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  1. Article ; Online: Medical decision-making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians.

    Vrouenraets, Lieke Josephina Jeanne Johanna / de Vries, Annelou L C / Arnoldussen, Marijn / Hannema, Sabine E / Lindauer, Ramón J L / de Vries, Martine C / Hein, Irma M

    European child & adolescent psychiatry

    2022  Volume 32, Issue 11, Page(s) 2343–2361

    Abstract: According to international transgender care guidelines, transgender adolescents should have medical decision-making competence (MDC) to start puberty suppression (PS) and halt endogenous pubertal development. However, MDC is a debated concept in ... ...

    Abstract According to international transgender care guidelines, transgender adolescents should have medical decision-making competence (MDC) to start puberty suppression (PS) and halt endogenous pubertal development. However, MDC is a debated concept in adolescent transgender care and little is known about the transgender adolescents', their parents', and clinicians' perspectives on this. Increasing our understanding of these perspectives can improve transgender adolescent care. A qualitative interview study with adolescents attending two Dutch gender identity clinics (eight transgender adolescents who proceeded to gender-affirming hormones after PS, and six adolescents who discontinued PS) and 12 of their parents, and focus groups with ten clinicians was conducted. From thematic analysis, three themes emerged regarding transgender adolescents' MDC to start PS: (1) challenges when assessing MDC, (2) aspects that are considered when assessing MDC, and (3) MDC's relevance. The four criteria one needs to fulfill to have MDC-understanding, appreciating, reasoning, communicating a choice-were all, to a greater or lesser extent, mentioned by most participants, just as MDC being relative to a specific decision and context. Interestingly, most adolescents, parents and clinicians find understanding and appreciating PS and its consequences important for MDC. Nevertheless, most state that the adolescents did not fully understand and appreciate PS and its consequences, but were nonetheless able to decide about PS. Parents' support of their child was considered essential in the decision-making process. Clinicians find MDC difficult to assess and put into practice in a uniform way. Dissemination of knowledge about MDC to start PS would help to adequately support adolescents, parents and clinicians in the decision-making process.
    MeSH term(s) Child ; Humans ; Male ; Adolescent ; Female ; Transgender Persons ; Gender Identity ; Puberty ; Qualitative Research ; Parents
    Language English
    Publishing date 2022-09-17
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1118299-4
    ISSN 1435-165X ; 1018-8827 ; 1433-5719
    ISSN (online) 1435-165X
    ISSN 1018-8827 ; 1433-5719
    DOI 10.1007/s00787-022-02076-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 3524: Show issues Location:
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  2. Article ; Online: Dealing with Moral Challenges in Treatment of Transgender Children and Adolescents: Evaluating the Role of Moral Case Deliberation.

    Vrouenraets, Lieke Josephina Jeanne Johanna / Hartman, Laura A / Hein, Irma M / de Vries, Annelou L C / de Vries, Martine C / Molewijk, Bert A C

    Archives of sexual behavior

    2020  Volume 49, Issue 7, Page(s) 2619–2634

    Abstract: Treatment teams providing affirmative medical transgender care to young people frequently face moral challenges arising from the care they provide. An adolescent's capacity to consent, for example, could raise several issues and challenges. To deal with ... ...

    Abstract Treatment teams providing affirmative medical transgender care to young people frequently face moral challenges arising from the care they provide. An adolescent's capacity to consent, for example, could raise several issues and challenges. To deal with these challenges more effectively, several Dutch treatment teams started using a relatively well-established form of clinical ethics support (CES) called Moral Case Deliberation (MCD). MCD is a facilitator-led, collective moral inquiry based on a real case. This study's purpose is to describe the teams' perceived value and effectiveness of MCD. We conducted a mixed methods evaluation study using MCD session reports, individual interviews, focus groups, and MCD evaluation questionnaires. Our results show that Dutch transgender care providers rated MCD as highly valuable in situations where participants were confronted with moral challenges. The health care providers reported that MCD increased mutual understanding and open communication among team members and strengthened their ability to make decisions and take action when managing ethically difficult circumstances. However, the health care providers also expressed criticisms of MCD: some felt that the amount of time spent discussing individual cases was excessive, that MCD should lead to more practical and concrete results, and that MCD needed better integration and follow-up in the regular work process. We recommend future research on three matters: studying how MCD contributes to the quality of care, involvement of transgender people themselves in MCD, and integration of CES into daily work processes.
    MeSH term(s) Adolescent ; Child ; Ethics Consultation/standards ; Female ; Humans ; Male ; Morals ; Surveys and Questionnaires ; Transgender Persons/psychology
    Language English
    Publishing date 2020-06-26
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 184221-3
    ISSN 1573-2800 ; 0004-0002
    ISSN (online) 1573-2800
    ISSN 0004-0002
    DOI 10.1007/s10508-020-01762-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1106: Show issues Location:
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  3. Article ; Online: Perceptions of Sex, Gender, and Puberty Suppression: A Qualitative Analysis of Transgender Youth.

