Pediatricians' Willingness to Suppress Puberty for Transgender Youth

Background and Purpose

Transgender youth are at risk for a number of psychosocial difficulties which may include rejection, trauma, abuse, harassment in educational settings, economic marginalization, and housing instability. The onset of puberty can be devastating for transgender youth or those with gender dysphoria and may lead to mental health issues such as depression, anxiety, and increased suicidality, and behaviors such as substance use and high-risk sexual behaviors. Thus, current guidelines call for the suppression of puberty for transgender youth using medication called GnRH analogues (puberty blockers). As the first medical provider that transgender youth will usually encounter, it is critical for pediatricians to understand and be willing to coordinate such care. Our aim was to explore general pediatricians’ experience with and willingness to manage puberty-blocking medication for transgender youth.

Methods

In April 2017, we conducted a pilot survey of all practicing general pediatricians in the ambulatory sites of a Midwest health system (N=50). Of those, 21 providers responded (42%). Eligible pediatricians were emailed a link to a 15-minute online survey. Survey topics included demographics, experiences treating transgender youth, and willingness to treat this population in the future. Respondents received a $10 gift card as a thank you. Descriptive statistics were conducted (means/standard deviations and frequencies).

Results

Respondents were 81% female and most (67%) had been in practice for 20 years or more. Half of respondents were white, about 1/3 were Asian, and 14% were African American. Just over half (52%) had provided care for a pediatric patient with gender dysphoria and 72.7% had provided counseling to a patient or patient’s family regarding gender identity issues. None of the respondents had newly prescribed puberty blockers and only 1 respondent had refilled such a prescription. 19% had referred patients to another provider for hormone blockers. 60% of respondents had received some formal training about the health of transgender youth, and two thirds (66.7%) had pursued informal education on this topic. Yet, only one third of respondents were familiar with puberty blocker regimens for transgender youth. 

None of the providers were willing to initiate puberty blockers for transgender youth. However, some were willing to continue (refill) puberty blockers initiated by other providers (14%). Barriers to providing this type of care included lack of time (62%), lack of familiarity with guidelines for gender-affirming care (57%), lack of training (62%), not knowing mental health providers that could confirm a gender dysphoria diagnosis (35%), lack of exposure to transgender patients (24%), and lack of knowledge about transgender patients among medical staff (24%).

Conclusions and Implications

Access to puberty blockers is critical for transgender youth. Over half of respondents had received some medical training regarding pediatric transgender health. While none were willing to prescribe puberty blockers, a few were willing to continue medications that had prescribed by another provider.  Additional training is needed for pediatricians, and social workers who work with transgender youth can help to advocate for the importance of access to puberty blockers for this population.