Challenges in Timing Puberty Suppression for Gender-Nonconforming Adolescents.

Abstract

* Abbreviation: GI — : gender incongruence Sorbara et al,1 in their report “Mental Health and Timing of Gender-Affirming Care” in this issue of Pediatrics , focus on the interesting matter of age of clinical presentation for gender-affirming medical interventions and its association with mental health in transgender youth. Because experiencing puberty is often stressful for gender-nonconforming youth, puberty suppression as a reversible medical intervention was introduced in clinical care in the early 2000s by Dutch clinicians Cohen-Kettenis et al.2 The aim of puberty suppression was to prevent the psychological suffering stemming from undesired physical changes when puberty starts and allowing the adolescent time to make plans regarding further transition or not. Following this rationale, younger age at the time of starting medical-affirming treatment (puberty suppression or hormones) would be expected to correlate with fewer psychological difficulties related to physical changes than older individuals. Sorbara et al1 confirmed this in their study. Adolescents presenting at younger age (<15 years) reported lower rates of self-reported diagnosed depression, self-harm, suicide thoughts … Address correspondence to Annelou L.C. de Vries, MD, PhD, Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers, Location VUmc, Room 1y130, PO Box 7057, 1007 MB, Amsterdam, Netherlands. E-mail alc.devries{at}amsterdamumc.nl