A Preliminary Survey on Clinical Practice for Children and Adolescents with Gender Dysphoria in Japan: Current Situation and Challenges

Little is known about the treatment of gender dysphoria among children and adolescents in Japan. This preliminary survey aims to improve understanding of current clinical practice for treatment of children with gender dysphoria. Subjects were 315 certified child and adolescent psychiatrists in Japan. The questionnaire asked about clinical experiences concerning gender dysphoria and gender identity-related concerns. A total of 128 psychiatrists responded to the questionnaire. Mean length of clinical experience was 24.2±10.0 years in total and 16.9±11.5 years as child and adolescent psychiatry specialists. Among the respondents, 74 (57.8%) had seen children and adolescents with DSM-5 gender dysphoria, and 87 (67.7%) had examined cases with gender identity-related concerns. The mean number of experienced cases with gender dysphoria was 1.80±2.3 per respondent. We found that even among certified child and adolescent psychiatrists in Japan, experience with treatment of children with gender dysphoria was limited.

Trastorno de identidad de género. Parte II: terapia endocrinológica en el proceso de readecuación corporal / Gender identity disorder. Part II: endocrine therapy in the process of body readjustment

Endocrinology step of transgender readjustment therapy is made according to previously published in the part 1 of article: “gender identity disorder in rev. chil. endocrinol. diabetes 2015, 8 (4): 167-173.During started puberty in Tanner stage 2-3, the persistence of the experience that their identity male or female gender is not coherent with its bodily, authorize to start the endocrinological therapy, as an important step of body readjusting. In the process of transition from male to female or female to male, should stop pubertal development, what we do with GNRH analogues: intramuscle leuprolideor triptorelin 11.25 mg. every 12 weeks or with medroxyprogesterone acetate 150 mg. monthly. This process continues until 16 years, adding antiandrogen, preferably spironolactone in the process of body readjusting of male to female. At 16 years old, starts the cross hormonal therapy to masculinizing or feminizing. Maintaining gonadotrophin suppression, female to male, testosterone undecanoate or other injectable testosterone esters is administered, customizing the date of administration and inMale to female, daily use of oral estradiol valerate or transdermal gel. Plasma levels of estradiol andtestosterone should not be located in high or supraphysiological range to avoid thromboembolism or polycythemia risk in those who receive testosterone. Should to be explained the time to obtain the bodily effects, achieving a realistic attitude of the goals and the need for regular checks. Attendance to emotional changes, mainly to meet the social gender role. The laboratory, metabolic, hormonal, hemogram and electrolytic changes are evaluated. To be indicated bone densitometry and study images of internal genitals and breasts are necesary...

Gender dysphoria with homosexuality and comorbid depressive disorder: complexities in concept and management.

Gender identity disorder (GID) and homosexuality are complex entities debated over decades, whether should be categorized as a disorder or not. There are a number of problems specifically related to the criteria of the GID diagnosis like differences in the terms trans-sexualism and GID, failure of the proposed criteria in conceptualizing the whole spectrum of gender variance phenomena, the potential risk of physically invasive examinations to rule out intersex conditions and the application of diagnosis even after hormonal and surgical treatment. We hereby report complexities faced in the case of a male to female transsexual with homosexuality and depressive disorder and its management.

Intervenciones terapéuticas en disforia de género de niños y adolescentes / Therapeutic Interventions in gender dysphoria in children and adolescents

El concepto de Identidad de Género (IG) hace referencia a la convicción personal e internalizada de pertenencia a un determinado género y no a otro. Esta experiencia, temprana en el devenir del ser humano, establece los cimientos del desarrollo psicosexual. El distrés psicológico personal que produce el sentimiento de incongruencia entre la identidad de género y el sexo biológico asignado es conocido como Disforia de Género (DG). Los niños y adolescentes con DG constituyen un grupo de riesgo para sufrir problemas de salud mental, tanto por sus sentimientos disfóricos, como por el estigma y aislamiento social y familiar del que pueden ser objeto. Los psiquiatras infanto juveniles deben estar capacitados para evaluar y diagnosticar a aquellos pacientes que presentan estas dificultades, así como ser capaces de ofrecer tratamientos y soporte que les permita reestablecer la salud mental. El presente artículo es una revisión actualizada de los conceptos relacionados con la DG y su abordaje terapéutico, desde un enfoque multidisciplinario.

Gender identity refers to the internal and personal belief that a person belongs to one gender and not the other. This early developmental experience establishes the foundation for psychosexual development. The psychological distress that is produced by the incongruence between gender identity and biological sex is known as Gender Dysphoria (GD). Children and adolescents with GD constitute a risk group for mental health problems, both due to their dysphoria and the social stigma and isolation they may suffer. Child and adolescent psychiatrists need to know how to assess and diagnose patients with these symptoms, and be able to offer treatment and support to help reestablish their mental health. This is an updated review of the concepts related to GD and their treatment, from a multiprofesional perspective.

The Histologic Features of the Uterus and Adnexa Extirpated from Gender Identity Disorder Patients with Depot Androgen Injection / 대한불임학회지

OBJECTIVE: To investigate the histologic features of the uterus and adnexae extirpated from gender identity disorder (GID) patients that received depot androgen injection. METHODS: We reviewed the histologic findings of the uterus and adnexae removed from sixteen GID patients, who had taken depot androgen injection for 5~168 months. RESULTS: Fourteen patients (87.5%) showed the atrophied epithelium of exocervix and all of 16 patients (100%) showed the atrophy of endometrium. Seven patients (43.7%) showed multiple cystic follicles in the ovarian cortex and 6 patients (37.5%), 3 patients (18.7%) showed corpus albicans and corpus luteum, respectively. CONCLUSIONS: Exogenous androgen induced atrophy of cervix and endometrium. This effect was more prominent in the endometrium. In addition, PCO-like histologic features were observed in the ovary.