The Impact of Early Medical Treatment in Transgender Youth

项目总结/摘要 跨性别儿童和青少年是一个知之甚少和明显研究不足的人口， 美国的有限的可用数据表明，患有性别焦虑症的青少年患以下疾病的风险增加： 消极的心理和医疗健康结果，包括焦虑、抑郁、艾滋病毒感染、自杀， 与他们的同龄人相比，物质使用。因此，医疗干预的目的是减轻性别焦虑 并改善潜在的负面结果。2011年，医学研究所呼吁进行研究， 并改善性别少数群体的生活。2015年，儿童医院洛杉矶/南加州大学，波士顿 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/西北大学被授予NIH资助R 01 HD 082554，以开发和实施 多学科、前瞻性、观察性研究：早期医学治疗对跨性别青年的影响 （TYC）。最初的目的是检查生理和心理的影响，医疗干预， 观察24个月的变性和性别多样化（TGD）青年性别焦虑。迄今为止，TYC已 在两个队列中成功招募了超过其目标基线样本的人员：㈠ 95名开始进入青春期的青年 沿着一名父母/监护人使用促性腺激素释放激素类似物（GnRHa）抑制（n=95）， 以及（ii）316名青年开始性别肯定激素（GAH）治疗（睾酮或雌激素）。早期结果 在心理健康方面，对肯定性别平等的干预措施的反应呈现出积极的趋势。的 这项观察性、纵向、多中心更新研究的主要目的是评估长期 在青春期开始的现有医疗方案对青年的生理和心理影响 患有性别焦虑症的人最多可以再待4年第二个目标是加强 现有的队列通过招募额外的有色人种青年（YOC）进入两个队列（n=89），并招募额外的 出生时将男性专门分配到GAH队列（n=110）。最终目标是增加测量 心理社会变量需要回答新的问题提出了这个更新的应用程序。的关键特征 在更新期，原始GnRHa队列中的大多数个体将开始GAH治疗。通过检查 TGD青少年开始GAH治疗有和没有青春期抑制史的结果，TYC将 能够很好地检查有关青春期抑制和GAH治疗顺序的关键问题 健康结果。继续我们目前的研究是当务之急，以扩大目前缺乏的证据基础 指导TGD青年的临床护理，因此具有相当大的公共卫生意义。结果从这个 这项研究有可能通过提供给美国TGD青少年的服务来显著影响他们。 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

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.