Care pathways of children and adolescents referred to specialist gender services: a systematic review

Jo Taylor; Ruth Hall; Trilby Langton; Lorna Fraser; Catherine Elizabeth Hewitt

doi:10.1136/archdischild-2023-326760

Care pathways of children and adolescents referred to specialist gender services: a systematic review

Jo Taylor, Ruth Hall, Trilby Langton, Lorna Fraser, Catherine Elizabeth Hewitt

Health Sciences

Research output: Contribution to journal › Review article › peer-review

Abstract

BACKGROUND: Increasing numbers of children and adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services. However, little is currently known about the proportions accessing different types of care and treatment following referral.

AIM: This systematic review examines the range of care pathways of children/adolescents (under 18) referred to specialist gender or endocrinology services.

METHODS: Database searches were performed (April 2022), with results assessed independently by two reviewers. Peer-reviewed articles providing data for numbers of children and/or adolescents at referral/assessment and their treatment pathways were included. A narrative approach to synthesis was used and where appropriate proportions were combined in a random-effects meta-analysis.

RESULTS: 23 studies across nine countries were included, representing 6133 children and/or adolescents with a median age at assessment of 14-16 and overall a higher percentage of birth-registered females. Of those assessed, 36% (95% CI 27% to 45%) received puberty suppression, 51% (95% CI 40% to 62%) received masculinising or feminising hormones, 68% (95% CI 57% to 77%) received puberty suppression and/or hormones and 16% (95% CI 10% to 24%) received surgery. No study systematically reported information about the full pathway or psychological care received by children/adolescents. Follow-up in many studies was insufficient or unclear. Reasons for discontinuation were rarely provided.

CONCLUSIONS: Prospective studies with long-term follow-up reporting information about the full range of pathways are needed to understand what happens to children and adolescents referred to specialist gender services. Information about provision of psychological care is needed considering high rates of psychosocial difficulties in this population.PROSPERO registration number CRD42021289659.

Original language	English
Number of pages	8
Journal	Archives of Disease in Childhood
Early online date	9 Apr 2024
DOIs	https://doi.org/10.1136/archdischild-2023-326760
Publication status	E-pub ahead of print - 9 Apr 2024

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Cite this

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title = "Care pathways of children and adolescents referred to specialist gender services: a systematic review",

abstract = "BACKGROUND: Increasing numbers of children and adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services. However, little is currently known about the proportions accessing different types of care and treatment following referral.AIM: This systematic review examines the range of care pathways of children/adolescents (under 18) referred to specialist gender or endocrinology services.METHODS: Database searches were performed (April 2022), with results assessed independently by two reviewers. Peer-reviewed articles providing data for numbers of children and/or adolescents at referral/assessment and their treatment pathways were included. A narrative approach to synthesis was used and where appropriate proportions were combined in a random-effects meta-analysis.RESULTS: 23 studies across nine countries were included, representing 6133 children and/or adolescents with a median age at assessment of 14-16 and overall a higher percentage of birth-registered females. Of those assessed, 36% (95% CI 27% to 45%) received puberty suppression, 51% (95% CI 40% to 62%) received masculinising or feminising hormones, 68% (95% CI 57% to 77%) received puberty suppression and/or hormones and 16% (95% CI 10% to 24%) received surgery. No study systematically reported information about the full pathway or psychological care received by children/adolescents. Follow-up in many studies was insufficient or unclear. Reasons for discontinuation were rarely provided.CONCLUSIONS: Prospective studies with long-term follow-up reporting information about the full range of pathways are needed to understand what happens to children and adolescents referred to specialist gender services. Information about provision of psychological care is needed considering high rates of psychosocial difficulties in this population.PROSPERO registration number CRD42021289659.",

author = "Jo Taylor and Ruth Hall and Trilby Langton and Lorna Fraser and Hewitt, {Catherine Elizabeth}",

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doi = "10.1136/archdischild-2023-326760",

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TY - JOUR

T1 - Care pathways of children and adolescents referred to specialist gender services

T2 - a systematic review

AU - Taylor, Jo

AU - Hall, Ruth

AU - Langton, Trilby

AU - Fraser, Lorna

AU - Hewitt, Catherine Elizabeth

PY - 2024/4/9

Y1 - 2024/4/9

N2 - BACKGROUND: Increasing numbers of children and adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services. However, little is currently known about the proportions accessing different types of care and treatment following referral.AIM: This systematic review examines the range of care pathways of children/adolescents (under 18) referred to specialist gender or endocrinology services.METHODS: Database searches were performed (April 2022), with results assessed independently by two reviewers. Peer-reviewed articles providing data for numbers of children and/or adolescents at referral/assessment and their treatment pathways were included. A narrative approach to synthesis was used and where appropriate proportions were combined in a random-effects meta-analysis.RESULTS: 23 studies across nine countries were included, representing 6133 children and/or adolescents with a median age at assessment of 14-16 and overall a higher percentage of birth-registered females. Of those assessed, 36% (95% CI 27% to 45%) received puberty suppression, 51% (95% CI 40% to 62%) received masculinising or feminising hormones, 68% (95% CI 57% to 77%) received puberty suppression and/or hormones and 16% (95% CI 10% to 24%) received surgery. No study systematically reported information about the full pathway or psychological care received by children/adolescents. Follow-up in many studies was insufficient or unclear. Reasons for discontinuation were rarely provided.CONCLUSIONS: Prospective studies with long-term follow-up reporting information about the full range of pathways are needed to understand what happens to children and adolescents referred to specialist gender services. Information about provision of psychological care is needed considering high rates of psychosocial difficulties in this population.PROSPERO registration number CRD42021289659.

AB - BACKGROUND: Increasing numbers of children and adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services. However, little is currently known about the proportions accessing different types of care and treatment following referral.AIM: This systematic review examines the range of care pathways of children/adolescents (under 18) referred to specialist gender or endocrinology services.METHODS: Database searches were performed (April 2022), with results assessed independently by two reviewers. Peer-reviewed articles providing data for numbers of children and/or adolescents at referral/assessment and their treatment pathways were included. A narrative approach to synthesis was used and where appropriate proportions were combined in a random-effects meta-analysis.RESULTS: 23 studies across nine countries were included, representing 6133 children and/or adolescents with a median age at assessment of 14-16 and overall a higher percentage of birth-registered females. Of those assessed, 36% (95% CI 27% to 45%) received puberty suppression, 51% (95% CI 40% to 62%) received masculinising or feminising hormones, 68% (95% CI 57% to 77%) received puberty suppression and/or hormones and 16% (95% CI 10% to 24%) received surgery. No study systematically reported information about the full pathway or psychological care received by children/adolescents. Follow-up in many studies was insufficient or unclear. Reasons for discontinuation were rarely provided.CONCLUSIONS: Prospective studies with long-term follow-up reporting information about the full range of pathways are needed to understand what happens to children and adolescents referred to specialist gender services. Information about provision of psychological care is needed considering high rates of psychosocial difficulties in this population.PROSPERO registration number CRD42021289659.

U2 - 10.1136/archdischild-2023-326760

DO - 10.1136/archdischild-2023-326760

M3 - Review article

C2 - 38594052

SN - 0003-9888

JO - Archives of Disease in Childhood

JF - Archives of Disease in Childhood

ER -