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Management of gender nonconformity in children and adolescents

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


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 "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 "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 "Gender development and clinical presentation of gender nonconformity in children and adolescents", section on 'Referral'.)


Evidence to guide the management of gender nonconformity in children and adolescents has increased with the increasing numbers of multidisciplinary centers providing treatment for gender-nonconforming youth [1-8]. This information supplements the experience from case series of adults who underwent gender-affirming surgery [9].

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 [10]. In the absence of a clear understanding of the etiology of gender nonconformity, these views influence the management approach and may be applied according to the individual patient's needs and goals. Patient-centered approaches to treating gender-nonconforming children and adolescents have been outlined by the University of California, San Francisco Center of Excellence for Transgender Care [11], Endocrine Society [12], the American Academy of Child and Adolescent Psychiatry [13], and the World Professional Association for Transgender Health [14,15]. Our approach is generally consistent with the recommendations in these guidelines.

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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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