Cited by 127LGBTQ Health, Identity, and PolicySexual Differentiation and DisordersEthics and Legal Issues in Pediatric Healthcare

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Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study

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Vrouenraets, Lieke Josephina Jeanne Johanna, Fredriks, A. Miranda, Hannema, Sabine E., Cohen-Kettenis, Peggy T., de Vries, Martine C.·2015·Journal of Adolescent Health

DOI 10.1016/j.jadohealth.2015.04.004

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Abstract

Purpose 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.

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Authors: Vrouenraets, L. J. J. J., Fredriks, A. M., Hannema, S. E., Cohen-Kettenis, P. T., & de Vries, M. C.
Affiliations: Leiden University (NL)
Leiden University Medical Center (NL)
Corresponding author: Vrouenraets, Lieke Josephina Jeanne Johanna
ORCID: Vrouenraets, Lieke Josephina Jeanne Johanna
Hannema, Sabine E.
de Vries, Martine C.
Venue: Journal of Adolescent Health
Publisher: Elsevier BV
Published: 2015-10
Volume: 57
Issue: 4
Pages: 367-373
ISSN: 1054-139X (ISSN-L)
DOI: 10.1016/j.jadohealth.2015.04.004
OpenAlex: W1565459500
Cited by: 127
References: 42
Citations by year: 2026: 6 · 2025: 6 · 2024: 6 · 2023: 28 · 2022: 13 · 2021: 13 · 2020: 16 · 2019: 12 · 2018: 12 · 2017: 8 · 2016: 4 · 2015: 2
FWCI: 14.22
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Adolescent Health (publishedVersion)
PubMed (publishedVersion)
Pure Amsterdam UMC (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Leiden Repository (Leiden University) (submittedVersion)
Funders: European Society for Paediatric Endocrinology
Universiteit Leiden
ZonMw (731010002)
Leids Universitair Medisch Centrum
Topics: Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Sexual Differentiation and Disorders
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
Keywords: gender dysphoria, puberty suppression, GnRH agonist, early medical intervention, transgender youth, ethical considerations, treatment guidelines, child competence, gender identity development, comorbidities
MeSH terms: Child Health, Adolescent Health, Gender Dysphoria, Adolescent, Child, Female, Gender Identity, Humans, Gonadotropin-Releasing Hormone, Male, Puberty, Gonadal Steroid Hormones, Sexual Maturation, Practice Guidelines as Topic, Qualitative Research

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Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study

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