Teenage gender dysphoria and improving primary care services

Teenage gender dysphoria and improving primary care services
© iStock/Eoneren

With a growing number of adolescents identifying as transgender, a review aims to help primary care services address teenage gender dysphoria.

Published in Canadian Medical Association Journal (CMAJ), researchers look at emerging evidence to enhance primary care services for managing teenage gender dysphoria, including social and medical approaches particularly for the youth who are transitioning.

Tackling teenage gender dysphoria

Dr Joseph Bonifacio, Department of Paediatrics, St. Michael’s Hospital, Canada, notes: “The hallmark of care will remain a thoughtful, affirming, well-reasoned individualised approach that attempts to maximize support for this vulnerable population, as youth and their caregivers make complex and difficult decisions.”

Gender dysphoria is essentially defined as the distress experienced by an individual when their gender identity and their gender assigned at birth are conflicting.

Although precise numbers are unknown, studies from other countries indicate that 1.2% to 4.1% of adolescents identify as a different gender from their birth gender, a rate higher than in the adult population.

Moreover, a recent Canadian study found that less than half of transgender youth are comfortable discussing their health care needs with their family doctor.

“Ideally, the approach to youth with gender dysphoria revolves around collaborative decision-making among the youth, family or guardians, and care providers.” adds Bonifacio.

“The youth’s voice is always paramount”

The review follows the Endocrine Society’s guideline recommendation that medication to suppress puberty, which allows youth to explore their changing gender identity, should not be used before puberty.

In the published study, Bonifacio wrote: “Some youth find that their dysphoria abates as puberty starts, making it important to allow initial pubertal changes to occur.”

“On the other hand, some youth may find their gender dysphoria increases with puberty, corroborating their need for further care.”

Improving patient care services

As the topic of teenage gender dysphoria is a relatively new field of research, there are gaps in the research base, such as the number of nonbinary youths who identify outside male-female genders and data on adolescents requesting surgery.

The authors also note that ethnocultural diversity is underrepresented in study populations and in their clinics in Toronto, Canada and needs to be better understood.

The authors of the study conclude: “Accessing optimal individualized care may be difficult for certain populations, making it important that generalists are supported to increase their capacity to care for youth with gender dysphoria and to liaise with other professions to support families.”

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