The objective of the study was to identify national trends in the utilization of histrelin acetate implants among transgender children in the United States.
We analyzed demographic, diagnostic and treatment data from 2004 to 2016 on the use of histrelin acetate reported to the Pediatric Health Information System (PHIS) to determine the temporal trends in its use for transgender-related billing diagnoses, e.g. “gender identity disorder”. Demographic and payer status data on this patient population were also collected.
Between 2004 and 2016, the annual number of implants placed for a transgender-related diagnosis increased from 0 to 63. The average age for placement was 14 years. Compared to natal females, natal males were more likely to receive implants (57 vs. 46) and more likely to have implants placed at an older age (62% of natal males vs. 50% of natal females were ≥;13 years; p<0.04). The majority of children were White non-Hispanic (White: 60, minority: 21). When compared to the distribution of patients treated for precocious puberty (White: 1428, minority: 1421), White non-Hispanic patients were more likely to be treated with a histrelin acetate implant for a transgender-related diagnosis than minority patients (p<0.001). This disparity was present even among minority patients with commercial insurance (p<0.001).
Utilization of histrelin acetate implants among transgender children has increased dramatically. Compared to natal females, natal males are more likely to receive implants and also more likely to receive implants at an older age. Treated transgender patients are more likely to be White when compared to the larger cohort of patients being treated with histrelin acetate for central precocious puberty (CPP), thus identifying a potential racial disparity in access to medically appropriate transgender care.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
2. Eugster EA, Clarke W, Kletter GB, Lee PA, Neely EK, et al. Efficacy and safety of histrelin subdermal implant in children with central precocious puberty: a multicenter trial. J Clin Endocrinol Metab 2007;92:1697–704.10.1210/jc.2006-2479Search in Google Scholar PubMed
3. Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 2009;123:e752–62.10.1542/peds.2008-1783Search in Google Scholar PubMed
4. de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, et al. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics 2014;134:696–704.10.1542/peds.2013-2958Search in Google Scholar PubMed
5. Coleman E, Bockting W, Botzer P, Cohen-Kettenis P, DeCuypere G, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people. Int J Transgend 2011;11:165–232.10.1016/B978-0-12-803506-1.00058-9Search in Google Scholar
6. Bertelloni S, Mul D. Treatment of central precocious puberty by GnRH analogs: long-term outcome in men. Asian J Androl 2008;10:525–34.10.1111/j.1745-7262.2008.00409.xSearch in Google Scholar PubMed
7. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009;94:3132–54.10.1210/jc.2009-0345Search in Google Scholar PubMed
8. Fletcher DM. Achieving data quality. How data from a pediatric health information system earns the trust of its users. J AHIMA 2004;75:22–6.Search in Google Scholar
9. Meyer IH, Brown TN, Herman JL, Reisner SL, Bockting WO. Demographic characteristics and health status of transgender adults in select US regions: behavioral risk factor surveillance system, 2014. Am J Public Health 2017;107:582–9.10.2105/AJPH.2016.303648Search in Google Scholar PubMed PubMed Central
10. Canner JK, Harfouch O, Kodadek LM, Pelaez D, Coon D, et al. Temporal trends in gender-affirming surgery among transgender patients in the United States. JAMA Surg 2018.10.1001/jamasurg.2017.6231Search in Google Scholar PubMed PubMed Central
11. Dhejne C, Lichtenstein P, Boman M, Johansson AL, Långström N, Landén M. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One 2011;6:e16885.10.1371/journal.pone.0016885Search in Google Scholar PubMed PubMed Central
12. Reisner SL, Vetters R, Leclerc M, Zaslow S, Wolfrum S, et al. Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. J Adolesc Health 2015;56:274–9.10.1016/j.jadohealth.2014.10.264Search in Google Scholar PubMed PubMed Central
13. Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ. The treatment of adolescent transsexuals: changing insights. J Sex Med 2008;5:1892–7.10.1111/j.1743-6109.2008.00870.xSearch in Google Scholar PubMed
14. Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2017;102:3869–903.10.1210/jc.2017-01658Search in Google Scholar PubMed
15. Spack NP, Edwards-Leeper L, Feldman HA, Leibowitz S, Mandel F, et al. Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics 2012;129:418–25.10.1542/peds.2011-0907Search in Google Scholar PubMed
16. Chen M, Fuqua J, Eugster EA. Characteristics of referrals for gender dysphoria over a 13-year period. J Adolesc Health 2016;58:369–71.10.1016/j.jadohealth.2015.11.010Search in Google Scholar PubMed PubMed Central
17. Wood H, Sasaki S, Bradley SJ, Singh D, Fantus S, et al. Patterns of referral to a gender identity service for children and adolescents (1976–2011): age, sex ratio, and sexual orientation. J Sex Marital Ther 2013;39:1–6.10.1080/0092623X.2012.675022Search in Google Scholar PubMed
18. GIDS Referrals figures for 2016/17. In.: Gender Identity Development Service, National Health Service, 2016–7.Search in Google Scholar
19. James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 transgender survey. Washington, DC: National Center for Transgender Equality, 2016.Search in Google Scholar
20. Edwards-Leeper L, Spack NP. Psychological evaluation and medical treatment of transgender youth in an interdisciplinary “Gender Management Service” (GeMS) in a major pediatric center. J Homosex 2012;59:321–36.10.1080/00918369.2012.653302Search in Google Scholar PubMed
22. Larson M, Cars T, Hallas J. A MiniReview of the use of hospital-based databases in observational inpatient studies on drugs. Basic Clin Pharmacol Toxicol 2012;112:13–8.10.1111/j.1742-7843.2012.00928.xSearch in Google Scholar PubMed
23. Kulkarni S, Perez C, Pichardo C, Castillo L, Gagnon M, et al. Use of pediatric health information system database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013. Pediatr Transplant 2015;19:888–95.10.1111/petr.12596Search in Google Scholar PubMed
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