Approach to Children and Adolescents with Gender Dysphoria

Educational Gaps

1. Clinicians should be aware that patients who have gender dysphoria (GD) often suffer from psychiatric comorbidities that worsen during puberty, at which time they are at high risk of suicide.

2. It is beneficial for clinicians to appreciate their critical role in accruing a thorough and sensitive history suggestive of GD and the complexity therein and in being familiar with both the process and benefits of evaluation and therapy.

3. Primary caregivers must recognize that there is an ideal window of opportunity for patients to receive hormonal intervention, necessitating prompt referrals.

Objectives

After completing this article, the reader should be able to:

1. Define and describe gender dysphoria.

2. Define the terms sex, gender, gender identity, genderqueer, cisgender, gender expression, gender variant, gender nonconforming, transgender, and sexual orientation.

3. Recognize how a child or adolescent who has gender dysphoria can present to the primary clinician.

4. Recognize the controversies about current gender dysphoria prevalence data.

5. Describe the evaluation of a child or adolescent for gender dysphoria.

6. Describe the primary clinician’s role in caring for a patient who has gender dysphoria.

7. Describe the benefits of long-term treatment for children and adolescents whose gender dysphoria persists through puberty.

Note: We discuss the use of gonadotropin-releasing hormone analogs for puberty suppression in adolescents who have gender dysphoria, but this is not a U.S. Food and Drug Administration-approved use of these drugs.

Clinical Case

Riccardo was a 17-year-old natal male who described himself as “being a girl with boy parts,” a proclamation that he verbalized at 15 years of age. She preferred to be referred to with female pronouns. She explained that these feelings manifested when she was very young, noting that she …