title: Children and adolescents with gender identity disorder referred to a pediatric medical center.
abstract: OBJECTIVE
  To describe the patients with gender identity disorder referred to a pediatric medical center. We identify changes in patients after creation of the multidisciplinary Gender Management Service by expanding the Disorders of Sex Development clinic to include transgender patients.
  
  
  METHODS
  Data gathered on 97 consecutive patients <21 years, with initial visits between January 1998 and February 2010, who fulfilled the following criteria: long-standing cross-gender behaviors, provided letters from current mental health professional, and parental support. Main descriptive measures included gender, age, Tanner stage, history of gender identity development, and psychiatric comorbidity.
  
  
  RESULTS
  Genotypic male:female ratio was 43:54 (0.8:1); there was a slight preponderance of female patients but not significant from 1:1. Age of presentation was 14.8 ± 3.4 years (mean ± SD) without sex difference (P = .11). Tanner stage at presentation was 4.1 ± 1.4 for genotypic female patients and 3.6 ± 1.5 for genotypic male patients (P = .02). Age at start of medical treatment was 15.6 ± 2.8 years. Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%).
  
  
  CONCLUSIONS
  After establishment of a multidisciplinary gender clinic, the gender identity disorder population increased fourfold. Complex clinical presentations required additional mental health support as the patient population grew. Mean age and Tanner Stage were too advanced for pubertal suppressive therapy to be an affordable option for most patients. Two-thirds of patients were started on cross-sex hormone therapy. Greater awareness of the benefit of early medical intervention is needed. Psychological and physical effects of pubertal suppression and/or cross-sex hormones in our patients require further investigation.
authors.affiliation: Division of Endocrinology, Children's Hospital Boston, Boston, MA 02115, USA. norman.spack@childrens.harvard.edu
authors.forename: Norman P
authors.initials: NP
authors.lastname: Spack
authors.forename: Laura
authors.initials: L
authors.lastname: Edwards-Leeper
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.forename: Scott
authors.initials: S
authors.lastname: Leibowitz
authors.forename: Francie
authors.initials: F
authors.lastname: Mandel
authors.forename: David A
authors.initials: DA
authors.lastname: Diamond
authors.forename: Stanley R
authors.initials: SR
authors.lastname: Vance
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005783:Gender Identity; D006801:Humans; D008297:Male; D010372:Pediatrics; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D019968:Sexual and Gender Disorders / Q000175:diagnosis / Q000628:therapy*; D018709:Statistics, Nonparametric; D014189:Transsexualism / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome