Clinical profiles and care of transgender children and adolescents in a specialized consultation in the Île-de-France region

In a study published in Neuropsychiatrie de l’enfance et de l’adolescence in June 2023, researchers Lagrange and colleagues revisit the figures from the specialized support consultation for trans youth at the Pitié-Salpêtrière Hospital.

Among a population followed since 2012 of 239 young people aged 3 to 20 years, the results indicate an average age at first appointment of 14.5 years. No increase of an “epidemic” nature was observed. One third of the 218 young people meeting the criteria for gender incongruence (ICD-11) had expressed this incongruence before puberty. Two thirds of the young people seen were assigned female at birth, echoing a trend observed in foreign hospital centers. Among those under 12 years old, the proportion was reversed, with two thirds assigned male at birth. Social transitions had already been carried out before the first consultation in 40 % of cases. Among the 239 young people supported, only one suspended their transition.

Co-occurring psychiatric disorders (28 % with a history of psychiatric hospitalization) were dominated by depression (60 % before care) and suicidal behaviours (46 % with a history of suicidality, 24 % with prior suicide attempts), all in a social context strongly marked by discrimination, insults, harassment, violence, and school rejection. A quarter of the young people were out of school for at least three months at the first appointment, and nearly all (97 %) were able to return to school during follow-up care. Attention-deficit/hyperactivity traits were present in 6 % of the young people; autistic traits were observed in 9 %; and anorexia nervosa in 7 %.

Regarding trans-specific care, these interventions were far from systematic. Puberty blockers, indicated only for adolescents, were prescribed to 26 young people (11 %), with a mean age of 13.9 years, after an average delay of 10 months following the first consultation. Hormonal transitions, whether feminizing or masculinizing, involved 105 young people (44 %), at an average age of 16.9 years, after a delay of 14 months. Chest masculinization surgeries were performed for 30 young people (20 % of the transmasculine individuals) at an average age of 18.4 years. No genital surgery was performed before the age of majority.

The Pitié-Salpêtrière consultation is distinguished from other European clinics by a lower rate of hormonal transitions, possibly linked to a greater emphasis on dialogue within the Parisian care system, potentially broadening the range of care options offered to young people.

Click here to access the study