The Impact of Early Medical Treatment in Transgender Youth

项目摘要/摘要 在美国，变性儿童和青少年是一个鲜为人知、研究明显不足的群体。 美国。有限的现有数据表明，患有性别焦虑症的青少年患上 消极的心理和医疗健康后果，包括焦虑、抑郁、感染艾滋病毒、自杀和 物质使用与他们的同龄人相比。因此，医学干预的目的是缓解性别焦虑症 以及改善潜在的负面后果。2011年，医学研究所呼吁通过研究来了解 并改善性别少数群体的生活。2015年，波士顿洛杉矶/南加州大学儿童医院 儿童医院/哈佛医学院、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，以开发和实施 多学科、前瞻性、观察性研究：早期医疗对跨性别青年的影响 (TYC)。最初的目的是检查医疗干预的生理和心理社会影响。 观察了24个月的变性人和性别多元化(TGD)青年的性别焦虑症。迄今为止，TYC已经 在两个队列中成功招募了超过其目标基线样本的人员：(1)95名青春期青年 促性腺激素释放激素类似物(GnRHa)与父母/监护人(n=95)一起抑制AS 以及(2)316名青年开始性别肯定激素(GAH)治疗(睾酮或雌激素)。初步结果 在性别肯定干预措施的心理健康反应方面显示出积极的趋势。这个 这项观察性、纵向、多中心更新研究的主要目标是评估较长期的 青春期启动的现有医疗方案对青少年的生理和心理影响 有性别焦虑症长达4年之久。第二个目标是加强生物多样性和规模 通过将更多有色人种青年(YOC)纳入这两个队列(n=89)，并在现有队列中注册其他 将出生时的男性专门分配到GAH队列(n=110)。最终目标是添加以下测量结果 回答此续签申请中提出的新问题所需的心理社会变量。的一项关键功能 更新期是原GnRHa队列中的大多数人将开始GAH治疗。通过检查 有和没有青春期抑制史的TGD青年开始GAH治疗的结果，TYC将 准备好研究有关青春期抑制和GAH治疗顺序的关键问题 对健康结果的影响。继续我们目前的研究势在必行，以扩大目前稀少的证据基础 因此，指导TGD青少年的临床护理具有重要的公共卫生意义。由此产生的结果 这项研究有可能显著影响向美国TGD青年提供的服务 以青春期为基础的早期治疗的长期影响和安全性的严格科学证据 发展阶段。

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.