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Micangeli G, Profeta G, Colloridi F, Pirro F, Tarani F, Ferraguti G, Spaziani M, Isidori AM, Menghi M, Fiore M, Tarani L. The role of the pediatrician in the management of the child and adolescent with gender dysphoria. Ital J Pediatr 2023; 49:71. [PMID: 37316904 DOI: 10.1186/s13052-023-01466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/01/2023] [Indexed: 06/16/2023] Open
Abstract
Gender dysphoria is a clinical condition characterized by significant distress due to the discordance between biological sex and gender identity. Currently, gender dysphoria is also found more frequently in children and adolescents, thanks to greater social sensibleness and new therapeutic possibilities. In fact, it is estimated that the prevalence of gender dysphoria in pediatric age is between 0.5% and 2% based on the statistics of the various countries. Therefore, the pediatrician cannot fail to update himself on these issues and above all should be the reference figure in the management of these patients. Even if the patient must be directed to a referral center and be followed up by a multidisciplinary team, the treating pediatrician will care to coordinate the clinical and therapeutic framework. The aim of the present report is therefore to integrate literature data with our clinical experience to propose a new clinical approach in which the pediatrician should be the reference in the care of these patients, directing them towards the best therapeutic approach and staying in contact with the specialists of the referral center.
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Affiliation(s)
- Ginevra Micangeli
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Profeta
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | | | - Federica Pirro
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Tarani
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Giampiero Ferraguti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Matteo Spaziani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - Michela Menghi
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy.
| | - Luigi Tarani
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy.
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Using Standardized Patients to Augment Communication Skills and Self-Efficacy in Caring for Transgender Youth. Acad Pediatr 2021; 21:1441-1448. [PMID: 34022426 DOI: 10.1016/j.acap.2021.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the impact of standardized patient encounters (SPEs) on gender-affirming communication skills and self-efficacy of pediatrics learners. METHODS Fourth-year medical students, pediatrics interns, psychiatry interns, and nurse practitioner trainees on 1-month adolescent medicine blocks completed a curriculum with e-learning activities that was expanded to include SPEs. Following e-learning, learners completed 2 SPEs featuring transgender adolescent cases. Faculty observers and standardized patients completed checklists focused on history-taking, counseling, and interpersonal communication, and provided learner feedback after each case. The curriculum was evaluated by comparing skills checklists scores from case 1 to case 2 via Wilcoxon signed-rank tests. Self-efficacy was assessed precurriculum (Assessment 1), post-e-learning (Assessment 2), and post-SPE (Assessment 3) using a previously developed instrument. Changes in self-efficacy scores were assessed via linear regression models with generalized estimating equations. RESULTS Forty-three eligible learners participated in the study. The majority were pediatrics interns, and 5 learners had worked in a transgender clinic prior to the curriculum participation. Learners increased median total checklist scores between cases from 22 to 28 (P < .001) (maximum score of 34). Learners' overall self-efficacy scores improved by 3.4 (confidence interval [CI]: 2.9-3.9; P < .001) between Assessments 1 and 2 and by 1.5 (CI: 1.2-1.7; P < .001) from Assessment 2 to 3. Similar improvements in checklist scores and self-efficacy occurred within stratified learner types. CONCLUSIONS The combination of SPEs with e-learning is effective at improving self-efficacy and gender-affirming communication skills for a multidisciplinary pediatrics learners. The comprehensive curriculum allowed learners inexperienced with transgender youth to apply knowledge and practice skills.
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3
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Lane J, McCarthy C, Dart G, Furlotte K. Establishing a province-wide referral network to improve access to gender-affirming primary healthcare services. Nurse Pract 2021; 46:39-43. [PMID: 34397772 DOI: 10.1097/01.npr.0000753844.78841.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT It is possible and necessary to provide trans and gender nonconforming (TGNC) individuals with gender-affirming care (GAC) in primary care settings. A known risk of increased suicidality among TGNC individuals and a lack of provider training on prescribing gender-affirming hormones (GAH) in the Canadian province of Nova Scotia highlighted a need for building capacity around GAC delivery. A referral network was established across the province, which reduced wait times to access GAH by several months.
