Care of the Transgender Adolescent with Type 1 Diabetes

Abstract

Approximately 1% of high school aged youth identify as transgender and recent increased societal acceptance of gender dysphoria (GD) has resulted in higher utilization of gender affirming medical interventions. Given that type 1 diabetes (T1D) is one of the most common chronic disease in childhood, it is expected that pediatric diabetes providers will encounter adolescents with both T1D and GD. Pioneering studies from the Netherlands in 1998 described the first use of pubertal suppression with a gonadotropin releasing hormone agonist (GnRHa) in adolescents and the addition of gender affirming sex hormone, testosterone or estrogen, to transition the person to the true gender identity. The Pediatric Endocrine Society, Endocrine Society, and World Professional Association for Transgender Health have published guidelines and standards of care for gender affirming providers. However, very little has been published about the specific considerations in the treatment of these adolescents who have T1D and GD. We report on our experience (n=5) of the unique challenges of managing the T1D during gender transition. There is risk for infection, diabetic ketoacidosis, poor adherence, diabulimia, anxiety and depression in these adolescents. Close monitoring and open conversations between the pediatric diabetes provider and the adolescent with T1D and GD are essential. Disclosure J. Avila: None. T. Aye: None.