The Impact of Early Medical Treatment in Transgender Youth

早期医疗对跨性别青少年的影响

• 批准号: 9119044
• 负责人: Yee-Ming Chan
• 金额: $ 122.03万
• 依托单位: CHILDREN'S HOSPITAL OF LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9119044
• 关键词: Adolescence; Adolescent; Age; Agonist; Alcohol or Other Drugs use; Anxiety; Behavior; Birth; Bone Density; Boston; California; Caring; Characteristics; Chicago; Child; Clinic; Clinical Practice Guideline; Country; Data; Depression and Suicide; Development; Distress; Electrolytes; Enzymes; Exhibits; Fasting; Feminine; Gender; Gender Identity; Glucose; Glycosylated hemoglobin A; Goals; Gonadal Steroid Hormones; Gonadotropin Hormone Releasing Hormone; Guidelines; HIV; HIV Infections; Health; Hemoglobin; Hormonal; Hormone use; Hormones; Individual; Institute of Medicine (U.S.); Insulin; Intervention; Knowledge; Lesbian Gay Bisexual; Lipids; Liver; Los Angeles; Masculine; Medical; Mental Depression; Mental Health; Metabolic; Multicenter Studies; Observational Study; Outcome; Patients; Pediatric Hospitals; Personal Satisfaction; Physiological; Population; Psyche structure; Puberty; Quality of life; Recommendation; Recruitment Activity; Reporting; Research; Risk; Safety; San Francisco; Self-Injurious Behavior; Sex Characteristics; Site; Specific qualifier value; Staging; Suicide; Time; Treatment Protocols; Treatment/Psychosocial Effects; United States; Universities; Youth; base; bone health; clinical care; clinical practice; cohort; community center; evidence base; experience; follow up assessment; follow-up; gender dysphoria; gender transition; peer; psychologic; psychosocial; reduce symptoms; sex; sex risk; therapy development; transgender; transgender women; trauma symptom

 DESCRIPTION (provided by applicant): Transgender children and adolescents are a poorly understood and a distinctly understudied population in the United States. The limited available data suggest that transgender youth who are gender dysphoric (persistently distressed about gender incongruence) are at increased risk for negative mental and medical health outcomes including anxiety, depression, HIV acquisition, suicide, and substance use compared to their peers. Therefore, medical intervention is aimed at alleviating gender dysphoria and ameliorating potential negative outcomes. Existing strategies for treating transgender youth depend on the developmental stage at which these youth present for care. For those transgender youth that present for care in the early stages of pubertal development, treatment is aimed at suppressing their endogenous puberty in order to avoid the development of undesired secondary sexual characteristics that intensify the distress associated with gender incongruence. For those youth in later stages of puberty, the goal of treatment is to use cross-sex hormones in order to induce the development of desired secondary sexual characteristics that bring the body into closer alignment with the youth's internal sense of gender. In 2011, the Institute of Medicine emphasized a clear need for the development of evidence-based and rigorous research aimed at understanding the health implications of hormone use in transgender individuals. The proposed study networks four academic sites around the country (Children's Hospital Los Angeles/University of Southern California, Boston Children's Hospital, Lurie Children's Hospital of Chicago/Northwestern University, and University of California San Francisco) with dedicated transgender youth clinics to conduct a multi-site observational study examining the physiological and psychosocial outcomes of existing medical treatment protocols for transgender youth with gender dysphoria. The study will include two groups of gender dysphoric youth: one in the earliest stages of pubertal development to assess the impact of puberty suppression, and one in later stages of pubertal development to assess the impact of cross-sex hormones for gender transition. Specifically, in the earlier pubertal cohort (Tanner stages 2-3; n=80) the study will evaluate the impact on mental health, psychological well-being, physiologic parameters and bone health as well as document safety of GnRH agonists administered for puberty suppression. In the later pubertal cohort (Tanner stages 4-5; n=200) the study will evaluate the impact on mental health, psychological well-being, and metabolic/physiologic parameters, as well as document the safety of cross-sex hormones administered for gender transition. This multi-center study will be the first in the U.S. to evaluate longitudinal outcomes of medical treatment for transgender youth and will provide essential evidence-based data on the physiological and psychosocial effects and safety of treatments currently used for transgender youth.

 描述（由申请人提供）：跨性别儿童和青少年在美国是一个知之甚少，研究明显不足的人群。有限的可用数据表明，与同龄人相比，性别焦虑（持续为性别不一致而苦恼）的跨性别青年出现负面心理和医疗健康结果的风险增加，包括焦虑，抑郁，艾滋病毒感染，自杀和物质使用。因此，医疗干预的目的是减轻性别焦虑和改善潜在的负面结果。治疗变性青年的现有战略取决于这些青年接受护理的发展阶段。对于那些在青春期发育的早期阶段前来接受治疗的变性青年，治疗的目的是抑制他们的内源性青春期，以避免发展不受欢迎的第二性征，从而加剧与性别不一致有关的痛苦。对于那些处于青春期后期的青年，治疗的目标是使用跨性别激素，以诱导所需的第二性征的发展，使身体与青年的内在性别感更加一致。2011年，医学研究所强调，显然需要开展循证和严格的研究，旨在了解跨性别者使用激素对健康的影响。这项拟议中的研究将全国四个学术地点联网（洛杉矶儿童医院/南加州大学、波士顿儿童医院、芝加哥卢里儿童医院/西北大学、和加州旧金山弗朗西斯科大学）与专门的跨性别青年诊所进行多-现场观察性研究，检查现有的跨性别青少年医疗方案的生理和心理社会结果，烦躁不安该研究将包括两组性别焦虑青年：一组处于青春期发育的早期阶段，以评估青春期抑制的影响，另一组处于青春期发育的后期阶段，以评估跨性别激素对性别转变的影响。具体而言，在青春期早期队列（坦纳2-3期; n=80）中，研究将评价对心理健康、心理健康、生理参数和骨骼健康的影响，并记录GnRH激动剂用于青春期抑制的安全性。在青春期后期队列（坦纳4-5期; n=200）中，研究将评估对心理健康、心理健康和代谢/生理参数的影响，并记录为性别转换而给予的跨性别激素的安全性。这项多中心研究将是美国第一项评估跨性别青少年药物治疗纵向结果的研究，并将提供有关目前用于跨性别青少年的生理和心理社会影响以及治疗安全性的重要循证数据。