Pediatric Transgender Care: Experience of a Swiss Tertiary Center Over the Past Decade

Abstract

Youth with gender dysphoria are increasing in numbers worldwide. We investigated the cohort of gender dysphoric youth for this trend referred to a Swiss University Children’s Hospital and assessed clinical characteristics and outcome of hormonal treatments at the Division of Pediatric Endocrinology. The retrospective study included 57 pediatric individuals referred between 2012 and 2021. Characteristics of 28 hormonally treated subjects with a diagnosis of transsexualism (ICD-10) were assessed. The number of subjects with gender dysphoria and with a diagnosis of transsexualism increased over the years, but the increase was less pronounced in the latter. A similar trend was found in a nationwide survey for the nine largest pediatric endocrine units in Switzerland. Of the 28 hormonally treated subjects in our center, 78% were trans males and 61% had psychiatric comorbidities. Height and BMI of individuals with transsexualism were normal and did not change under hormonal therapies in the first years. Thus, our study confirms the world-wide trend of increasing numbers of adolescents with gender dysphoria and transsexualism in Switzerland, and the predominance of trans males over trans females. In our cohort, however, numbers of subjects receiving hormonal treatments did not rise proportionally, possibly due to strict diagnosis and psychological assessments before referral. Similar to other studies, we also found an alerting high prevalence of psychiatric comorbidities that needed additional treatment. Therefore, hormonal treatments should only be offered to trans gender youth after careful evaluation by specialized mental health care professionals as recommended in current guidelines.