title: Current management of gender identity disorder in childhood and adolescence:  guidelines, barriers and areas of controversy.
abstract: OBJECTIVE
  The approach to gender identity disorder (GID) in childhood and adolescence has been rapidly evolving and is in a state of flux. In an effort to form management recommendations on the basis of the available literature, The Endocrine Society published clinical practice guidelines in 2009. The guidelines recommend against sex role change in prepubertal children, but they recommend the use of gonadotropin-releasing hormone (GnRH) agonists to suppress puberty in adolescence, and the use of cross-sex hormones starting around age 16 for eligible patients. In actual practice, the approach to GID is quite variable due to continued lack of consensus and specific barriers to treatment that are unique to GID.
  
  
  RESULTS
  Recent literature has focused on the mental health approach to prepubertal children with GID and short-term outcomes using pubertal suppression and cross-sex steroids in adolescents with GID.
  
  
  CONCLUSIONS
  This review will describe the literature published since the release of The Endocrine Society guidelines regarding the management of GID in both children and adolescents.
authors.affiliation: Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts, USA. shumer@childrens.harvard.edu
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Shumer
authors.forename: Norman P
authors.initials: NP
authors.lastname: Spack
mesh_terms: D000293:Adolescent; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005783:Gender Identity; D012739:Gonadal Steroid Hormones / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011627:Puberty / Q000187:drug effects / Q000523:psychology*; D014189:Transsexualism / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*
chemical_list: D012739:Gonadal Steroid Hormones; D007987:Gonadotropin-Releasing Hormone