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: 10401756
• 负责人: Yee-Ming Chan
• 金额: $ 96.86万
• 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 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10401756
• 关键词: Adolescence; Adolescent; Adolescent Development; Age; Anxiety; Award; Behavioral; Birth; Blood Pressure; Boston; California; Cardiovascular system; Caring; Chicago; Child; Clinical; Clinical Management; Clinical Practice Guideline; Cohort Studies; Data; Data Collection; Development; Early treatment; Enrollment; Estrogens; Female; Feminization; Funding; Gender; Goals; Gonadal Steroid Hormones; Gonadotropin-Releasing Hormone Analog; Grant; HIV; Health; Height; Hormone use; Hormones; Individual; Institute of Medicine (U.S.); Intervention; Investments; Lesbian Gay Bisexual Transgender; Lipids; Los Angeles; Masculine; Measurement; Measures; Medical; Mental Depression; Mental Health; Mental Health Services; Metabolic; Modeling; Not Hispanic or Latino; Obesity; Observational Study; Outcome; Parents; Pediatric Hospitals; Persons; Physiologic calcification; Physiological; Population; Positioning Attribute; Psyche structure; Psychological Impact; Psychosocial Factor; Puberty; Public Health; Publishing; Quality of life; Recording of previous events; Reporting; Research; Risk; Safety; Sampling; San Francisco; Services; Site; Subgroup; Suicide; Sum; Testosterone; Time; Treatment Protocols; Treatment/Psychosocial Effects; United States; United States National Institutes of Health; Universities; University Hospitals; Weight; Youth; base; bone health; cardiovascular risk factor; children of color; clinical care; cohort; demographics; emerging adult; evidence base; family support; follow-up; gender dysphoria; gender minority group; gender minority stress; hormone therapy; improved; male; medical schools; minority children; multidisciplinary; peer; preadolescence; prospective; psychologic; psychosocial; psychosocial wellbeing; racial and ethnic; recruit; response; sex; side effect; stress resilience; substance use; transfeminine; transgender; trend

PROJECT SUMMARY/ABSTRACT Transgender children and adolescents are a poorly understood and a distinctly understudied population in the United States. The limited available data suggest that youth with gender dysphoria 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. In 2011, the Institute of Medicine called for research to understand and improve the lives of gender minority populations. In 2015, Children’s Hospital Los Angeles/USC, Boston Children’s Hospital/Harvard Medical School, Benioff Children’s Hospitals/UCSF and Lurie Children’s Hospital of Chicago/Northwestern University were awarded NIH grant R01HD082554 to develop and implement a multidisciplinary, prospective, observational study: The Impact of Early Medical Treatment in Transgender Youth (TYC). The original aims were to examine physiological and psychosocial effects of medical intervention for transgender and gender diverse (TGD) youth with gender dysphoria observed for 24-months. To date, TYC has successfully recruited beyond its targeted baseline sample in two cohorts: (i) 95 youth initiating pubertal suppression with gonadotropin releasing hormone analogs (GnRHa) along with one parent/guardian (n=95), as well as (ii) 316 youth initiating gender-affirming hormone (GAH) therapy (testosterone or estrogen). Early results have demonstrated a positive trend regarding mental health response to gender affirming interventions. The primary objective of this observational, longitudinal, multicenter renewal study is to evaluate the longer-term physiological and psychological impact of existing medical treatment protocols initiated in adolescence on youth with gender dysphoria for up to an additional 4 years. A second objective is to enhance the diversity and size of existing cohorts by enrolling additional youth of color (YOC) into both cohorts (n=89) and enroll additional assigned males at birth specifically into the GAH cohort (n=110). The final objective is to add measurements of psychosocial variables required to answer new questions posed in this renewal application. A key feature of the renewal period is that most individuals in the original GnRHa cohort will be starting GAH treatment. By examining outcomes of TGD youth who initiated GAH treatment with and without histories of puberty suppression, TYC will be well positioned to examine key questions about the sequencing of puberty suppression and GAH treatment on health outcomes. Continuing our current research is imperative to expand the scant evidence-base currently guiding the clinical care of TGD youth and thus, is of considerable public health significance. Results from this study have the potential to significantly impact services provided to TGD youth in the U.S. by making available rigorous scientific evidence outlining the longer-term impact and safety of early treatments based on pubertal development stage.

项目概要/摘要 跨性别儿童和青少年是人们对跨性别儿童和青少年知之甚少、研究明显不足的群体。 美国。有限的可用数据表明，患有性别不安的青少年面临更大的风险 负面的心理和医疗健康结果，包括焦虑、抑郁、艾滋病毒感染、自杀和 与同龄人相比，物质使用情况。因此，医疗干预的目的是缓解性别不安 并改善潜在的负面结果。 2011 年，医学研究所呼吁开展研究以了解 并改善性别少数群体的生活。 2015年，洛杉矶/南加州大学波士顿儿童医院 儿童医院/哈佛大学医学院、贝尼奥夫儿童医院/加州大学旧金山分校和卢里儿童医院 芝加哥/西北大学获得 NIH 拨款 R01HD082554 来开发和实施 多学科、前瞻性、观察性研究：早期医疗对跨性别青少年的影响 （TYC）。最初的目的是检查医疗干预对生理和心理社会的影响 对患有性别不安的跨性别和性别多样化 (TGD) 青少年进行为期 24 个月的观察。迄今为止，TYC已 成功招募了超出其目标基线样本的两个队列：(i) 95 名进入青春期的青少年 使用促性腺激素释放激素类似物 (GnRHa) 以及一名家长/监护人 (n=95) 进行抑制，如 (ii) 316 名青少年开始性别肯定激素 (GAH) 治疗（睾酮或雌激素）。早期结果 在心理健康对性别肯定干预措施的反应方面表现出积极的趋势。这 这项观察性、纵向、多中心更新研究的主要目标是评估长期 青春期开始的现有医疗方案对青少年的生理和心理影响 患有性别焦虑症的时间最多可达 4 年。第二个目标是增强多样性和规模 通过将额外的有色人种青年 (YOC) 纳入两个队列 (n=89) 并招募更多的现有队列 将出生时的男性专门分配到 GAH 队列中 (n=110)。最终目标是添加测量 回答此更新申请中提出的新问题所需的心理社会变量。该产品的一个关键特点是 更新期是原始 GnRHa 队列中的大多数个体将开始 GAH 治疗。通过检查 开始 GAH 治疗（有或没有青春期抑制史）的 TGD 青少年的结果，TYC 将 能够很好地研究有关青春期抑制和 GAH 治疗顺序的关键问题 关于健康结果。继续我们当前的研究对于扩大目前缺乏的证据基础至关重要 指导 TGD 青少年的临床护理具有重要的公共卫生意义。结果由此 研究有可能通过提供给美国 TGD 青少年的服务产生重大影响 严格的科学证据概述了基于青春期的早期治疗的长期影响和安全性 发展阶段。