Dysphorie de genre chez l’enfant et l’adolescent : place de l’endocrinologue pédiatre et des traitements hormonaux

Abstract

Gender dysphoria is characterized by the dissociation between one's expressed gender and the gender of rearing as assigned at birth, which generates significant clinical distress with social, academic, and other important forms of isolation. For the last 15 years, the management of gender dysphoria in children and adolescents has developed internationally. Since 2013, several pediatric psychiatry and endocrinology departments have initiated a multidisciplinary evaluation and management approach for these patients in France. This management includes early recognition of gender dysphoria and after a thorough combined evaluation, the discussion of starting from early pubertal developmental stages a treatment by GnRH analogs. This treatment allows the suppression of further development of the secondary sexual characteristics of the natal gender, followed after several years, by the induction of puberty in the desired gender by androgens or estrogens. This article reviews the different steps of evaluation and hormonal management of gender dysphoria in adolescents as it is currently proposed in France, based on the international recommandations.