Delaying Puberty Could Help Gender Confused Kids

However, enduring puberty when you feel you are in the wrong body can cause intense distress, and has even driven some teenagers to contemplate suicide.

"They self-harm, they develop an enormous aversion against their bodies, they isolate themselves and their school performance suffers," says Delemarre-van de Waal.

Marvin Belzer of Children's Hospital in Los Angeles, who has treated several 12 and 13 year-olds with puberty blockers, agrees that there are some difficulties, but that the risks should be weighed against the benefits.

"That's what informed consent is all about," he says. While it's possible that a teenager might change his or her mind, "The question is, can we go back and say, 'yes, but you and your family had informed consent, and we knew that that was one of the risks, but that risk was small'."

The guidelines have been welcomed by transgender support groups who work with young people. "It is an excellent piece of work," says Bernard Reed, a trustee of the Gender Identity Research and Education Society (GIRES), based in Ashtead, UK. He hopes that British doctors will read the guidelines and consider delaying puberty in young teenagers with gender identity disorder.

Assessment Issues

Meanwhile, in the US, where just a handful of clinics – including Belzer's – offer puberty blockers to young teenagers, the guidelines may encourage more physicians to consider this option.

"This document may spur more to want to treat this," says Belzer. "What I worry is, will they really have the mental health providers [qualified to assess young teenagers]? Many of them will, and hopefully they'll acquire more experience over time."

He also hopes that the guidelines - which offer advice on treating adult transsexuals as well as teenagers - will encourage insurance companies to cover more of the medical costs of treating gender identity disorder. Puberty blockers currently cost around $800 a month, for example.

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