for puberty suppression and gender affirmation hormone treatment using oestrogen and testosterone.

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