The treatment of adolescent transsexuals: changing insights.
BACKGROUND
Treatment of individuals with gender identity disorder (GID) has in medicine nearly always met with a great deal of skepticism. Professionals largely follow the Standards of Care of the World Professional Association for Transgender Health. For adolescents, specific guidelines have also been issued by the British Royal College of Psychiatrists.


OBJECTIVE
To describe the stepwise changes in treatment policy which, in recent years, have been made by the team of the Gender Identity Clinic at the VU University Medical Center in Amsterdam, The Netherlands.


METHODS
The first step taken to treat adolescents was that, after careful evaluation, (cross-sex hormone) treatment could start between the ages of 16 and 18 years. A further step was the suppression of puberty by means of gonadotropin-releasing hormone analogs in 12-16 year olds; the latter serves also as a diagnostic tool. Very recently, other clinics in Europe and North America have followed this policy. Results. The first results from the Amsterdam clinic show that this policy is promising.


CONCLUSIONS
Professionals who take responsibility for these youth and are willing to help should yet be fully aware of the impact of their interventions. In this article, the pros and cons of the various approaches to youngsters with GID are presented, hopefully inciting a sound scientific discussion of the issue.
Cohen-Kettenis
Peggy T
PT
Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands. Kettenis@vumc.nl <Kettenis@vumc.nl>
Delemarre-van de Waal
Henriette A
HA
Gooren
Louis J G
LJ
D000293:Adolescent; D000328:Adult; D002648:Child; D004992:Ethics, Medical; D005260:Female; D005783:Gender Identity; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006291:Health Policy; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D008297:Male; D009426:Netherlands; D010348:Patient Care Team / Q000941:ethics; D011627:Puberty / Q000187:drug effects; D012017:Referral and Consultation / Q000941:ethics; D014189:Transsexualism / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D055815:Young Adult
D007987:Gonadotropin-Releasing Hormone