Objective: To describe patient characteristics at presentation, management and response to treatment of children and adolescents with gender dysphoria (GD) in Israel.
Methods: A retrospective chart review of 46 consecutive children and adolescents (< 18 years) with GD referred to and followed at the Israeli multidisciplinary Pediatric Gender Dysphoria Clinic from 2013- 2017.
Results: Of the 46 patients, 16 (35%) identified as female-to-male (FtM), 30 (65%) as male-to-female (MtF). The GD population increased since the establishment of the clinic from 1-2 new referrals to 10 new referrals per 6 months. Median age at referral was 16.1 years (range 4.58-18 years). At time of referral, 80% had completed sexual maturation in their biological gender. Of 25 pubertal MtF patients, 8 (32%) underwent fertility preservation compared to none of FtM patients. Gonadotropin-releasing-hormone analog (GnRHa) treatment was prescribed in 33 (72%) patients at a mean age of 16±1.7 years. Cross-sex-hormones (CSH) were prescribed in 27 (59%) patients at a mean age of 16.7±1.3 years (range 14.2-18.5 years). No severe side effects were recorded. One MtF patient underwent genital sex reassignment surgery at age 18.2 years. Three FtM and one MtF patients underwent mastectomy and breast augmentation respectively.
Conclusion: After establishment of the Pediatric GD Clinic, referral rate increased fivefold. Treatment with GnRHa and CSH, in collaboration with mental health support, is an intervention that appears to be appropriate in carefully selected youth with GD. Long-term follow-up studies are needed to determine the safety and efficiency of these treatments in this age group.
