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TOPIC: transgender medicine

LGBTQ Plus

How A Dutch Clinic Pioneered Pediatric Transgender Healthcare, Through 40 Years Of Criticism

Since its founding in the 1970s, the Amsterdam-based Center of Expertise on Gender Dysphoria has been working with often very young children and their parents to address gender identity issues. Their model has been both adopted and widely criticized around the world.

AMSTERDAM — Relationships between patients and physicians last a long time at Amsterdam’s Center of Expertise on Gender Dysphoria. Some of today’s adult patients have been visiting the clinic since the age of 5, when their parents first noticed signs of gender dysphoria — the experience of distress that can occur when a person’s gender identity does not match the sex they were assigned at birth. For some very young children, the negative feelings subside with the passage of time and they no longer identify as transgender. But for other children, the distress persists into the years leading up to puberty.

These youth can come to the clinic to discuss embarking on a treatment protocol that begins with a diagnostic phase that lasts around six months. During this time, the young people speak with clinicians, fill out questionnaires, and receive mental health support. After that, youth who are interested in a medical transition will be prescribed puberty blockers. From there, they may need to wait a couple of years until becoming eligible for hormones that initiate the development of secondary sex characteristics aligned with their gender identity. At 16, individuals assigned female at birth can get mastectomies. At 18, patients can meet with their physicians to discuss other gender-affirming surgeries, such as hysterectomies, vaginectomies, and phalloplasties (the surgical construction of a penis) for trans men, and vaginoplasties (the surgical construction of a vagina) for trans women.

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