{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:31:28Z","timestamp":1791340288143,"version":"4.3.1"},"reference-count":18,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVES:<\/jats:title>\n                  <jats:p>To describe the patients with gender identity disorder referred to a pediatric medical center. We identify changes in patients after creation of the multidisciplinary Gender Management Service by expanding the Disorders of Sex Development clinic to include transgender patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>Data gathered on 97 consecutive patients &amp;lt;21 years, with initial visits between January 1998 and February 2010, who fulfilled the following criteria: long-standing cross-gender behaviors, provided letters from current mental health professional, and parental support. Main descriptive measures included gender, age, Tanner stage, history of gender identity development, and psychiatric comorbidity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Genotypic male:female ratio was 43:54 (0.8:1); there was a slight preponderance of female patients but not significant from 1:1. Age of presentation was 14.8 \u00b1 3.4 years (mean \u00b1 SD) without sex difference (P = .11). Tanner stage at presentation was 4.1 \u00b1 1.4 for genotypic female patients and 3.6 \u00b1 1.5 for genotypic male patients (P = .02). Age at start of medical treatment was 15.6 \u00b1 2.8 years. Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>After establishment of a multidisciplinary gender clinic, the gender identity disorder population increased fourfold. Complex clinical presentations required additional mental health support as the patient population grew. Mean age and Tanner Stage were too advanced for pubertal suppressive therapy to be an affordable option for most patients. Two-thirds of patients were started on cross-sex hormone therapy. Greater awareness of the benefit of early medical intervention is needed. Psychological and physical effects of pubertal suppression and\/or cross-sex hormones in our patients require further investigation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2011-0907","type":"journal-article","created":{"date-parts":[[2012,2,21]],"date-time":"2012-02-21T01:26:56Z","timestamp":1329787616000},"page":"418-425","source":"Crossref","is-referenced-by-count":329,"title":["Children and Adolescents With Gender Identity Disorder Referred to a Pediatric Medical Center"],"prefix":"10.1542","volume":"129","author":[{"given":"Norman P.","family":"Spack","sequence":"first","affiliation":[{"name":"Division of Endocrinology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Edwards-Leeper","sequence":"additional","affiliation":[{"name":"Division of Endocrinology,"},{"name":"Departments of Psychiatry and"},{"name":"Urology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry A.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Division of Endocrinology,"},{"name":"Clinical Research Program, Children\u2019s Hospital Boston, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Leibowitz","sequence":"additional","affiliation":[{"name":"Departments of Psychiatry and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francie","family":"Mandel","sequence":"additional","affiliation":[{"name":"Division of Endocrinology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Diamond","sequence":"additional","affiliation":[{"name":"Urology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley R.","family":"Vance","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts; and"},{"name":"Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2012,3,1]]},"reference":[{"key":"2021120903032829000_B1"},{"issue":"7","key":"2021120903032829000_B2","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1097\/00004583-199707000-00008","article-title":"Gender identity disorder: a review of the past 10 years","volume":"36","author":"Bradley","year":"1997","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"12","key":"2021120903032829000_B3","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1097\/CHI.0b013e31818956b9","article-title":"Psychosexual outcome of gender-dysphoric children","volume":"47","author":"Wallien","year":"2008","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"2","key":"2021120903032829000_B4","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s10508-009-9540-4","article-title":"The DSM diagnostic criteria for gender identity disorder in children","volume":"39","author":"Zucker","year":"2010","journal-title":"Arch Sex Behav"},{"issue":"9","key":"2021120903032829000_B5","doi-asserted-by":"crossref","first-page":"3132","DOI":"10.1210\/jc.2009-0345","article-title":"Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline","volume":"94","author":"Hembree","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"2021120903032829000_B6","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1521\/suli.2007.37.5.527","article-title":"Transgender youth and life-threatening behaviors","volume":"37","author":"Grossman","year":"2007","journal-title":"Suicide Life Threat Behav"},{"key":"2021120903032829000_B7"},{"issue":"21","key":"2021120903032829000_B8","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1056\/NEJM198311243092104","article-title":"Long-term treatment of central precocious puberty with a long-acting analogue of luteinizing hormone-releasing hormone. 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