News

Stanford Children's Health begins to offer transgender care

Multidisciplinary clinic to open in Santa Clara County in eight to 12 months

Stanford Children's Health has begun to offer medical and other services to transgender children and adolescents, with an eye toward opening within the next year a more comprehensive multidisciplinary clinic to support what health providers say is a growing population.

Stanford begun offering hormonal treatments to transgender children and adolescents for the first time about six months ago, filling a void in the Peninsula. Families in the area seeking this care typically go to the Child and Adolescent Gender Center at University of California, San Francisco (UCSF), which offers comprehensive medical and psychological care, as well as advocacy and legal support, to transgender and gender non-conforming youth and adolescents.

Families who previously approached Stanford for care would typically be referred to the UCSF center, said Tandy Aye, a Stanford pediatric endocrinologist who started treating transgender children and adolescents about six months ago. She said she saw an "increasing need" and felt compelled to support local families.

Aye is currently seeing nine patients and receives several referrals per month. One family drove from as far away as six and a half hours because they couldn't access the services they needed where they live; another lives as close as Palo Alto, Aye said. Her patients are as young as 4 1/2 years old and as old as 15 years old.

"We're assessing the need, but it seems like the need is there and growing," Aye said.

In addition to providing medical services, Aye is also working with mental health providers and social workers to guide and advise families throughout their personal processes, which vary greatly from family to family and also, depending on the age of the child.

A younger child who has yet to enter puberty might be a candidate for puberty blockers, a set of medications that are prescribed by an endocrinologist to suppress or inhibit the production of sex hormones.

A teenager who has already gone through puberty, however, might opt for cross-sex hormone treatment, which can induce the physical and psychological characteristics of the sex that matches the patient's gender identity.

Patients must be evaluated by a mental health professional before receiving these treatments.

Though controversial, recognizing a child's gender dysphoria early – before puberty – and opting for puberty blockers can change the course of his or her transition drastically. The treatment is fully reversible, but can give "young people time to achieve greater self-awareness of their gender identification," according to the UCSF center's website.

"People are noticing, also, that if these children get the treatment they need even from an earlier age and not wait so long, the depression and suicide and other comorbidities ... are improved," Aye said. "Kids are happier."

Teenagers with persistent gender dysphoria experience a high rate of psychiatric comorbidities, including depression, suicidal ideation and attempted suicide, according to UCSF.

Transitioning during puberty can also mean "less corrective surgery down the road," Aye said.

A patient of any age might be in the process of deciding whether or not to socially transition at school, a decision that Aye and other professionals also work to support.

"That's all, to me, part of the treatment," she said.

This approach is a preview of what's to come at Stanford within the next year: a multidisciplinary clinic that would bring all of the subspecialties transgender children and adolescents need to access – pediatric endocrinology, adolescent medicine, psychiatry, psychology, social work, OBGYN and urology – under one roof. This increases access for both patients and their providers, who can then more easily collaborate with each other, Aye said.

Stanford Children's Health plans to open this clinic somewhere in Santa Clara County in the next eight to 12 months.

Aye, along with Stanford child and adolescent psychiatrist David Hong, is also in the midst of a pilot study that will follow both children with and without gender dysphoria for two to three years as they go through puberty.

The study aims to examine the physiological effects of puberty blockers and cross-sex hormones, an area Aye said has not been studied before in the United States. They are currently accepting study participants.

Comments

8 people like this
Posted by cynic
a resident of Fairmeadow
on Oct 8, 2015 at 10:25 am

Sounds like this must be a growth field in terms of revenue for Stanford. Either that or research (and research funding) is the objective.


12 people like this
Posted by Sylvia
a resident of Midtown
on Oct 8, 2015 at 12:01 pm

Good for Stanford. Treatment for children with gender dysphoria is important.


11 people like this
Posted by Keith
a resident of Community Center
on Oct 8, 2015 at 12:36 pm

As a parent of a transgender child, I am very glad that Stanford is moving forward on this front. Its a big challenge for parents when their child identifies or even seems to identify as the opposite gender from the one assigned at birth. Its likely Stanford considers the demand to justify a business case for providing such counseling and medical services. Most people don't encounter transgender issues within their own families, but some do, and in a population as big as live in the Stanford served area, that could be a large number.


1 person likes this
Posted by Member
a resident of Crescent Park
on Oct 8, 2015 at 5:37 pm

[Post removed.]


6 people like this
Posted by Cece
a resident of Portola Valley
on Oct 8, 2015 at 7:40 pm

This is wonderful. It's such a long wait to get into UCSF's gender clinic.

For those feeling cynical: you may not be aware that the number of kids who need these services seems to be growing at a huge rate. No one seems to know why yet: is it changes in society, or changes in the environment/biology? Certainly there are a lot of adults who have gone through the difficult process of gender reassignment later in life, whose lives might have been much less painful if they could have grown up in a body that matched their self-identity. Let's allow this generation of kids the chance to feel more integrated in their bodies and selves.

