Management of gender dysphoria in adolescents in primary care

Abstract

Adolescents with gender dysphoria present in a variety of health care settings, including primary care. Gender dysphoria is the distress experienced by an individual when their gender identity and their gender assigned at birth are discordant. Many tertiary pediatric centres across Canada and the Unites States have opened gender clinics for adolescents with gender dysphoria.1 However, high demand often exceeds the capacity of these clinics, and many youth are prevented from accessing such centres for a variety of reasons (e.g., lack of parental or physician support, geographical distance). Primary care providers are well placed to provide critical support for youth with gender dysphoria and their caregivers and families. However, primary care providers often lack exposure to trans health issues in training, and may lack experience in managing gender dysphoria in youth. A recent Canadian national survey found that less than 50% of transgender youth felt comfortable discussing their trans-related health care needs with their family doctor.2 We provide an overview of the management of gender dysphoria in postpubertal adolescents, including practical advice on approaches to social and medical transitioning, aimed at supporting primary care practitioners in supporting youth with gender dysphoria in their practices. We use the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria when referring to gender dysphoria. Because definitions and approaches to care have changed over the past 2 decades, we focus mainly on recent research that reflects the current diagnostic criteria, studies that apply contemporary assessment and measurement strategies, and findings that are applicable across multiple clinical settings. Our approach to gathering evidence used in this review is presented in Box 1. Box 2 defines commonly used terms.