Treating Children with Gender Identity Disorder

By Shoshana Tell

Gender identity disorder (GID) is characterized by gender dysphoria and strong cross-gender identification, which often results in extreme distress. While most children aged 5-12 with GID do not maintain cross-gender identification through adolescence, most adults with GID do report that their cross-gender identification began in childhood. [1]

The medical establishment is increasingly stepping in to help these children delay puberty and/or transition to their desired gender at a later age. Norman Spack, a pediatric endocrinologist who treats transgender youth, explains: “We’re talking about a population that has the highest rate of suicide attempts in the world, and it’s strongly linked to non-treatment, especially if they are rejected within their family for being who they think they are.”[2] Spack also notes that at least one fourth of his patients have admitted to “serious self-harm” before seeking medical treatment.

For children with GID, doctors can delay puberty by administering continuous Gonadotropin Releasing Hormone (GnRH) analogues. In transgender children, the beginning signs of puberty often increase body dysphoria, depression, anxiety, and suicidality. [1] Thus, delaying puberty in children with GID can serve to protect mental health as well as facilitate gender transition if desired at a later date.

However, some argue that delaying puberty may not be the best course, as gender identity in children is in “constant flux.”[2] And while the GnRH therapy is reversible (ie once GnRH is stopped normal puberty can resume), it does have some limited adverse side effects, such as decreased bone mineral density. (However, bone mineral density returns to normal once hormones of the desired gender are later administered.) [1]

Once GID children reach age 16, the next stage in gender transition is initiation of cross-gender hormones (such as estrogen or testosterone), in order to achieve desired masculinization or feminization (in line with their gender identity). The final step, surgical gender reassignment, is not generally performed in the United States until the age of 18. [1]

Some have charged that youth at age 16 are not yet sufficiently mature to weigh the benefits and risks of initiating cross-gender hormone therapy. Taking hormones of the opposite sex causes GID patients to be permanently sterile—as it damages the gonads so they can no longer produce viable sperm or eggs. “This is one of the most controversial aspects of this. At what age can a young person fully understand the implications of doing something that will make fertility for them, by today’s technology, virtually impossible?” explains Dr. Spack, the pediatric endocrinologist. [2]

Shoshana Tell is a second year medical student at the Albert Einstein College of Medicine and an EJBM Contributing Editor.


1. Olson J, Forbes C, Belzer M. Management of the transgender adolescent. Arch Pediatr Adolesc Med. 2011 Feb; 165(2): 171-176.
2. Speigel, Alix. Parents Consider Treatment to Delay Son’s Puberty. NPR: All Things Considered. Access at:

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