Editor's note:The 2018 AAP National Conference & Exhibition will take place from Nov. 2-6 in Orlando.
If pediatric endocrinologist and adolescent medicine specialist Norman Spack, M.D., were giving a presentation on caring for transgender youths 15-20 years ago, pediatricians’ reaction might have been: “Why is this relevant to me?”
“In my more recent experience, I find that the pediatricians I have spoken to are craving more information about these kids,” said Dr. Spack, founder and director emeritus of Gender Management Service (GeMS) at Boston Children’s Hospital and associate clinical professor of pediatrics at Harvard Medical School.
Dr. Spack aims to satisfy pediatric health care professionals’ desire for more information during a plenary session titled “Caring for Transgender Youth (P4042)” from 10:50-11:10 a.m. Tuesday, Nov. 6, in the Valencia Ballroom of the convention center.
He will begin by defining terms that often are a source of confusion such as gender, sex, sexual orientation and gender identity. Then, he will review the use of puberty blockers, outcomes data and the mental health consequences of starting treatment after puberty, which he has seen firsthand.
Dr. Spack began working with transgender adults in 1985. Since then, he has cared for about 250 adults, most of whom were not treated in early adolescence and were physically mature in ways that were not easily changeable. As a result, many showed serious social and family disruption, he said.
Now, transgender adolescents have access to medications that suppress puberty through a clinical protocol pioneered in the Netherlands. Later, if desired, they can take cross-sex hormones and undergo gender reassignment surgery. If an adolescent decides to stop taking the puberty-blocking medication, he or she will progress through puberty.
“The Dutch developed this protocol (to block puberty) because they were giving their adult patients everything anyone could get — free care, free medicine, free surgery — and yet their suicidality was horrible,” said Dr. Spack, who went to the Netherlands to learn about the protocol.
The Academy recently published the policy statement Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents (https://doi.org/10.1542/peds.2018-2162), which outlines the pediatrician’s role in promoting the health and positive development of transgender youths. The policy states that interventions, including pubertal suppression, hormones and surgery, may be appropriate for some transgender individuals, but risks, benefits and factors unique to each patient and family should be considered.
Since he began caring for transgender children in 1990, Dr. Spack has had hundreds of patients. He plans to show photos of some of them to illustrate the physical effects of puberty blockers and discuss the positive impact he has seen on their mental health.
“Do you know that if nobody does anything or provides support to the kids who happen to be transgender, between age 16 and 25, 45% will attempt suicide in that interval,” he said.
Therefore, it’s important for pediatricians to ask nonthreatening questions to determine if youths are struggling with their gender identity and to support them, Dr. Spack said.
“I want them (pediatricians) to understand that kids who I get (as patients) have been in somebody’s pediatric practice,” he said. “That’s why I want them to be prepared.”
For more coverage of the 2018 AAP National Conference & Exhibition visit http://www.aappublications.org/content/aap-national-conference-2018 and follow @AAPNews on Twitter and Facebook.