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4
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Verveen A, Kreukels BP, de Graaf NM, Steensma TD. Body image in children with gender incongruence. Clin Child Psychol Psychiatry 2021; 26:839-854. [PMID: 33761780 PMCID: PMC8264630 DOI: 10.1177/13591045211000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the DSM-5 diagnosis of childhood Gender Dysphoria, two of the eight criteria focus on body satisfaction of the child. Nevertheless, this subject is understudied. This study aims to describe the body image of children with gender incongruence (GI) in relation to birth assigned sex and the intensity of GI. METHOD Self-report and parent-report measures on body satisfaction and gender incongruence were obtained from 207 children (<12 years) who were referred to the Center of Expertise on Gender Dysphoria at the Amsterdam University Medical Centers, location VUmc, between 2010 and 2016. First, a general description of body satisfaction in children who took part in this study is provided. Secondly, body image of birth assigned boys and girls are compared using chi-square tests and univariate ANCOVA's. Thirdly, the association between intensity of GI and body image is examined using multiple linear regression analyses. RESULTS Of the 207 children with GI, 50% reported dissatisfaction with their gender-specific characteristics. Overall, children were less dissatisfied with their neutral body characteristics. Birth assigned girls report greater dissatisfaction with their body characteristics than birth assigned boys. Intensity of GI was significantly related to satisfaction with gender specific body characteristics where a greater intensity of GI relates to more body dissatisfaction. CONCLUSION Mental health practitioners should be aware of the diversity in body dissatisfaction in this group. Furthermore, evaluation of body image should be an important topic in the counseling of these children. Future research should focus on the relation of body dissatisfaction and the development of gender incongruent feelings in children with GI.
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Affiliation(s)
- Anouk Verveen
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, location VUmc, The Netherlands
| | - Baudewijntje Pc Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, location VUmc, The Netherlands
| | - Nastasja M de Graaf
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, location VUmc, The Netherlands
| | - Thomas D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, location VUmc, The Netherlands
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5
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Chang JC, Lai MC, Tai YM, Gau SSF. Mental health correlates and potential childhood predictors for the wish to be of the opposite sex in young autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:146-159. [PMID: 34120486 DOI: 10.1177/13623613211024098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Autistic people/people with autism spectrum disorder are more likely to experience gender dysphoria. However, the possible longitudinal predictors and underlying mechanisms of this co-occurrence are unclear. To fill this knowledge gap, we assessed 88 people with autism spectrum disorder and 42 typically developing individuals at their average ages of 13.0 (baseline, childhood/adolescence) and 20.2 years old (follow-up, adulthood). At follow-up, their endorsement on the item "I wish I was the opposite sex" was used to evaluate gender dysphoric symptoms. We compared mental health symptoms between adults with and without this item endorsement at the follow-up assessment. We explored parent-reported family and autism characteristics-related predictors in childhood/adolescence to this item endorsement in adulthood. We found that more autistic adults reported the wish to be of the opposite sex than did typically developing individuals. Autistic adults who endorsed this item experienced more mental health challenges, more school bullying and cyberbullying, more suicidal ideation, and worse quality of life. Moreover, parent-reported lower family support and more stereotyped/repetitive behaviors during childhood/adolescence predicted the self-reported wish to be of the opposite sex in adulthood in autistic individuals. More attention and support should be provided to autistic people regarding gender development and related mental health and quality of life impact, especially during the transition period to young adulthood.
