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Males vs Females: more than the physical differences

organized by the Endocrinology & Diabetes Section

The Royal Society of Medicine

Tuesday 10 October 2006

I attended the above meeting yesterday afternoon, which was held in the North Hall at the RSM in Wimpole St London.  There were several presentations by eminent professionals during the four hour session.  Primarily my motives for attending; have relation to my recent Research Call:  “Gender Identity Disorder in Children & Adolescents”(A Confusing Time for Everyone)

Therefore, my interest the presentations; ‘Gender Dysphoria in the adolescent:

(a)   The UK experience in management, which was presented by Dr Caroline Brain, Dr Polly Carmichael & Dr Russell Viner.

(b)   The Dutch experience in management, which was presented by Professor Henriette Delemarre van de Waal

The UK presentation from my point of view was not very convincing, around their protocol/ethics of not providing GnRH analogue (GnRHa) treatment for the suppression of endogenous puberty, even though these adolescents fulfil the DSM-IV criteria for gender disorder at Tanner Stage two.  Treatment in the UK does not commence until after the 16^th birthday (Tanner Stage four/five).  I can comprehend how these adolescents at 16 years age (adulthood) feel, they have been allowed to develop physically in the opposite gender.  They then have to face the same regime of treatments as adults with GID, is there any wonder they suffer; depression, suicidal, socially and often unable to form relationships.  The guidance published by the Royal College of Psychiatrists (1998) & Standards of Care Harry Benjamin International Gender Dysphoria Association (2001) both permit treatment with hormone blockers at Tanner Stage two for those who are experiencing profound and persistent gender dysphoria.  The UK presenters were reminded of this from the audience by both Dr Simona Giordano and Bernard Reed.

The Dutch presentation was excellent in both the verbal and photographic evidence of results of their treatment of gender dysphoric adolescents.  The Professor discussed the adolescents attending the Dutch Clinic, who fulfilled the DSM-IV criteria, who were eligible for the suppression of endogenous puberty, along with that they were psychologically stable and were living in a supportive environment.  The suppression of puberty she stated “is seen as supporting the diagnostic treatment, that if the patient exploring his/her gender identity in therapy no longer wishes to pursue sex reassignment, the pubertal delay will be discontinued”

The advantages of early treatment are the suppression of secondary sex characteristics; FTM breast development, MtF testicular volume regressed.  Cross-sex steroid hormones are given at 16 years, if there were no contraindications.  There are changes in bone structure; the Professor remarked that with this treatment regime the height velocity for MtF slightly decreased and for FtM slightly increased.  We were then shown pictures of a 19 year old MtF and FtM who have gone through this whole cycle of treatment at the Dutch Clinic. The results were outstanding; to everyone they would be thought of as being biological female and male.  From my point of view the UK team were put back on their heels a little and failed to answer adequately the few questions allowed after the Dutch presentation.