The Impact of Early Medical Treatment in Transgender Youth

 描述(申请人提供)：在美国，变性人儿童和青少年是一个很少被理解和研究明显不足的群体。有限的可用数据表明，与同龄人相比，患有性别焦虑症(持续对性别不一致感到苦恼)的变性人青年出现负面心理和医疗健康结果的风险更高，包括焦虑、抑郁、艾滋病毒感染、自杀和药物使用。因此，医学干预的目的是缓解性别焦虑症，改善潜在的负面后果。现有的治疗变性人青年的战略取决于这些青年接受照料的发展阶段。对于那些在青春期发育早期接受护理的变性青年，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，这加剧了与性别不一致有关的痛苦。对于那些处于青春期后期的年轻人，治疗的目标是使用跨性别激素，以诱导期望的第二性征的发展，使身体与年轻人内在的性别意识更接近。2011年，医学研究所强调，显然需要开展以证据为基础的严格研究，以了解跨性别者使用激素对健康的影响。这项拟议的研究将全国四个学术地点(洛杉矶儿童医院/南加州大学、波士顿儿童医院、芝加哥/西北大学卢里儿童医院和加州大学旧金山分校)与专门的变性人青年诊所联网，以进行一项多地点观察性研究，调查患有性别焦虑症的变性人青年现有医疗方案的生理和心理社会结果。这项研究将包括两组性别焦虑症青年：一组在青春期发育的最早阶段评估青春期抑制的影响，另一组在青春期发育的后期评估跨性别激素对性别转变的影响。具体地说，在较早的青春期队列中(Tanner阶段2-3；n=80)，这项研究将评估用于抑制青春期的促性腺激素释放激素激动剂对精神健康、心理健康、生理参数和骨骼健康的影响以及文件安全性。在后来的青春期队列中(Tanner阶段4-5；n=200)，这项研究将评估对精神健康、心理健康和代谢/生理参数的影响，并证明为性别转变而使用的跨性别激素的安全性。这项多中心研究将是美国第一个评估变性人青年医疗治疗纵向结果的研究，并将提供关于目前用于变性人青年的治疗的生理和心理社会影响和安全性的重要循证数据。

 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.