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Affiliation(s)
| | - Meng-Chuan Lai
- National Taiwan University Hospital, Taiwan.,Centre for Addiction and Mental Health, Canada.,The Hospital for Sick Children, Canada.,University of Toronto, Canada.,University of Cambridge, UK
| | | | - Susan Shur-Fen Gau
- National Taiwan University Hospital, Taiwan.,Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taiwan
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Frew T, Watsford C, Walker I. Gender dysphoria and psychiatric comorbidities in childhood: a systematic review. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1900747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tabitha Frew
- Faculty of Health, Psychology, University of Canberra, Canberra, Australia
| | - Clare Watsford
- Faculty of Health, Psychology, University of Canberra, Canberra, Australia
| | - Iain Walker
- Faculty of Health, Psychology, University of Canberra, Canberra, Australia
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Skordis N, Kyriakou A, Dror S, Mushailov A, Nicolaides NC. Gender dysphoria in children and adolescents: an overview. Hormones (Athens) 2020; 19:267-276. [PMID: 32020566 DOI: 10.1007/s42000-020-00174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
Over the last decade, we have witnessed considerable progress in gender dysphoria (GD) terminology in an attempt to better describe the condition based on certain criteria. The ever-increasing social acceptance and destigmatization of children and adolescents with GD have resulted in an increased number of transgender individuals seeking endocrine care. In addition to terminology and diagnostic criteria, the tremendous progress of genetics and neuroimaging has enabled us to have a deeper understanding of the complex pathogenesis of GD. Although helpful guidelines for treatment with GnRH analogs and gender-affirming hormones have been proposed, several challenges and controversies still exist. In this article, the current knowledge about GD in adolescents is reviewed, with particular emphasis on terminology, clinical manifestations, and epidemiologic data. The neurobiological basis of the condition is presented, and both hormonal treatment and mental issues of transgender individuals are discussed. Undoubtedly, further research will optimize the diagnostic and therapeutic approach of children and adolescents with GD.
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Affiliation(s)
- Nicos Skordis
- Division of Pediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus.
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus.
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK
| | - Shai Dror
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Avital Mushailov
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Nicolas C Nicolaides
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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Lapinski J, Covas T, Perkins JM, Russell K, Adkins D, Coffigny MC, Hull S. Best Practices in Transgender Health: A Clinician's Guide. Prim Care 2018; 45:687-703. [PMID: 30401350 DOI: 10.1016/j.pop.2018.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Providing culturally competent and medically knowledgeable care to the transgender community is increasingly falling within the realms of practice for primary care providers. The purpose of this article is to provide an overview of best practices as they relate to transgender care. This article is by no means a comprehensive guide, but rather a starting point for clinicians as they provide high-quality care to their transgender patients.
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Affiliation(s)
- Jessica Lapinski
- Department of Community and Family Medicine, Duke University Health System, Duke University, 2100 Erwin Road, Durham, NC 27710, USA.
| | - Tiffany Covas
- Department of Community and Family Medicine, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | - Jennifer M Perkins
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | - Kristen Russell
- Department of Case Management, Duke Child and Adolescent Gender Care, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | - Deanna Adkins
- Duke Child and Adolescent Gender Care, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | | | - Sharon Hull
- Department of Community and Family Medicine, Duke University School of Medicine, 2100 Erwin Road, Durham, NC 27710, USA
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Ganie Y, Aldous C, Balakrishna Y, Wiersma R. The Spectrum of Ovotesticular Disorders of Sex Development in South Africa: A Single-Centre Experience. Horm Res Paediatr 2018; 87:307-314. [PMID: 28376506 DOI: 10.1159/000466693] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/24/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the clinical characteristics, biochemistry, histopathology, and long-term outcomes in subjects with ovotesticular (OT) disorder of sex development (DSD). STUDY DESIGN This is a retrospective subset analysis of 64 cases of histologically confirmed OT DSD. RESULTS All subjects were South African; 97% (n = 62) were African and 92% (n = 59) were of Zulu ethnicity. The most common karyotype was 46,XX (88%; n = 56), followed by 46,XY (8%), 46,XY/45,X (3%), and 46,XX/46,XY (1%). The median age at presentation was 7 months (0.5 months to 5.1 years). Sixty-one of the subjects (95%) presented with DSD. The ovotestis was the most frequent gonad (56%), followed by the ovary (23%) and the testis (16%). Testes were more commonly located on the right and ovaries on the left (p < 0.0001). The male gender was the predominant sex of rearing in two-thirds of the subjects. Gender dysphoria was noted in 8 subjects (11%) at a median of 6.4 (4.3-9.3) years. Long-term follow-up (n = 14) revealed spontaneous puberty in 5 subjects, gender dysphoria in 2 subjects, and neuropsychiatric disorders in 4 subjects. CONCLUSION OT DSD is an important differential diagnosis in Black South Africans with 46,XX DSD.
