Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov;144(5):e20191368.
doi: 10.1542/peds.2019-1368. Epub 2019 Oct 16.

Trends in Referrals to a Pediatric Transgender Clinic

Ted Handler  1 , J Carlo Hojilla  2   3 , Reshma Varghese  4 , Whitney Wellenstein  4 , Derek D Satre  2   3 , Eve Zaritsky  4
Affiliations

Trends in Referrals to a Pediatric Transgender Clinic

Ted Handler et al. Pediatrics. 2019 Nov.

Abstract

Objectives: We characterized referral trends over time at a transgender clinic within an integrated health system in Northern California. We identified the transition-related requests of pediatric transgender and gender-nonconforming patients and evaluated differences in referrals by age group.

Methods: Medical records were analyzed for all patients <18 years of age in the Kaiser Permanente Northern California health system who were referred to a specialty transgender clinic between February 2015 and June 2018. Trends in treatment demand, demographic data, service requests, and surgical history were abstracted from medical charts and analyzed by using descriptive statistics.

Results: We identified 417 unique transgender and gender-nonconforming pediatric patients. The median age at time of referral was 15 years (range 3-17). Most (62%) identified on the masculine spectrum. Of the 203 patients with available ethnicity data, 68% were non-Hispanic. During the study period, the clinic received a total of 506 referrals with a significant increase over time (P < .001). Most referrals were for requests to start cross-sex hormones and/or blockers (34%), gender-affirming surgery (32%), and mental health (27%). Transition-related requests varied by age group: younger patients sought more mental health services, and older patients sought hormonal and surgical services. Eighty-nine patients underwent gender-affirming surgeries, mostly before age 18 and most frequently mastectomies (77%).

Conclusions: The increase in referrals supports the need for expanded and accessible health care services for this population. The transition-related care of patients in this large sample varied by age group, underscoring the need for an individualized approach to gender-affirming care.

PubMed Disclaimer

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Number of pediatric patients referred to a specialty transgender clinic in Northern California between February 2015 and June 2018. The volume of referrals increased significantly, from 56 in 2015 to 154 in year-to-date 2018 (linear test of trend P <.001).
FIGURE 2
FIGURE 2
Services requested varied by age group. Patients aged 8 years or younger were primarily referred for mental health services. Those in early adolescence (9–13 years old) mostly requested mental health services and puberty suppression or cross-sex hormones. The majority of patients in middle adolescence (14–17 years old) were referred for gender-affirming surgery and puberty suppression or cross-sex hormones. Referral categories are not mutually exclusive because patients could request multiple services. P <.001.
See this image and copyright information in PMC

References

    1. Arcelus J, Bouman WP, Van Den Noortgate W, et al. Systematic review and meta-analysis of prevalence studies in transsexualism. Eur Psychiatry. 2015;30(6):807–815 - PubMed
    1. Becerra-Culqui TA, Liu Y, Nash R, et al. Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics. 2018;141(5):e20173845. - PMC - PubMed
    1. Durwood L, McLaughlin KA, Olson KR. Mental health and self-worth in socially transitioned transgender youth. J Am Acad Child Adolesc Psychiatry. 2017;56(2):116–123.e2 - PMC - PubMed
    1. Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE. Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. J Adolesc Health. 2015;57(2):144–149 - PMC - PubMed
    1. Reilly M, Desousa V, Garza-Flores A, Perrin EC. Young children with gender nonconforming behaviors and preferences. J Dev Behav Pediatr. 2019;40(1):60–71 - PubMed

Publication types