    Vrouenraets, Lieke Josephina Jeanne Johanna / Fredriks, A Miranda / Hannema, Sabine E / Cohen-Kettenis, Peggy T / de Vries, Martine C

    Archives of sexual behavior

    2016  Volume 45, Issue 7, Page(s) 1697–1703

    Abstract: International guidelines recommend the use of Gonadotropin-Releasing Hormone (GnRH) agonists in adolescents with gender dysphoria (GD) to suppress puberty. Little is known about the way gender dysphoric adolescents themselves think about this early ... ...

    Abstract International guidelines recommend the use of Gonadotropin-Releasing Hormone (GnRH) agonists in adolescents with gender dysphoria (GD) to suppress puberty. Little is known about the way gender dysphoric adolescents themselves think about this early medical intervention. The purpose of the present study was (1) to explicate the considerations of gender dysphoric adolescents in the Netherlands concerning the use of puberty suppression; (2) to explore whether the considerations of gender dysphoric adolescents differ from those of professionals working in treatment teams, and if so in what sense. This was a qualitative study designed to identify considerations of gender dysphoric adolescents regarding early treatment. All 13 adolescents, except for one, were treated with puberty suppression; five adolescents were trans girls and eight were trans boys. Their ages ranged between 13 and 18 years, with an average age of 16 years and 11 months, and a median age of 17 years and 4 months. Subsequently, the considerations of the adolescents were compared with views of clinicians treating youth with GD. From the interviews with the gender dysphoric adolescents, three themes emerged: (1) the difficulty of determining what is an appropriate lower age limit for starting puberty suppression. Most adolescents found it difficult to define an appropriate age limit and saw it as a dilemma; (2) the lack of data on the long-term effects of puberty suppression. Most adolescents stated that the lack of long-term data did not and would not stop them from wanting puberty suppression; (3) the role of the social context, for which there were two subthemes: (a) increased media-attention, on television, and on the Internet; (b) an imposed stereotype. Some adolescents were positive about the role of the social context, but others raised doubts about it. Compared to clinicians, adolescents were often more cautious in their treatment views. It is important to give voice to gender dysphoric adolescents when discussing the use of puberty suppression in GD. Otherwise, professionals might act based on assumptions about adolescents' opinions instead of their actual considerations. We encourage gathering more qualitative research data from gender dysphoric adolescents in other countries.
    MeSH term(s) Adolescent ; Female ; Gonadotropin-Releasing Hormone/agonists ; Gonadotropin-Releasing Hormone/therapeutic use ; Humans ; Male ; Puberty/drug effects ; Qualitative Research ; Transgender Persons/psychology
    Chemical Substances Gonadotropin-Releasing Hormone (33515-09-2)
    Language English
    Publishing date 2016-06-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 184221-3
    ISSN 1573-2800 ; 0004-0002
    ISSN (online) 1573-2800
    ISSN 0004-0002
    DOI 10.1007/s10508-016-0764-9
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1106: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study.

    Vrouenraets, Lieke Josephina Jeanne Johanna / Fredriks, A Miranda / Hannema, Sabine E / Cohen-Kettenis, Peggy T / de Vries, Martine C

    The Journal of adolescent health : official publication of the Society for Adolescent Medicine

    2015  Volume 57, Issue 4, Page(s) 367–373

    Abstract: Purpose: The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in ...

    Abstract Purpose: The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions. The aim of this study was to explicate the considerations of proponents and opponents of puberty suppression in GD to move forward the ethical debate.
    Methods: Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide.
    Results: Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits.
    Conclusions: As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required.
    MeSH term(s) Adolescent ; Adolescent Health ; Child ; Child Health ; Female ; Gender Dysphoria/diagnosis ; Gender Dysphoria/drug therapy ; Gender Dysphoria/epidemiology ; Gender Identity ; Gonadal Steroid Hormones/therapeutic use ; Gonadotropin-Releasing Hormone/therapeutic use ; Humans ; Male ; Practice Guidelines as Topic ; Puberty ; Qualitative Research ; Sexual Maturation
    Chemical Substances Gonadal Steroid Hormones ; Gonadotropin-Releasing Hormone (33515-09-2)
    Language English
    Publishing date 2015-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1063374-1
    ISSN 1879-1972 ; 1054-139X
    ISSN (online) 1879-1972
    ISSN 1054-139X
    DOI 10.1016/j.jadohealth.2015.04.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.B 2453: Show issues Location:
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