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Affiliation(s)
- Yasmeen Ganie
- Department of Paediatrics and Child Health, Nelson R. Mandela School of Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Division of Paediatric Endocrinology, Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, Durban, South Africa
| | - Colleen Aldous
- Department of Internal Medicine, Nelson R. Mandela School of Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Rinus Wiersma
- Department of Paediatric Surgery, Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, Durban, South Africa.,Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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10
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Statement on gender-affirmative approach to care from the pediatric endocrine society special interest group on transgender health. Curr Opin Pediatr 2017; 29:475-480. [PMID: 28562420 DOI: 10.1097/mop.0000000000000516] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals, as well as to improve the understanding of the rights of transgender youth. RECENT FINDINGS Transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care. SUMMARY The Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender nonconforming/transgender youth, as well as adequate mental health and medical care. This document provides a summary of relevant definitions, information and current literature on which the medical management and affirmative approach to care of transgender youth are based.
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Vance SR, Deutsch MB, Rosenthal SM, Buckelew SM. Enhancing Pediatric Trainees' and Students' Knowledge in Providing Care to Transgender Youth. J Adolesc Health 2017; 60:425-430. [PMID: 28065519 DOI: 10.1016/j.jadohealth.2016.11.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/20/2016] [Accepted: 11/13/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To enhance pediatric trainees' and students' knowledge of the psychosocial and medical issues facing transgender youth through a comprehensive curriculum. METHODS During the 2015-2016 academic year, we administered a transgender youth curriculum to fourth-year medical students, pediatric interns, psychiatry interns, and nurse practitioner students on their 1-month adolescent and young adult medicine rotation. The curriculum included six interactive, online modules and an observational experience in a multidisciplinary pediatric gender clinic. The online modules had a primary care focus with topics of general transgender terminology, taking a gender history, taking a psychosocial history, performing a sensitive physical examination, and formulating an assessment, psychosocial plan, and medical plan. At the completion of the curriculum, learners completed an evaluation that assessed change in perceived awareness and knowledge of transgender-related issues and learner satisfaction with the curriculum. RESULTS Twenty learners participated in the curriculum with 100% completing the curriculum evaluations, 100% reporting completing all six online modules, and 90% attending the gender clinic. Learners demonstrated a statistically significant improvement in all pre-post knowledge/awareness measures. On a Likert scale where 5 indicated very satisfied, learners' mean rating of the quality of the curriculum was 4.5 ± .7; quality of the modules was 4.4 ± .7; and satisfaction with the observational experience was 4.5 ± .8. CONCLUSIONS A comprehensive curriculum comprised interactive online modules and an observational experience in a pediatric gender clinic was effective at improving pediatric learners' perceived knowledge of the medical and psychosocial issues facing transgender youth. Learners also highly valued the curriculum.
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Affiliation(s)
- Stanley R Vance
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | - Madeline B Deutsch
- Department of Family Community Medicine, University of California, San Francisco, San Francisco, California
| | - Stephen M Rosenthal
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Sara M Buckelew
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
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Rice T, Kufert Y, Walther A, Feldman E, Garcia-Delgar B, Coffey BJ. Psychopharmacotherapy of Severe Self-injury in an Adolescent with Gender Dysphoria and Comorbidity. J Child Adolesc Psychopharmacol 2016; 26:646-50. [PMID: 27642794 DOI: 10.1089/cap.2016.29114.bjc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Yael Kufert
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Andreas Walther
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Elyana Feldman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Bianca Garcia-Delgar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Barbara J Coffey
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
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