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Background
In the past two decades, there has been a rapid increase in the number of referrals at gender diversity clinics. Youth and their families may be presented with a wide range of cosmetic, medical, and surgical treatments. Little is known about the specific needs of gender diverse youth assigned female at birth (AFAB) receiving care in these clinics. Our goal was to describe treatment provided to this specific population and assess clinical outcomes.
Methods
We conducted a retrospective cohort study in a large tertiary care gender diversity clinic located in Quebec, Canada. All patients assigned female at birth seen at the clinic between November 2016 and May 2021 were included. We analyzed patients from 10 and 18 years-old at the time of the initial consultation. A retrospective chart review was completed regarding population characteristics, medical and surgical treatments with their respective outcomes according to clinical and biochemical criteria. Local IRB approval was obtained.
Results
A total of 187 patients were included, with a mean age of 14,9 years-old at first consultation. Duration of follow-up varied from 0 to 1 499 days (Mdn=504 days). 80% of our population identified as binary male gender at first and for 82,9%, identity did not change over the follow-up time. 88% had their menarche before or during the follow-up. Regarding medical treatment, 15% received no treatment at all, 42,8% received GnRH agonist, and 48,1% received testosterone at one point in their follow-up. Binary transmale were more likely to receive testosterone (55,3%) but less likely to receive GnRH agonists (44%) compared to non-binary gender individuals (20% and 63,6%).The mean age at initiation of GnRH agonists was 14,3 (9,8-17,9) years-old. 89,5% of patients receiving GnRH agonists has a monotherapy experienced amenorrhea as opposed to 56,6% of patients who received testosterone only. Levels of LH showed significant decrease (6,29 to 0,61 U/L) 3 months after initiation of GnRH agonists but almost no change 3 months after testosterone initiation. Estrogen levels showed similar patterns. Regarding surgical treatment, 1,1% of our population did not express desire to have a mastectomy while 5,9% went through the surgery during the study period.
Conclusions
Young AFAB in gender diversity clinics have complex gynecological needs which may vary with fluidity of gender identity. Patient goals and gender affirming-approach have to be at the center of our care and discussions. There is a need for additional studies to better understand the clinical outcomes of affirmative medical treatments and the impact on the well-being of young AFAB.
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© 2023 Published by Elsevier Inc.
