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Transgender and Gender Diverse Care
Published in S Paige Hertweck, Maggie L Dwiggins, Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
If a patient is not able to use puberty blockers, may offer menstrual suppression agents for those assigned female at birthTransmasculine patients typically will prefer non-estradiol methodsCounsel that no method is perfect, but some are better than others at menstrual suppressionConsider need for pregnancy prevention when choosing a method
Transgender care in adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Stephanie Cizek, Gylynthia Trotman
Although puberty blockers are reversible, they prevent maturation of primary oocytes and spermatogonia to mature oocytes and sperm. Transgender females who use estrogen may have impairment of spermatogenesis and an absence of Leydig cells in the testis. Testosterone use may result in ovarian stromal hyperplasia and follicular atresia. Although some of the effects of gender-affirming hormone therapy appear partially reversible, the threshold for which fertility is impaired is unknown, and duration of use will likely be an important factor.2,15 Further research is needed to establish effects of hormone treatment on natal gonads. As TGN youth are presenting and initiating treatment at younger ages, a discussion on the limited currently available information and the potential for irreversible effects of hormone treatment on fertility is particularly important. However, adolescents may not feel qualified to make decisions on fertility or may not be able to consider the true impact.2
Breast
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Drugs used in the treatment of prostate cancer LH releasing hormone (LHRH) analogues (e.g. Zoladex used in the treatment of prostate cancer) increases testosterone and then decreases it due to negative feedback.There is increasing use in transgender patients – primarily as puberty blockers but also in adults; here, increasing breast size is a welcome side effect.Anti-androgens (cyproterone acetate) and oestrogens (stilboestrol).
“It’s like my kid came back overnight”: Experiences of trans and non-binary young people and their families seeking, finding and engaging with clinical care in England
Published in International Journal of Transgender Health, 2021
Anna Carlile, Ethan Butteriss, Annie Pullen Sansfaçon
Families’ experiences of frustration, delay, and desperation were especially apparent in any efforts to obtain a prescription for puberty blocking hormones. Puberty blockers are recognized as a useful approach to addressing the gender dysphoria many of our participants described (Edwards-Leeper, Liebowitz, & Sangganjanavanich, 2016; Jessen & Roen, 2019; Lynch, Khandheria and Meyer III, 2015; Mahfouda et al., 2017; Nahata, Chelvakumar, and Leibowitz 2017; Pullen Sansfaçon et al., 2019), including by the GIDS clinicians in England, UK (Butler, Wren, & Carmichael, 2019). The interviewees all described improved mood once affirmative treatment had started. The benefits extended into school attendance, friendships, and increased participation in society. However, most of our interviewees were delayed in receiving these medications. Instead, most of the participants we interviewed who were assigned female at birth were prescribed high-dose contraceptive hormones in the absence of puberty blocking or gender-affirming medication. These are recognized as an alternative treatment in countries where medical insurers refuse to pay for the alternative, but acknowledged as potentially harmful (Nahata, Chelvakumar, and Leibowitz, 2017): their inconsistent impacts on menstrual bleeding and mood and physically feminizing effects were described as highly undesirable by our interviewees.
Bell v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274: Weighing current knowledge and uncertainties in decisions about gender-related treatment for transgender adolescents
Published in International Journal of Transgender Health, 2021
Annelou L. C. de Vries, Christina Richards, Amy C. Tishelman, Joz Motmans, Sabine E. Hannema, Jamison Green, Stephen M. Rosenthal
The High Court inferred from the low detransition rates not that the young people were being appropriately selected through the stringent clinical assessment process employed, but rather that puberty suppression was the first part of a treatment which would inevitably and causatively lead to affirming hormones and surgeries with lifelong consequences for fertility, relationships, and gender identity. Therefore, the High Court concluded that the younger adolescents must not only make a decision on puberty blockers, with reversible effects, but also on the subsequent treatment with irreversible effects. However, we do not agree. Our reading of the research findings is one of reassurance that careful assessment before starting medical treatment leads to provision of puberty blockers only to those adolescents with a high likelihood of lasting gender incongruence into adulthood. The fact that they continue with hormonal care when they are older validates a stability in gender identity experienced over time; this indicates that these youth were able to make informed choices at an earlier age without regrets in later adolescence and early adulthood.
“Just because I don't bleed, doesn't mean I don't go through it”: Expanding knowledge on trans and non-binary menstruators
Published in International Journal of Transgender Health, 2020
The available research focuses on the use of hormonal contraception technologies including depot medroxyprogesterone acetate and levonorgestrel intrauterine devices as effective menstrual suppression techniques, utilized to achieve therapeutic amenorrhea and therefore alleviate any associated gender dysphoria (Akgul et al., 2019; Chrisler et al., 2016; Kanj et al., 2019; Schwartz et al., 2019). Gonadotropin-releasing hormone agonists, commonly called puberty blockers, are also discussed in the literature as a tool to suppress puberty, menarche and alleviate gender dysphoria associated with its onset (Pradhan & Gomez-Lobo, 2019; Schwartz et al., 2019). Often menstrual suppression is discontinued upon initiation of gender-affirming hormone therapy regimens, specifically testosterone, which can be used to achieve amenorrhea on its own (Akgul et al., 2019). Those with incomplete menstrual suppression on testosterone may continue to use these, or try progesterone therapies, to achieve and maintain amenorrhea (Boudreau & Mukerjee, 2019; Schwartz et al., 2019).