LAUSR

It is estimated that as many as 1% of American adolescents have a gender identity that is not congruent with their sex assigned at birth.1 Guidelines developed in the Netherlands and then adopted throughout the world allow clinicians to prevent physical changes of puberty with the use of gonadotropin-releasing hormone analogs (GnRHa) when the first signs of puberty have manifested, a point at which the patient’s dysphoria surrounding gender often intensifies. This may be followed with exogenous testosterone or estrogen therapy at ages as young as 14 years, but more typically at approximately 16 years of age, to more closely align the adolescent’s body with their inner sense of their gender.2,3 Despite widespread use of these treatments, there is to our knowledge currently only 1 published longitudinal study that follows up transgender adolescents into adulthood.4 In that study of 55 adolescents, psychiatric symptoms improved over the period of the protocol, and none of the adolescents changed their minds or chose to discontinue the gender affirmation process. In our clinical experience, nearly all adolescents who initiate treatment with a GnRHa maintain a transgender identity and continue hormone treatment in adulthood. Occasionally, some adolescents discontinue hormones. Here we present one of those cases, along with a discussion of how clinicians can better understand and support these youths.