Young people are assessed in line with the criteria published by The Endocrine Society Guidelines 2017. Puberty blockers are prescribed to transgender youth who fulfil the criteria, once they have started puberty. Gender affirming hormones are prescribed to youth under the age of 17 if there are ‘compelling reasons to do so’ as agreed by the Endocrine Society 2017.
We follow Gillick competency - the legal provision that allows children to consent to medical treatment - but also work with the individual and the family to build the best treatment plan for them. Once a child has reached tanner stage 2 they are typically ready to physically start puberty blockers. Gender-affirming hormones usually come later in line with peer development. But, as with all things at GenderGP, this will be discussed with the child and family as appropriate to ensure the best options and that consent and capacity are both properly ascertained.
The Endocrine Society 2017 Guidelines, and the WPATH Standards of Care Version 7 are internationally recognised as providing excellent guidance in the management of transgender patients.
All of our prescribing physicians have extensive knowledge and experience in endocrinology and are fully qualified to treat children and adults. Both NHS and private gender specialists come from many backgrounds, counselling, psychology, general practice, general medicine, psychiatry, endocrinology, paediatrics.
The WPATH criteria for mental health professionals working with children include:
* Meet the competency requirements for mental health professionals working with adults;
* Trained in childhood and adolescent developmental psychopathology;
* Competent in diagnosing and treating the ordinary problems of children and adolescents.
The Endocrine Society Guidelines 2017 advise the following ‘We advise that only MHPs who meet the following criteria should diagnose GD/gender incongruence in children and adolescents:
* training in child and adolescent developmental psychology and psychopathology,
* competence in using the DSM and/or the ICD for diagnostic purposes,
* the ability to make a distinction between GD/gender incongruence and conditions that have similar features (e.g., body dysmorphic disorder),
* training in diagnosing psychiatric conditions,
* the ability to undertake or refer for appropriate treatment,
* the ability to psychosocially assess the person’s understanding and social conditions that can impact gender-affirming hormone therapy,
* a practice of regularly attending relevant professional meetings, and
* knowledge of the criteria for puberty blocking and gender-affirming hormone treatment in adolescents.
* ‘We suggest that adolescents who meet diagnostic criteria for GD/gender incongruence, fulfil criteria for treatment, and are requesting treatment should initially undergo treatment to suppress pubertal development.
* ‘We suggest that clinicians begin pubertal hormone suppression after girls and boys first exhibit physical changes of puberty.
* ‘We recommend that, where indicated, GnRH analogues are used to suppress pubertal hormones.
* ‘In adolescents who request sex hormone treatment (given this is a partly irreversible treatment), we recommend initiating treatment using a gradually increasing dose schedule after a multidisciplinary team of medical and MHPs has confirmed the persistence of GD/gender incongruence and sufficient mental capacity to give informed consent, which most adolescents have by age 16 years.
* ‘We recognize that there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD/gender incongruence, even though there are minimal published studies of gender-affirming hormone treatments administered before age 13.5 to 14 years. As with the care of adolescents ≥16 years of age, we recommend that an expert multidisciplinary team of medical and MHPs manage this treatment.’