Results
During 2003 to 2011, 39 children and
adolescents were referred to the service
and assessed. Of these, 18 patients
were pre-adolescent and continued to
have ongoing developmental psychological
counselling. Twenty-one were
either approaching puberty or pubertal,
and were referred to a second
psychiatrist for formal confirmation of
a diagnosis of GID. Adolescent
patients with persistent GID were
then assessed by a paediatric endocrinologist.
The adolescent group
comprised 13 biological males and
eight biological females.
In the group of 21 adolescents
reviewed for consideration of hormone
treatment, the mean age at which GID
was first perceived to be a problem was
3.26 1.11 years. The mean age at
presentation for GID assessment to
any member of the service was
10.0 4.13 years. Two of the adolescents
were from dizygotic same-sex
twin sibships, discordant for GID.
During independent psychiatric
evaluation, all 21 adolescents reported
symptoms of anxiety or depression.
Suicidal ideation was also reported.
Many children expressed an intense
sense of revulsion towards parts of
their bodies and wished to have their
genitals cut or modified. Other
comorbid psychiatric disorders were
present in five children. These
included obsessional disorders in
two, and Asperger syndrome in three,
including patients of both biological
sexes. There was a reported family
history of homosexuality or gender
dysphoria in first- or second-degree
relatives in four of 12 children for
whom detailed family history data
were recorded.
Of the 21 adolescents reviewed for
consideration for hormone treatment,
four experienced resolution of
gender dysphoria or acceptance of
gender variance with ongoing psychological
counselling. Seventeen
adolescents experienced persistence
of profound GID with increased distress
following commencement of
puberty and were therefore considered
eligible for hormone treatment.
In this subset of eligible patients, 11
had made or planned to make an
application to the Family Court for
hormone treatment. As the families
are required to themselves apply for
court approval, in all cases the child
was supported in their application by
at least one parent. Reasons for not
seeking court-approved hormone
treatment included: age close to 18
years (when court approval is not
required) in two cases, court financial
cost in two cases, family not supporting
hormone treatment in one case
and one affirmed female patient who
purchased oestrogen independently
overseas without court approval.
Seven patients (three biological
males and four biological females)
commenced court-approved hormone
treatment. In this group, gender dysphoria
was first noted at 3–6 years of
age. Treatment with GnRH analogue
to suppress pubertal progression
(phase 1) was started at 10–16 years of
age. Cross-sex hormones (phase 2)
were introduced at 15.6–16 years.
Four patients received both GnRH
analogue and cross-sex hormones,
two had GnRH analogue alone and
two had only cross-sex hormones.
One patient also received continuous
oral oestrogen and progesterone followed
by depot medroxyprogesterone
acetate for menstrual suppression
before phase 1 treatment with GnRH
analogue. Five patients commenced
medical intervention before completion
of puberty in their biological sex.
All patients who had phase 1 treatment
went on to hav