By Andrew M. Seaman
(Reuters Health) – Puberty can be one of the worst times in a transgender or gender-nonconforming child’s life, but for these children, access to drugs that prevent puberty may be getting easier, researchers say in a new paper.
“You can just imagine what it must be like for a child who believes at the core of their being that they’re a boy and they’re having a period every month,” said Dr. Aron Janssen, director of the NYU Langone Medical Center’s Gender and Sexuality Service in New York City.
“How does that feel? It’s horrible,” Janssen told Reuters Health.
That feeling - known as gender dysphoria - may increase the risks of suicidal thoughts, suicide attempts, depression and anxiety for some transgender and gender-nonconforming children, said Janssen, who wasn’t involved with the new paper.
Writing in Pediatrics, Dr. Elyse Pine and colleagues report on 36 patients, ages seven to 17, who were treated at two health clinics between 2010 and 2015. On average, the youths were at an early stage of puberty known as Tanner stage 3 - when the penis or breasts begin to enlarge.
The irreversible changes that come with puberty can be detrimental to the psychological and general well-being of people whose bodies don’t match their gender identities, Pine and colleagues wrote.
“Puberty blockers allow those changes to be put on hold and gives kids and families time to think through the consequences, benefits and alternatives of their choices and options,” Janssen said.
In their essay, Pine and colleagues say 89 percent of their patients eventually received puberty blockers, and insurance ultimately covered the cost in 72 percent of cases.
In some cases, insurance carriers approved puberty blockers right away, some cases were approved after an appeal and another patient coverage after a state discrimination appeal.
Two of the most popular puberty blocking treatments involve either injections or a small device implanted under the skin. Depending on the patient’s age and the brand of treatment, the costs can range from approximately $3,500 to more than $20,000, Pine’s team reports.
“A lot of people have heard the message that these medicines are expensive and out of reach; don’t even try,” she said.
But in fact, “this treatment can be obtained through advocacy,” said Pine, who is affiliated with Chase Brexton Health Care in Baltimore, Maryland.
The U.S. Department of Health and Human Services and several states now say a gender non-discrimination clause in the 2010 Affordable Care Act covers transgender and gender-nonconforming people.
Healthcare providers, the authors say, should know that appealing insurance denials can succeed.
“We have a responsibility as physicians caring for these children to know a way around the insurance appeals process to know the legal routes we have available to us,” Janssen said.
Pine said parents and guardians of transgender and gender-nonconforming children without health insurance should apply for coverage under the Affordable Care Act. Additionally, she said, they should know that some pharmaceutical companies offer prescription assistance programs to help cover the costs of treatments.
SOURCE: bit.ly/1MCoqus Pediatrics, online November 2, 2015.