Paeds Cases · adolescent-and-young-adult-medicine
Gender-affirming adolescent care OSCE — assessment, staging and a family conversion request
Observed structured encounter testing an affirming, developmentally appropriate assessment of a peripubertal trans adolescent, a pubertal-suppression eligibility decision, bone-health and fertility planning, and a respectful refusal of a family conversion request.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is an affirming biopsychosocial assessment of a 12-year-old trans girl at Tanner 2 with intensifying dysphoria, including an eligibility decision for pubertal suppression. Station B is a parent who requests conversion-style therapy; the candidate must decline respectfully and redirect to the affirmative model.
Station objectives
- Conduct an affirming, developmentally appropriate biopsychosocial assessment, using the young person's chosen name and pronouns. [1]
- Establish pubertal stage, persistence of dysphoria, and eligibility for suppression. [2]
- Plan bone-health and fertility surveillance alongside the staged pathway. [10] [3]
- Decline respectfully a family request for conversion-style therapy and redirect to the affirmative model. [8]
References6ShowHide
- [1]Rafferty J Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics, 2018.PMID 30224363
- [2]Hembree WC, Cohen-Kettenis PT, Gooren L, et al Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2017.PMID 28945902
- [3]Coleman E, Radix AE, Bouman WP, et al Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health, 2022.PMID 36238954
- [7]Turban JL, King D, Carswell JM, Keuroghlian AS Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. Pediatrics, 2020.PMID 31974216
- [8]Turban JL, Beckwith N, Reisner SL, Keuroghlian AS Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. JAMA Psychiatry, 2020.PMID 31509158
- [10]Vlot MC, Klink DT, den Heijer M, et al Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents. Bone, 2017.PMID 27845262