XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

From Gender Ambiguity to Gender Dysphoria: Endocrine Treatment of Transgendered Teens and Young Adults in a Pediatric Academic Center

SPACK, NORMAN U.S.A.
E-mail: spack@al.tch.harvard.edu

Gender Dysphoria has received little attention in the curricula of most medical schools and pediatric training programs or at meetings of pediatric and endocrine academic societies. However, as a result of advocacy by members of the intersex community, the evaluation and treatment of genital ambiguity has become the focus of multiple national endocrine symposia, culminating in the formation of the multidisciplinary National Task Force on Intersex. A new therapeutic paradigm for gender "assignment" of intersexed newborns emphasizes the impact of the intrauterine hormonal milieu on the formation of gender identity, particularly testosterone "imprinting," and discourages any genital reconstructive surgery during infancy or childhood. As individuals whose gender identity is in contradistinction to their fetal and postnatal hormonal environment, the transgendered are exceptions to the paradigm. With the recent focus in pediatric centers on gender "assignment," the involvement of transgendered individuals as patients and mentors in pediatric centers provides an opportunity to broaden the topic to gender identity formation. The Endocrine Division is currently providing hormonal therapy to six transgendered teens and young adults (3 MTF and 3 FTM), and regularly includes members of the transgendered community at teaching conferences for community pediatricians and trainees in Pediatrics, Endocrinology, Urology, and Adolescent Medicine.