Management of gender nonconformity in children and adolescents
- Johanna Olson-Kennedy, MD
Johanna Olson-Kennedy, MD
- Associate Professor of Clinical Pediatrics
- University of Southern California, Keck School of Medicine
- Michelle Forcier, MD, MPH
Michelle Forcier, MD, MPH
- Associate Professor of Pediatrics
- Warren Alpert School of Medicine, Brown University
- Section Editors
- David Brent, MD
David Brent, MD
- Section Editor — Childhood Mental Disorders
- Professor of Psychiatry, Pediatrics and Epidemiology
- University of Pittsburgh School of Medicine
- Mitchell E Geffner, MD
Mitchell E Geffner, MD
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Keck School of Medicine, University of Southern California
- Diane Blake, MD
Diane Blake, MD
- Section Editor — Adolescent Medicine
- Professor of Pediatrics
- University of Massachusetts Medical School
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 .
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 . 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 , Endocrine Society , the American Academy of Child and Adolescent Psychiatry , and the World Professional Association for Transgender Health [14,15]. Our approach is generally consistent with the recommendations in these guidelines.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GUIDING PRINCIPLES
- TYPES OF INTERVENTIONS
- Mental health interventions
- - Mental health approaches
- - Indications for mental health referral
- Phenotypic interventions
- - Social transition
- - Hormonal interventions
- - Surgical interventions
- APPROACH IN PREPUBERTAL CHILDREN
- General suggestions
- Social transition
- APPROACH IN PUBERTAL CHILDREN AND ADOLESCENTS
- Youth with binary gender identity
- Youth with nonbinary gender identity
- OVERVIEW OF HORMONAL INTERVENTIONS FOR ADOLESCENTS
- Potential indications
- Counseling and consent
- Availability of care
- Suppression of endogenous puberty
- - Rationale
- - Timing
- - Regimen
- - Potential adverse effects
- - Monitoring
- Gender-affirming hormone therapy
- - Rationale and indications
- - Timing
- - Male-to-female
- - Female-to-male
- - Monitoring
- SURGICAL INTERVENTIONS
- SUMMARY AND RECOMMENDATIONS