Doc­tor speaks on treat­ing trans­gen­der youth

Greenwich Time - - NEWS - By Amanda Cuda

Decades ago, it was nearly un­heard of for pe­di­a­tri­cians to treat their young pa­tients for gen­der iden­tity is­sues.

But that has changed, said Dr. Nor­man Spack, co-founder emer­i­tus of the Gen­der Man­age­ment Ser­vice at Bos­ton Chil­dren’s Hospi­tal.

“I do think gen­der dys­pho­ria (trans­gen­der) has come out of the closet — and now that it’s come out of the closet, it’s go­ing to show up in your pe­di­atric of­fice,” said Spack, an as­so­ciate clin­i­cal pro­fes­sor of pe­di­atrics at Har­vard Med­i­cal School.

Spack spoke at the Mar­riott in Trun­bull on Wed­nes­day be­fore roughly 50 pe­di­a­tri­cians and other health pro­fes­sion­als as part of Bridge­port Hospi­tal’s 41st an­nual Maxwell Bo­gin MD Lec­tures in Pe­di­atrics.

He talked about the dif­fer­ences be­tween gen­der iden­tity and sex­ual ori­en­ta­tion; the of­ten-complicated process of start­ing gen­der re­as­sign­ment and the im­por­tance of iden­ti­fy­ing and treat­ing trans­gen­der pa­tients rel­a­tively early.

The lat­ter is es­pe­cially im­por­tant, Spack said, cit­ing re­search show­ing trans­gen­der youth have “one of the high­est sui­cide co­horts in this coun­try.”

In 2014, the Na­tional Trans­gen­der Dis­crim­i­na­tion Sur­vey, con­ducted by the Na­tional Gay and Les­bian Task Force and Na­tional Cen­ter for Trans­gen­der Equal­ity, found 45 per­cent of trans­gen­der Amer­i­cans ages 18 to 24 had at­tempted sui­cide — higher that the over­all sui­cide rate among trans­gen­der peo­ple, which was 41 per­cent. By com­par­i­son, the sui­cide rate among the gen­eral pub­lic is 4.6 per­cent.

Spack dis­cussed a Den­mark study show­ing treat­ing trans­gen­der youth with hor­mone therapy around the on­set of pu­berty — be­tween ages 12 and 14 for males, and be­tween 10 and 12 for fe­males — can lead to a smoother gen­der tran­si­tion for young pa­tients.

“The data show that kids claim­ing the op­po­site gen­der (from the one as­signed at birth) may vac­il­late when they are young, but by the on­set of pu­berty, it’s pretty much set,” he said.

Spack said he only had two pa­tients who changed their minds about tran­si­tion­ing, and both were able to re­verse the process.

The way trans­gen­der and gen­der iden­tity are treated by med­i­cal com­mu­nity has changed a lot over the past half-cen­tury, Spack said.

“We couldn’t be hav­ing this con­ver­sa­tion 50 years ago, be­cause this wouldn’t be in the pe­di­atric theater,” he said. “It would be a psy­cho­log­i­cal” is­sue.

The field has evolved over the past decade or so. When he founded the Gen­der Man­age­ment Ser­vice at Bos­ton Chil­dren’s in 2007, it had only a hand­ful of pa­tients, but, by 2015, it was serv­ing roughly 200.

How­ever, de­spite more aware­ness about trans­gen­der youth and more op­tions for them, there are still ob­sta­cles. For in­stance, many states don’t have gen­der clinics.

Con­necti­cut has at least two — the Gen­der Pro­gram at Con­necti­cut Chil­dren’s Med­i­cal Cen­ter in Hart­ford and the Yale Medicine Gen­der Pro­gram in New Haven.

Ev­ery year, the Bo­gin lec­tures ad­dress hot top­ics among doc­tors who serve chil­dren and ado­les­cents. Past top­ics have in­cluded sports medicine and Zika virus. This year’s topic was “New Ap­proaches to Prob­lems in En­docrinol­ogy.”

In ad­di­tion to Spack’s talk on help­ing pe­di­atric trans­gen­der pa­tients, doc­tors spoke on ad­vances in di­a­betes treat­ment and the im­pact of child­hood can­cer on growth and pu­berty.

Brian A. Pounds / Hearst Con­necti­cut Me­dia

Dr. Nor­man Spack, co-founder emer­i­tus of the Gen­der Man­age­ment pro­gram at Bos­ton Chil­dren’s Hospi­tal, speaks on his work with pe­di­atric trans­gen­der pa­tients at Bridge­port Hospi­tal’s 41st an­nual Maxwell Bo­gin MD Lec­tures in Pe­di­atrics at the Trum­bull Mar­riott in Trum­bull on Wed­nes­day.

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