Thursday, December 19, 2019

From the journals: "Care of Transgender Persons"

The good news is that the prestigious New England Journal of Medicine has a December 12 peer-reviewed article titled Care of Transgender Persons (free subscription required). The conclusions are consistent with WPATH and Endocrine Society guidelines:
click to enlarge
The “agonists” referred to in the second bullet point are GnRH agonists which are puberty blockers.

The authors of the study, Joshua D. Safer, M.D., and Vin Tangpricha, M.D., Ph.D:

From the Center for Transgender Medicine and Surgery, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York (J.D.S.); and the Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, and the Atlanta Veterans Affairs Medical Center — both in Atlanta (V.T.).
The doctors provide a thorough, well edited review or clinical options; from puberty blockers to surgery including a number of graphics. The article is intended for a professional audience but Drs. Safer and Tangpricha keep the obscure medical jargon to a minimum.

For our religious friends (footnote markers deleted):
Although the mechanisms that inform gender identity are unknown, current data suggest a biologic underpinning programmed from birth. For example, there are reports of XY chromosome intersex persons raised as female who report male gender identity and identical twin siblings of transgender persons are more likely than fraternal twin siblings of transgender persons to be transgender. Associations between brain anatomy and gender identity have also been reported.
Where I have a problem is with the atypical patient who is presumably a hypothetical:
A healthy 19-year-old college student presents with the statement that he is transgender and wants to start hormone therapy. The sex recorded at birth was female, but he notes having identified as a boy for as long as he can remember. More recently, his treatment goals have become clearer, including a wish to begin medical treatment and to begin presenting as male. He has no medical or behavioral health concerns and takes no medications. How would you advise this patient?
Perhaps the challenge is atypical by design. A 19-year-old trans man taking no medications would have developed female features including breast tissue. Such a patient would probably be in considerable distress. There is no mention of puberty blockers in his history.

Nevertheless, the presentation of a transgender case in a journal as notable as the NEJM is a significant advancement for transgender people.

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