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Medical treatment in gender dysphoric adolescents endorsed by SIAMS–SIE–SIEDP–ONIG

Authors
  • Fisher, A. D.1
  • Ristori, J.1
  • Bandini, E.1
  • Giordano, S.2
  • Mosconi, M.3
  • Jannini, E. A.4
  • Greggio, N. A.5
  • Godano, A.6
  • Manieri, C.7
  • Meriggiola, C.8
  • Ricca, V.9
  • Dettore, D.10
  • Maggi, M.1
  • 1 University of Florence, Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, Viale Pieraccini 6, Florence, 50139, Italy , Florence (Italy)
  • 2 Williamson Building Oxford Road, CSEP/iSEI, The University of Manchester, The School of Law, Manchester, M139PL, UK , Manchester (United Kingdom)
  • 3 Hospital S. Camillo-Forlanini, Gender Identity Development Service, Rome, Italy , Rome (Italy)
  • 4 University of L’Aquila, Endocrinology and Medical, Sexology, Experimental Medicine, L’Aquila, Italy , L’Aquila (Italy)
  • 5 Hospital-University of Padua, Pediatric Endocrinology and Adolescence Unit, Department of Woman and Child Health, Padua, Italy , Padua (Italy)
  • 6 ASL 1 Piemont Region, Turin, Italy , Turin (Italy)
  • 7 University of Turin, SCDU Endocrinology and Metabolic Diseases, Turin, Italy , Turin (Italy)
  • 8 University of Bologna and S. Orsola-Malpighi Hospital, Interdepartmental Center for Sexual Health Protection, Gynecology and Physiopathology of Human Reproduction, Bologna, Italy , Bologna (Italy)
  • 9 University of Florence, Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence, Italy , Florence (Italy)
  • 10 University of Florence, Department of Health Sciences, Florence, Italy , Florence (Italy)
Type
Published Article
Journal
Journal of Endocrinological Investigation
Publisher
Springer-Verlag
Publication Date
May 27, 2014
Volume
37
Issue
7
Pages
675–687
Identifiers
DOI: 10.1007/s40618-014-0077-6
Source
Springer Nature
Keywords
License
Yellow

Abstract

PurposeDespite international guidelines being available, not all gender clinics are able to face gender dysphoric (GD) youth population needs specifically. This is particularly true in Italy. Centers offering specialized support are relatively few and a commonly accepted Italian approach to GD youth has still not been defined. The aim of the present Position Statement is to develop and adhere to Italian guidelines for treatment of GD adolescents, in line with the “Dutch Approach”, the Endocrine Society (ES), and the World Professional Association for Transgender Health (WPATH) guidelines.MethodsAn in-depth brainstorming on the application of International guidelines in the Italian context was performed by several dedicated professionals.ResultsA staged approach, combining psychological support as well as medical intervention is suggested. In the first phase, individuals requesting medical help will undergo a psycho-diagnostic procedure to assess GD; for eligible adolescents, pubertal suppression should be made available (extended diagnostic phase). Finally, from the age of 16 years, cross-sex hormonal therapy can be added, and from the age of 18 years, surgical sex reassignment can eventually be performed.ConclusionsThe current inadequacy of Italian services offering specialized support for GD youth may lead to negative consequences. Omitting or delaying treatment is not a neutral option. In fact, some GD adolescents may develop psychiatric problems, suicidality, and social marginalization. With access to specialized GD services, emotional problems, as well as self-harming behavior, may decrease and general functioning may significantly improve. In particular, puberty suppression seems to be beneficial for GD adolescents by relieving their acute suffering and distress and thus improving their quality of life.

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