Fact: suicide rates in transgender teens are higher than almost any other group. They need our support and understanding. Please don't be cruel (if you're uncomfortable, you might be able to empathize at how much worse it is to feel uncomfortable with your body or gender, compared to the minor discomfort of thinking about someone else's struggles).


12 people like this
Posted by Tomboy
a resident of Mountain View
on Oct 8, 2015 at 8:48 pm

When I was about 4 to about 11 years old, I totally wanted to be a boy instead of a girl. In those days, we were referred to as tomboys. I was desperate to be a boy and I despised being a girl. I hated girl clothes and girl activities.
Fortunately, there were no options for transgender kids in those days, because if offered, I would have leaped on the chance to be a boy.
By several years after puberty, I realized that my former desires to be a boy disappeared.
Based on my personal experience, I believe that adults should not assume that a child who vocalizes a desire to be of the opposite sex must be taken seriously. Instead, the child must be given space to grow and find his or her own way in our world.


12 people like this
Posted by HereNow
a resident of Charleston Meadows
on Oct 8, 2015 at 9:21 pm

HereNow is a registered user.

@Tomboy: Tomboys still exist. No one's forcing or even encouraging tomboys or anyone to transition. Transgender children don't say they wish they were a boy/girl. They say they *are* a boy/girl. Big difference. They are insistent, consistent, persistent. It's rare for kids who identify as transgender to change their minds, but that's why we offer our kids puberty blockers -- just in case they do. Hormone blockers just push the pause button on puberty and are completely reversible and safe (they've been used for decades for kids with precocious puberty). What we do know is that 57% of transgender youth who aren't supported by their parents will attempt suicide. I have a happy transgender child. I'm very grateful she wasn't born back when "there were no options for transgender kids." I'm also happy Stanford will be opening their clinic in time for my daughter to take full advantage of their services.


2 people like this
Posted by Anon
a resident of another community
on Oct 9, 2015 at 2:11 am

HereNow,

That's not true--there have been a couple of studies of kids whose families sought treatment for their gender dysphoria and the vast majority (75-80 percent) of them did not become transgender as adults. (Most identify as gay or bi as adults.)

Hormone blockers are not "safe with zero repercussions". Lupron is one of the main puberty blockers used--there was a big settlement because Lupron has serious side effects:

Web Link

Also, the suicide rate is tragically high among those with gender dysphoria--but the rate doesn't drop post-transition--indicating that transitioning is not a cure-all.

Because the issue is so politicized, there's a real lack of research and critical analysis. I shudder at the idea of treating young kids with powerful drugs when we don't really know what the long-term repercussions are on brain, bone and muscle development.

I think adults should be able to do what they want as long as it doesn't infringe upon the rights of others and kids can wear the clothes of either gender (and have the right to a safe bathroom), but putting young kids on heavy-duty drugs when there's no medical need to do so, when they are in no position to give mature, informed consent horrifies me.


2 people like this
Posted by DSM_bloat
a resident of Another Palo Alto neighborhood
on Oct 9, 2015 at 7:01 am

"In the upcoming [now published] fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people whose gender at birth is contrary to the one they identify with will be diagnosed with gender dysphoria."

Web Link

"DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process."

Id.

The National Institute of Mental Health (NIHM) rejected the DSM, saying:

"The weakness” of the manual, [the Director of the NIHM] explained in a sharply worded statement, “is its lack of validity.” “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."

Such diagnoses, for children aged as young as 4 1/2, and prescription of powerful drugs to interfere with puberty should shock one's conscience.


Web Link


7 people like this
Posted by HereNow
a resident of Charleston Meadows
on Oct 9, 2015 at 7:05 am

HereNow is a registered user.


Dear Anon,

Those couple of studies you’re referring to that showed 75–80% of gender dysphoric children were not actually transgender have long been debunked:
Web Link

Your claim that the suicide rate doesn’t drop post-transition is also extremely flawed, as is also explained by the above article I provided, which sites all the original research.

There is a lack of research on the effects of pubertal suppression and cross-sex hormones in the U.S., but not in other parts of the world. The Netherlands has been way ahead of the U.S. in this field and in providing proper medical care to transgender youth. As with all medical intervention, there is always risk of adverse side effects. Parents must weigh the risk of these side effects with the risk of not providing their child with affirming medical care (depression, suicide, etc).

Pubertal suppression and cross-sex hormones has been shown to be safe and effective (2013, published by The Endocrine Society, “the world’s oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology”)
Web Link

Another (2014, published by Pediatrics, the official journal of the American Academy of Pediatrics):
“Conclusion: A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.”
Web Link

I’m a parent of a transgender child, so I’ve done my research. I’ll continue to follow the advice of my child’s medical team.


5 people like this
Posted by HereNow
a resident of Charleston Meadows
on Oct 9, 2015 at 7:30 am

HereNow is a registered user.

DSM_bloat,

You are saying that because the NIHM rejects the entire Diagnostic and Statistical Manual of Mental Disorders that this means children shouldn't be supported in their gender identity? That's quite a leap of logic. Should psychiatrists stop prescribing antidepressants to those with depression as well?

