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Overview of the management of gender nonconformity in children and adolescents

Authors
Johanna Olson-Kennedy, MD
Michelle Forcier, MD, MPH
Section Editors
David Brent, MD
Mitchell E Geffner, MD
Diane Blake, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Children generally are assigned a gender at birth based upon genital anatomy or chromosomes. For most children, gender assignment correlates with gender identity, which is the innate sense of maleness or femaleness. However, some children have a gender identity that does not correlate with assigned gender. These children are called gender-nonconforming, gender-variant, or sometimes transgender (table 1). (See "Overview of gender development and clinical presentation of gender nonconformity in children and adolescents", section on 'Terminology'.)

The trajectory of gender nonconformity in childhood is unpredictable; some children with gender nonconformity will grow up to be transgender adults and some will grow up to be cis-gendered adults (ie, adults in whom gender identity matches genital anatomy). (See "Overview of gender development and clinical presentation of gender nonconformity in children and adolescents", section on 'Trajectory'.)

This topic will provide an overview of the management of gender nonconformity in children and adolescents. Gender development and the clinical presentation of gender nonconformity in children and adolescents are discussed separately. (See "Overview of gender development and clinical presentation of gender nonconformity in children and adolescents", section on 'Referral'.)

OVERVIEW

There is little evidence to guide the management of gender nonconformity in children and adolescents and opinions about the best treatment vary [1,2]. Most experience comes from case series of adults who underwent sex reassignment surgery [3]. However, as the number of multidisciplinary centers providing treatment for gender-nonconforming youth increases, information about outcomes in this population is increasing [4-11]. (See "Transgender women: Evaluation and management".)

Clinicians have differing views on whether gender nonconformity should be regarded as a normal variation of gender expression, a medical condition, or a psychiatric disorder [12]. In the absence of a clear understanding of the etiology of gender nonconformity, these views influence the management approach. Approaches to treating gender-nonconforming children and adolescents have been outlined by the Endocrine Society, the American Academy of Child and Adolescent Psychiatry, and the World Professional Association for Transgender Health [2,13,14]. Our approach is generally consistent with the recommendations in these guidelines.

                                

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Literature review current through: Nov 2016. | This topic last updated: Thu Oct 27 00:00:00 GMT+00:00 2016.
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