What happens during puberty?
During puberty, the pituitary gland—a tiny gland at the bottom of the brain—releases hormones called gonadotrophins that stimulate the gonads to mature. In boys, gonadotrophins stimulate the testes, so that they start producing testosterone and sperm. In girls, they stimulate the ovaries to begin producing estrogen and ultimately to ovulate.
What medical treatment does Children's provide for transgender patients?
Children's transgender patients, all of whom have been previously screened by psychotherapists skilled in evaluation of gender identity, are counseled and evaluated by a Gender Management Service (GeMS) Clinic psychologist. Following an established international research protocol, patients undergo a series of psychological and medical tests in order to assess whether they have persistent clinical symptoms of transgenderism that interfere with their psychosocial functioning and put them at serious risk for self-harm. Patients are considered eligible for medical intervention when they fulfill the Diagnostic and Statistic Manual of Mental Disorders-IV criteria for gender identity disorder, have suffered from lifelong extreme gender dysphoria, are psychologically stable and live in a supportive environment.
Children's offers reversible medical intervention to a select group of at-risk transgender patients in order to suppress their production of estrogen or testosterone, but only after these patients have entered puberty. This reversible treatment gives patients time to reach an age when they can decide, with their families, whether to begin cross-sex hormone therapy. Cross-sex hormone therapy consists of testosterone for genetic females and estrogen for genetic males. If they decide not to transition to the opposite sex, pubertal suppression will be discontinued, genetic puberty will resume, and patients will mature into the gender/sex they were born as.
How does puberty-suppressing therapy work?
Children’s Hospital Boston doctors use drugs called GnRH analogues to temporarily suppress puberty. These drugs block the release of gonadotrophins thereby halting production of sex steroid hormones from the testes and ovaries. GnRH analogues have been used for many decades to assist in reproductive treatment for women and to stop precocious (early) puberty in children, and have not been shown to cause any major side effects.
What happens next?
Children's provides cross-sex hormone therapy to patients who are taking puberty-blocking drugs and who choose to continue with medical intervention, as well as to a select group of patients who have been referred to the GeMS clinic after they completed or nearly completed puberty. Cross-sex hormone therapy causes some irreversible effects: estrogen diminishes sperm production in males, and testosterone causes females to stop ovulating and menstruating. As with all sex steroid therapy, including the sex hormone therapy Children's endocrinologists routinely provide to offset medical deficiencies caused by cancer and other conditions, patients are closely monitored for side effects.
What are the health risks for untreated transgender youth?
Transgender youth, whether male or female, may be at serious risk for self-harm and often engage in life-threatening behaviors related to their transgender identity. Patients sense that they are "trapped in the wrong body" and many experience verbal or physical abuse as a result of their gender expression. Many transgender youth report having seriously thought about taking their lives. Over 25 percent of the transgender youth who participated in a recent study had actually attempted suicide.
How does medical intervention offset the life-threatening behaviors of transgender youth?
During the process of puberty, adolescents' bodies undergo irreversible or difficult-to-reverse physical changes. Among the changes produced by estrogen are breast development, menstruation, a female body contour and earlier closure of growth plates (as compared to males). Among the changes produced by testosterone are facial hair, a male body contour, a male facial bone structure, spontaneous erections, a deepened voice, an Adam's apple and larger hands and feet (as compared to females). Pre-pubescent transgender youth are so distressed by the changes that will occur during puberty that they are at risk for self-harm, including suicide.
Does Children's perform any surgeries that aid in gender reassignment?
No, Children's does not perform any surgeries that aid in gender reassignment for transgender patients.