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Challenges in the care of transgender and gender-diverse youth: an endocrinologist’s view

Abstract

An increasing number of transgender and gender-diverse (TGD) youth (early pubertal through to late adolescent, typically 9–10 through to 18 years of age) are seeking medical services to bring their physical sex characteristics into alignment with their gender identity — their inner sense of self as male or female or somewhere on the gender spectrum. Compelling research has demonstrated the clear mental health — even life-saving — benefits of gender-affirming care, but current clinical practice guidelines and standards of care are based on only several short-term and a few medium-term outcomes studies complemented by expert opinion. Nevertheless, although the relative paucity of outcomes data raises concerns, the stance of not intervening until more is known is not a neutral option, and large observational studies evaluating current models of care are necessary and are now underway. This Review highlights key advances in our understanding of transgender and gender-diverse youth, the challenges of providing gender-affirming care, gaps in knowledge and priorities for research.

Key points

  • Being transgender or gender diverse (TGD) is not rare and is no longer considered pathological; it represents an example of human diversity.

  • Scientific evidence supports biological underpinnings to gender identity development.

  • Gender-affirming medical care has clear mental health benefits, some of which might even be life-saving.

  • Long-term safety and efficacy studies are necessary to optimize care for TGD youth.

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Fig. 1: Gender identity probably reflects a complex interplay of biological, environmental and cultural factors.

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Acknowledgements

The author is grateful to and inspired by his patients, their families and his colleagues, from whom he has learned so much. He is also grateful to the National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development for their support of our research on “The Impact of Early Medical Treatment in Transgender Youth” (R01HD082554).

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Nature Reviews Endocrinology thanks J. Carswell and X. Lopez for their contribution to the peer review of this work.

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Rosenthal, S.M. Challenges in the care of transgender and gender-diverse youth: an endocrinologist’s view. Nat Rev Endocrinol 17, 581–591 (2021). https://doi.org/10.1038/s41574-021-00535-9

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