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Note: We discuss the use of gonadotropin-releasing hormone analogs for puberty suppression in adolescents who have gender dysphoria, but this is not a U.S. Food and Drug Administration-approved use of these drugs.

Riccardo was a 17-year-old natal male who described himself as “being a girl with boy parts,” a proclamation that he verbalized at 15 years of age. She preferred to be referred to with female pronouns. She explained that these feelings manifested when she was very young, noting that she wanted to play Cinderella with friends and that her favorite toys were Barbie dolls and a pink stuffed animal. Even as a toddler, Riccardo always preferred to associate with female peers. Socially, Riccardo had transitioned to female gender. She had long bleached blonde hair and wore make-up, jewelry, and typical female clothing. Riccardo was delighted to “pass” as a...

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