If pediatric endocrinologist and adolescent medicine specialist Norman Spack, M.D.,
were giving a presentation on caring for transgender youths 15-20 years ago, pediatricians’
reaction might have been: “Why is this relevant to me?”
“In my more recent experience, I find that the pediatricians I have spoken to are
craving more information about these kids,” said Dr. Spack, founder and director emeritus
of Gender Management Service (GeMS) at Boston Children’s Hospital and associate clinical
professor of pediatrics at Harvard Medical School.
Dr. Spack aims to satisfy pediatric health care professionals’ desire for more information
during a plenary session titled “Caring for Transgender Youth (P4042)” from 10:50-11:10
a.m. Tuesday, Nov. 6, in the Valencia Ballroom of the convention center.
He will begin by defining terms that often are a source of confusion such as gender,
sex, sexual orientation and gender identity. Then, he will review the use of puberty
blockers, outcomes data and the mental health consequences of starting treatment after
puberty, which he has seen firsthand.
Dr. Spack began working with transgender adults in 1985. Since then, he has cared
for about 250 adults, most of whom were not treated in early adolescence and were
physically mature in ways that were not easily changeable. As a result, many showed
serious social and family disruption, he said.
Now, transgender adolescents have access to medications that suppress puberty through
a clinical protocol pioneered in the Netherlands. Later, if desired, they can take
cross-sex hormones and undergo gender reassignment surgery. If an adolescent decides
to stop taking the puberty-blocking medication, he or she will progress through puberty.
“The Dutch developed this protocol (to block puberty) because they were giving their
adult patients everything anyone could get — free care, free medicine, free surgery
— and yet their suicidality was horrible,” said Dr. Spack, who went to the Netherlands
to learn about the protocol.
The Academy recently published the policy statement Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children
and Adolescents (https://doi.org/10.1542/peds.2018-2162), which outlines the pediatrician’s role in promoting the health and positive development
of transgender youths. The policy states that interventions, including pubertal suppression,
hormones and surgery, may be appropriate for some transgender individuals, but risks,
benefits and factors unique to each patient and family should be considered.
Since he began caring for transgender children in 1990, Dr. Spack has had hundreds
of patients. He plans to show photos of some of them to illustrate the physical effects
of puberty blockers and discuss the positive impact he has seen on their mental health.
“Do you know that if nobody does anything or provides support to the kids who happen
to be transgender, between age 16 and 25, 45% will attempt suicide in that interval,”
Therefore, it’s important for pediatricians to ask nonthreatening questions to determine
if youths are struggling with their gender identity and to support them, Dr. Spack
“I want them (pediatricians) to understand that kids who I get (as patients) have
been in somebody’s pediatric practice,” he said. “That’s why I want them to be prepared.”