The Endocrine Society held their 97th annual meeting last weekend in San Diego. At that meeting Dr. Maja Marinkovich, MD, pediatric endocrinologist and Medical Director of the Gender Management Clinic at Rady's Children's Hospital of San Diego, an affiliate of UCSD, presented a new study which confirmed that the mental health of transgender youth improves with recognition and treatment of their gender dysphoria.

Ignoring it does not make it go away.

The photo is of transgender teens Isaac and Jacob preparing for a prom in Kansas City.

Youth with gender incongruence or dysphoria need a comprehensive, multidisciplinary approach to care.

They are in great need of experienced endocrinologists, therapists, psychiatrists, primary care providers and surgeons.

--Marinkovic

In gender dysphoria, the child's biological gender and the gender with which the child identifies do not match. Transgender is the persistent desire to change one's assigned gender, she said.

The study folowed 42 patients. Twenty six of them (62%) presented with depression, anxiety or both and/or had a history of self-cutting (7 patients). Eleven patients had additional psycjiatric or behavioral problems, such as ADHD, autism spectrum disorders and/or bipolar disorder.

Many of our patients suffer greatly from bullying, discrimination, isolation, and lack of support or lack of insurance coverage for the necessary treatment.

Often, she said, parents and school staff may not consider transgender, and a delay occurs in having the child assessed by a therapist who is experienced in gender identity problems until the transgender youth is deeply depressed or suicidal.

--Marinkovich

Twenty-eight of the patients began a male-to-female transition, 13 were female-to-male, and one, born female, identified as gender fluid, although that patient eventual chose to start male hormone treatment. Average age at first visit was 15.5 years. All consented to have their data entered in an endocrine database approved by an IRB. Thirty eight of the patients began treatment.

Treatment consisted of hormone agonists (GnRHa...so-called "puberty blockers") in seven of the patients, beginning at an average age of 12.5 years, and cross-gender hormones in 32 patients, beginning at an average age of 16.5 years. Only two patients did both.

FTM patients received depo-testosterone injections every 1-2 weeks. MTF patients received 17-beta estradiol orally twice per day, and most took spironolactone, a testosterone antagonist.

Two female-to-male patients had their breasts surgically removed (one at age a16.3, the other at age 18). Several others wished to have that surgery, but discovered that their insurance plans did not cover it...or they could not find an experienced local surgeon.

Legal name changes to match the affirmed gender have been completed by 12 patients (29%).

To date, none of the patients expressed regret or stopped therapy.

--Marinkovich

Mental health follow-up data were available on 22 out of 26 of the patients. Mental health improved in all but two of the patients.

Marinkovich said that since the Gender Management Clinic opened in 2012, it has seen a constant and rapid increase in number pf patient referrals.

There needs to be not only greater awareness and acceptance of this minority group but also improved accessibility to care for youth with gender dysphoria, to decrease the problems often seen in patients who are transgender.

The management of transgender adolescents, although increasing across the U.S., is still sporadic and could be improved and standardized with research and systematic monitoring at dedicated centers, according to research presented at The Endocrine Society annual meeting.

These patients require a comprehensive care from a multispecialty team. Additionally, education of medical care providers, including students and residents, nursing and support staff is also an essential part of providing better care for this vulnerable group.

--Marinkovich

Based on our clinical study, mental health problems in transgender youth improved significantly with acknowledgement and treatment of gender dysphoria.

--Marinkovich

In upstate New York, Jennifer Surridge, mother of a transgender daughter, defended her eleven-year-old daughter's right to use the girls bathroom at a school board meeting. Other parents expressed their dismay that her daughter would be allowed to use the same changing facility as other girls in the Sodus Central school district. The school district is honoring Surridge's request, citing federal and state non-discrimination policies.

What if this child came to you and said, ‘Mommy, I’m not a boy. I’m a girl in here and no one can see me for who I am.

--Surridge

The child, who was assigned male at birth, has said she was a girl since she was 4.

I just couldn’t wrap my mind around it. I had a lot of people tell me it was just a phase and she’ll grow out of it and don’t let her wear a dress.

--Surridge

I have a small problem with the simple fact that they we’re going to allow possibly a boy in the girl’s bathroom and locker room.

--Another parent

If that parent could just accept that this is a girl, his fears would be allayed.

Surridge's daughter transitioned last December.

Transgender is not a choice. I don’t care what anyone says in this room, it is not a choice. Nobody would choose to live this kind of life.

--Surridge

Citing an amendment to the federal Higher Education Act of 1965, forcing transgender students to use facilities not consistent of their gender identity creates a situation of “separate but equal” and constitutes illegal discrimination.

--Superintendent Martin Cox