Leena Nahata1,2, Gwendolyn P Quinn3,4, Nicole M Caltabellotta2, Amy C Tishelman5,6. 1. 1 Division of Endocrinology, The Research Institute , Nationwide Children's Hospital, Columbus, Ohio. 2. 2 Center for Biobehavioral Health, The Research Institute , Nationwide Children's Hospital, Columbus, Ohio. 3. 3 Health Outcomes and Behavior Program, Moffitt Cancer Center , Tampa, Florida. 4. 4 Morsani College of Medicine, University of South Florida , Tampa, Florida. 5. 5 Harvard Medical School , Boston, Massachusetts. 6. 6 Departments of Endocrinology, Urology and Psychiatry, Boston Children's Hospital , Boston, Massachusetts.
Abstract
PURPOSE: Transgender youth are at high risk for mental health morbidities. Based on treatment guidelines, puberty blockers and gender-affirming hormone therapy should be considered to alleviate distress due to discordance between an individual's assigned sex and gender identity. The goals of this study were to examine the: (1) prevalence of mental health diagnoses, self-injurious behaviors, and school victimization and (2) rates of insurance coverage for hormone therapy, among a cohort of transgender adolescents at a large pediatric gender program, to understand access to recommended therapy. METHODS: An IRB-approved retrospective medical record review (2014-2016) was conducted of patients with ICD 9/10 codes for gender dysphoria referred to pediatric endocrinology within a large multidisciplinary gender program. Researchers extracted the following details: demographics, age, assigned sex, identified gender, insurance provider/coverage, mental health diagnoses, self-injurious behavior, and school victimization. RESULTS: Seventy-nine records (51 transgender males, 28 transgender females) met inclusion criteria (median age: 15 years, range: 9-18). Seventy-three subjects (92.4%) were diagnosed with one or more of the following conditions: depression, anxiety, post-traumatic stress disorder, eating disorders, autism spectrum disorder, and bipolar disorder. Fifty-nine (74.7%) reported suicidal ideation, 44 (55.7%) exhibited self-harm, and 24 (30.4%) had one or more suicide attempts. Forty-six (58.2%) subjects reported school victimization. Of the 27 patients prescribed gonadotropin-releasing hormone analogues, only 8 (29.6%) received insurance coverage. CONCLUSION: Transgender youth face significant barriers in accessing appropriate hormone therapy. Given the high rates of mental health concerns, self-injurious behavior, and school victimization among this vulnerable population, healthcare professionals must work alongside policy makers toward insurance coverage reform.
PURPOSE: Transgender youth are at high risk for mental health morbidities. Based on treatment guidelines, puberty blockers and gender-affirming hormone therapy should be considered to alleviate distress due to discordance between an individual's assigned sex and gender identity. The goals of this study were to examine the: (1) prevalence of mental health diagnoses, self-injurious behaviors, and school victimization and (2) rates of insurance coverage for hormone therapy, among a cohort of transgender adolescents at a large pediatric gender program, to understand access to recommended therapy. METHODS: An IRB-approved retrospective medical record review (2014-2016) was conducted of patients with ICD 9/10 codes for gender dysphoria referred to pediatric endocrinology within a large multidisciplinary gender program. Researchers extracted the following details: demographics, age, assigned sex, identified gender, insurance provider/coverage, mental health diagnoses, self-injurious behavior, and school victimization. RESULTS: Seventy-nine records (51 transgender males, 28 transgender females) met inclusion criteria (median age: 15 years, range: 9-18). Seventy-three subjects (92.4%) were diagnosed with one or more of the following conditions: depression, anxiety, post-traumatic stress disorder, eating disorders, autism spectrum disorder, and bipolar disorder. Fifty-nine (74.7%) reported suicidal ideation, 44 (55.7%) exhibited self-harm, and 24 (30.4%) had one or more suicide attempts. Forty-six (58.2%) subjects reported school victimization. Of the 27 patients prescribed gonadotropin-releasing hormone analogues, only 8 (29.6%) received insurance coverage. CONCLUSION: Transgender youth face significant barriers in accessing appropriate hormone therapy. Given the high rates of mental health concerns, self-injurious behavior, and school victimization among this vulnerable population, healthcare professionals must work alongside policy makers toward insurance coverage reform.
Authors: Tracy A Becerra-Culqui; Yuan Liu; Rebecca Nash; Lee Cromwell; W Dana Flanders; Darios Getahun; Shawn V Giammattei; Enid M Hunkeler; Timothy L Lash; Andrea Millman; Virginia P Quinn; Brandi Robinson; Douglas Roblin; David E Sandberg; Michael J Silverberg; Vin Tangpricha; Michael Goodman Journal: Pediatrics Date: 2018-04-16 Impact factor: 7.124
Authors: Nastasja M de Graaf; Thomas D Steensma; Polly Carmichael; Doug P VanderLaan; Madison Aitken; Peggy T Cohen-Kettenis; Annelou L C de Vries; Baudewijntje P C Kreukels; Lori Wasserman; Hayley Wood; Kenneth J Zucker Journal: Eur Child Adolesc Psychiatry Date: 2020-11-09 Impact factor: 4.785
Authors: Amy C Tishelman; Megan E Sutter; Diane Chen; Amani Sampson; Leena Nahata; Victoria D Kolbuck; Gwendolyn P Quinn Journal: J Assist Reprod Genet Date: 2019-01-03 Impact factor: 3.412
Authors: John F Strang; Meredith D Powers; Megan Knauss; Ely Sibarium; Scott F Leibowitz; Lauren Kenworthy; Eleonora Sadikova; Shannon Wyss; Laura Willing; Reid Caplan; Noor Pervez; Joel Nowak; Dena Gohari; Veronica Gomez-Lobo; David Call; Laura G Anthony Journal: J Autism Dev Disord Date: 2018-12