Doctor delivers lecture on treating transgender youth
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, cofounder 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.
“We always try to address major issues that come up in our population,” said Dr. Mary Lou Gaeta, Bridgeport Hospital chief of Pediatric Hospitalist Medicine. “All of these topics have been highprofile lately.”
That’s particularly true of transgender issues.
During a panel discussion that followed Spack’s presentation, Gaeta asked the doctors gathered in the room to raise their hand if they had any transgender patients, and the majority of them did.
Gaeta asked if they thought gender dysphoria had become more common in recent years, and many nodded in agreement.
Thus, many of the questions at the panel discussion were for Spack, and centered on gender issues. One audience member asked what physicians can do if they think a patient is transgender. Spack suggested observing the patient’s behavior.
“If you see someone dressing or acting in a cross-gender way, I don’t think it’s an affront” to approach them, he said.
As for what to do next, that can be trickier. One of the other speakers at the event was Dr. Jennifer Sherr, an associate professor of pediatrics at Yale University, who spoke about diabetes. During the panel discussion, she pointed out that, although Yale has a gender clinic there is a very long waiting list. Sherr recommended doctors with patients who might be transgender call the clinic and speak to on-call staff about possible options.