O0619 Oct.5: 2:48pm - Treatment Patterns for Pediatric Gender Dysphoria Vary by Baseline Clinical Data and Diagnosing Provider

Background/Purpose
Approximately 0.7% of US adolescents identify as transgender or gender diverse (TGD). In recent years, TGD children have been presenting for treatment at increasing rates. While this population is at increased risk for mental health comorbidities, studies have demonstrated that TGD children supported in their gender identity have decreased risk. To date, few studies have described how many TGD patients are ultimately treated or the time-to-treatment (TTT) in this population. The aim of this study was to understand medication practices, TTT, and how they vary by different demographic and clinical factors.

Methods
Patients were identified using TGD-related ICD codes from the Kaiser Permanente Northern California (KPNC) system health records between January 2015 and December 2018. TGD status was verified by manual chart review. Demographic data, medications prescribed, and surgical history were abstracted from medical charts. TTT was measured from the index diagnosis date to first prescription or surgical date. Data were analyzed with descriptive statistics.

Results
1,021 patients were diagnosed during the study period, of whom 805 (79%) were assigned female sex at birth. In all patients, median age at diagnosis was 15 years (IQR 4 years). 559 (55%) received at least one medical or surgical treatment. 39% of patients were first diagnosed by a medical provider, 43% by a mental health worker, and 17% by a social worker.

385 (38%) received hormone blockers, 451 (44%) received hormone therapy (HRT), and 123 (12%) received surgical treatment. The first treatment received varied significantly by natal sex (p<0.01).

Median TTT for the first treatment of any kind was 7 months (IQR 11 months). Median TTT increased by intervention, from 6 months for hormone blockers (IQR 9 months) to 11 months for HRT (IQR 13 months), to 23 months for gender-affirming surgery (IQR 15 months). Median time spent on blockers before initiating HRT was 5 months (IQR 7 months). Median age to start hormone blockers was 15 years (IQR 3 years), median age to start HRT was 17 years (IQR 3 years).

Of the 123 patients who received surgery, 117 (95%) were natal females. Median age for surgical treatment was 18 years old (IQR 2 years, range 13-21 years). No natal males completed surgery before the age of 18.

TTT did not vary significantly by race, sex, gender identity, or provider type. Access to treatment varied significantly by diagnosing providers. (p<0.01) Patients diagnosed by medical providers seemed less likely to receive treatment.

Conclusion
In a large integrated health care system, the median TTT is under 1 year. Treatment patterns vary by natal sex and diagnosing provider. Overall TTT did not vary by race, sex, or gender identity. Further studies are needed to understand the etiology of treatment variation and access.