At any rate, it appears that the NIHM is merely working on a new classification system and doesn't actually reject the DSM.
Web Link


2 people like this
Posted by DSM_bloat
a resident of Another Palo Alto neighborhood
on Oct 9, 2015 at 8:00 am

@HereNow

This statement by the NIMH has not been retracted:

"The weakness" of the manual, [the Director of the NIMH] explained in a sharply worded statement, "is its lack of validity." "Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."

Web Link

Cite if it has. I'd like to know if so.

Replacing an "invalid" DSM in favor of a body of work that has objective measure is no mere change. We'll see what disorders have an objective basis, and which did not. In the meantime, it's shocking that strong treatments are suggested for children when the underlying diagnosis has no objective basis.

As to depression, and other mental disorders in the DSM, my understanding is that there is an objective basis. It's the manual's bloat over time, based on clusters of clinical reports, that has the NIMH requiring that any research it funds not rely solely on the DSM.


5 people like this
Posted by HereNow
a resident of Charleston Meadows
on Oct 9, 2015 at 8:17 am

HereNow is a registered user.

DSM_bloat:
The article I cited explains that the NIHM is working on a new classification system that they believe will be better than the DSM, but that doesn't make the DSM invalid.

Gender dysphoria used to be classified as gender identity disorder in the DSM, but as it's no longer considered to be a mental illness it's now listed as gender dysphoria. Keeping gender dysphoria in the DSM is controversial, but without it being listed in the DSM, health insurance won't cover needed medical care. Unfortunately, that's how our system works right now. "Homosexuality" also used to be listed in the DSM.


5 people like this
Posted by DSM_bloat
a resident of Another Palo Alto neighborhood
on Oct 9, 2015 at 9:35 am

@HereNow

Again, the thrust is this: it's shocking that strong treatments, including interrupting natural development/puberty, are suggested for children when the underlying diagnosis has no objective basis according to the National Institute of Mental Health (NIMH). See comments above.

Three points and I'm finished commenting:

1) You write that "[g]ender dysphoria used to be classified as gender identity disorder in the DSM, but as it's no longer considered to be a mental illness it's now listed as gender dysphoria."

The DSM differs with you.

To begin with, all entries in the DSM are mental disorders, as identified by the psychiatrists' organization that publishes and updates the DSM. Indeed, DSM is an acronym for "Diagnosis and Statistical Manual of Mental Disorders" (Web Link).

Further, the DMS fact sheet (Id.) says

"[The new 5th edition of the Diagnosis and Statistical Manual of Mental Disorders] replaces the diagnostic name “gender identity disorder” [in an earlier edition] with “gender dysphoria,” as well as makes other important clarifications in the criteria. It is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition."

According to the DSM fact sheet, the re-naming is about stigma and insurance, not as you say "...it's no longer considered to be a mental illness." From the same DSM fact sheet's paragraph explaining the re-naming, above:

"While diagnostic terms facilitate clinical care and access to insurance coverage that supports mental health, these terms can also have a stigmatizing effect."

Again, it's the shockingly strong treatment, including interrupting natural development/puberty, suggested for children when the underlying diagnosis has no objective basis. The disorder rests only on a clinical perception of "distress."


2) The author of an article you cite describes himself as a founder and CEO of a website, and claims to be an expert in "...mental health online," (see article footer), whatever that may be. He is of the opinion that the National Institute of Mental Heath (NIMH) does not reject the DMS.

Nevertheless, the NIMH speaks for itself. The NIMH stands by the statement below, and will not fund research on disorders identified based on the DSM alone. Cite please if the NIMH has retracted.

"The weakness" of the manual, [the Director of the NIMH] explained in a sharply worded statement, "is its lack of validity." "Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."

Web Link

3) Your comment about earlier editions of the DSM including homosexuality as a disorder makes my point. Here, and with homosexuality if radically strong treatments were suggested to treat it as a DSM disorder, it's the mismatch between such strong treatment and no objective basis for the underlying DSM diagnosis that shocks the conscience.


5 people like this
Posted by HereNow
a resident of Charleston Meadows
on Oct 9, 2015 at 10:22 am

HereNow is a registered user.

DSM_bloat:
I'm not here to be a cheerleader for the DSM.
I was merely pointing out that your logic was flawed and continues to be (Just one ex: to "prove" your point that gender dysphoria is a mental illness you quote the DSM, including this part: "It is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition." Distress can be anxiety, depression, etc.)

If you care to read more about the science of gender nonconformity and why so many medical professionals disagree with you, here's a place to start: Web Link

I stand by my comments. I'm now going to spend the rest of the day with my happy, healthy children.


Like this comment
Posted by DSM_bloat
a resident of Another Palo Alto neighborhood
on Oct 9, 2015 at 10:46 am

@HereNow

Have a good day. When you have time, you should re-read the Diagnosis and Statistical Manual of Mental Disorders (DSM) cite because you conflate what the DSM refers to as "gender non-conformity" (deemed not a disorder) with "gender dysphoria," which is one of the DSM's disorders.








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