Committee Opinion No. 685 Summary: Care for Transgender Adolescents
Gender nonconforming youth are an underserved population who obstetrician–gynecologists are seeing increasingly in their practices. Currently, there are large gaps in training, knowledge, and comfort with transgender patients among obstetrician–gynecologists. The purpose of this document is to review current recommendations that apply to an obstetrician–gynecologist. It is important for obstetrician–gynecologists to be aware of the social and mental health risks for the transgender population. Consensus guidelines support initiating medical therapy after an adolescent has an established diagnosis of transgender identity and has reached Tanner stage II development. Medical management involves the suppression of puberty (typically in the form of gonadotropin-releasing hormone agonists) followed by cross-sex hormone therapy to induce puberty at age 16 years. A variety of surgical options are available, including bilateral mastectomy, hysterectomy with bilateral salpingo-oophorectomy or salpingectomy, and possible neophallus creation. Transgender patients are an at-risk population, and preventive medicine is imperative to their health. This includes proper screening for sexually transmitted infections, screening for suicidal thoughts and mental health issues, and appropriate vaccination. Like all patients, transgender adolescents should have a source for ongoing primary care.
Recommendations and Conclusions
The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:
© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
- Obstetrician–gynecologists should understand gender identity and be able to treat transgender patients or refer them appropriately for medical and surgical therapeutic options.
- A patient with gender dysphoria may first present to a gynecologist; therefore, it is important for the clinician to be aware of this condition.
- Obstetrician–gynecologists can provide referrals as well as support and resources to young patients.
- It is important for obstetrician–gynecologists to be aware of the social and mental health risks for the transgender population.
- Transgender male adolescents have a uterus, ovaries, and breast tissue and, thus, can develop medical complications of gynecologic organs and also become pregnant.
- The need to discuss fertility preservation before initiation of cross-sex hormones is another important reason that obstetrician–gynecologists may be involved in the care of transgender adolescents.
- Like all patients, transgender adolescents should have a source for ongoing primary care.