P0621 - A Retrospective Evaluation of Pediatric Transgender Patients Before and After Transition-Related Therapeutic Interventions

Background: Gender non-confirming youth are seeking to match their physical characteristics with their gender identity through hormonal and surgical interventions. The main study objective is to assess the prevalence of psychiatric comorbidities between patients who received only pharmacological treatment and those who also had gender affirming surgery. A secondary aim is to evaluate the degree of dysphoria before and after interventions.

Methods: A retrospective chart review of transgender adolescents attending a pediatric endocrinology clinic between 2014 and 2019 was conducted. Patients were younger than 21 years. Clinical characteristics and therapeutic interventions on those patients receiving pharmacological and/or surgical treatment were obtained from electronic medical records. Statistical analysis was performed (Chi square, Fisher test, T-test, Mann-Whitney) comparing hormonal versus hormonal plus surgical treatment.

Results: A total of 158 charts were reviewed, of which 107 (67.7%) were affirmed males (female to male), 47 (29.7%) affirmed females (male to female), and 4 (2.5%) considered themselves non-binary. Mean age at onset of treatment was 15.71 years. Of this entire cohort, 66 patients (41%) opted for hormonal treatment, and 20 individuals (12.6%) chose hormonal plus surgical treatment. Among affirmed males, 61 (57%) received testosterone only, 17 (15.8%) received testosterone and had chest reconstruction, and 1 (0.9%) had hysterectomy and oophorectomy in addition to testosterone and chest reconstruction. Among affirmed females, 19 (40,4%) received estradiol and spironolactone, 4 (8.5%) estradiol only, 1 (2.1%) estradiol plus leuprolide, 1 (2.1%) spironolactone plus leuprolide. In this same group, 2 (4.2%) had breast implant and 1 (2.1%) genital reconstruction in addition to hormonal treatment. When comparing both treatment groups, there was no significant baseline difference in psychiatric comorbidities such as depression, ADHD, bipolar disorder, anorexia or bulimia nervosa, except for higher anxiety rate in the hormone plus surgery group (p=0.002). The degree of gender dysphoria before and after starting hormonal treatment, reported on a scale of 0 (no dysphoria) to 10 (highest possible dysphoria), was 8.11/10 and 4.48/10 respectively, and for the hormonal plus surgical treatment group was 8.75/10 and 2.11/10. The difference in improvement of dysphoria between both treatment groups was statistically significant (p<0.001).

Conclusion: The degree of anxiety was higher among patients who had hormone treatment plus surgery, than on those who received only hormone treatment. This is likely the reason why surgical treatment was done at this age. Both groups have significant improvement in the degree of dysphoria after beginning treatment, however there is greater improvement in the hormonal plus surgery group. Surgery was not done in an important number of patients due to young age and lack of insurance coverage. Pediatric providers should be aware of the different therapeutic options for transgender patients since gender transition can significantly improve the well-being of transgender children and adolescents.