title: Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study.
abstract: OBJECTIVE
  The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions. The aim of this study was to explicate the considerations of proponents and opponents of puberty suppression in GD to move forward the ethical debate.
  
  
  METHODS
  Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide.
  
  
  RESULTS
  Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits.
  
  
  CONCLUSIONS
  As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required.
authors.affiliation: Department of Pediatric and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Oegstgeest, The Netherlands. Electronic address: L.J.J.J.Vrouenraets@curium.nl.
authors.forename: Lieke Josephina Jeanne Johanna
authors.initials: LJ
authors.lastname: Vrouenraets
authors.affiliation: Department of Pediatric and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Oegstgeest, The Netherlands.
authors.forename: A Miranda
authors.initials: AM
authors.lastname: Fredriks
authors.affiliation: Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Sabine E
authors.initials: SE
authors.lastname: Hannema
authors.affiliation: Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Peggy T
authors.initials: PT
authors.lastname: Cohen-Kettenis
authors.affiliation: Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Martine C
authors.initials: MC
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D000067697:Adolescent Health; D002648:Child; D000067576:Child Health; D005260:Female; D000068116:Gender Dysphoria / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005783:Gender Identity; D012739:Gonadal Steroid Hormones / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011627:Puberty; D036301:Qualitative Research; D012741:Sexual Maturation
chemical_list: D012739:Gonadal Steroid Hormones; D007987:Gonadotropin-Releasing Hormone
keywords: Adolescents; Ethics; Gender dysphoria; Interviews; Puberty suppression; Qualitative study; Questionnaires; Worldwide