New guidelines for teens with Gender Identity Disorder

androgynous kidGroundbreaking new guidelines about how to treat children with Gender Identity Disorder have been issued by the Endocrine Society. They suggest that at the first signs of puberty, physicians delay the onset of puberty and wait until the child is approximately 16 to begin any sort of hormone therapy involved in a gender transition.

Norman Spack, MD, co-director of Children’s Gender Management Service Clinic, is a part of the team that wrote these guidelines. We spoke with Spack about the guidelines and the history of treating children with Gender Identity Disorder.

According to Spack, puberty suppression is not a new idea. The early standard of care for individuals with Gender Identity Disorder started with the Harry Benjamin International Gender Dysphoria Association, more recently known as the World Professional Association for Transgender Health. The early standard of care was a method of pubertal delay that involved the use of progesterone, either in high dose oral daily form or through depot injections to shut down puberty, Dr. Spack said.

In the 1990s, the Dutch improvised on a method to block puberty via GnRH agonist injections, which had been shown to be safe and successful in treating central precocious puberty beginning in the 1970s during procedures given at Children’s and Mass. General Hospital.

Spack says that since boys and girls have similar body shapes and bone structures until puberty, you can more easily “keep kids in limbo at that age.”  Spack doesn’t believe lifelong decisions should be made in 10-12 year old genetic girls and 12-14 year old boys. Later in adolescence, if a decision is made to block the unwanted puberty, the affirmed gender can be hormonally provided after intensive psychological testing.

While these new guidelines do represent a step forward in treating Gender Identity Disorder, Spack believes that the real problem associated with it is that it is classified as a mental illness. “As long as it’s stuck in the manual under that classification, insurance will only pay for counseling leaving families to pay for expensive medications and surgeries,” Spack says.

The manual Spack refers to is the Diagnostic and Statistic Manual of Mental Disorders, the same one where homosexuality was classified as a mental illness until 1973. “There is a huge fight over whether Gender Identity Disorder can be removed from the manual,” he says.

The treatment suggested in the new guidelines for children with Gender Identity Disorder is costly. “GnRH agonists to suppress puberty can cost around one thousand dollars a month and may have to be used for two to four years,” Spack says. “If they get transgenderism out of the manual, it will hard for insurances companies to deny coverage for a condition that even the previously conservative Endocrine Society is now regarding as a medical diagnosis meriting endocrine treatment.”

In today’s world, “younger people consider this situation an affront to human fairness and decency,” he says. “It’s historic that the Endocrine Society, the oldest and largest organization of endocrinologists in the world, would do this.”