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Paeds Casesadolescent-and-young-adult-medicine

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.

osce communication and clinical station2 min readVerification in progress

Target exams

RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
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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

  1. Conduct an affirming, developmentally appropriate biopsychosocial assessment, using the young person's chosen name and pronouns. [1]
  2. Establish pubertal stage, persistence of dysphoria, and eligibility for suppression. [2]
  3. Plan bone-health and fertility surveillance alongside the staged pathway. [10] [3]
  4. Decline respectfully a family request for conversion-style therapy and redirect to the affirmative model. [8]
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References6ShowHide
  1. [1]Rafferty J Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics, 2018.PMID 30224363
  2. [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. [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
  4. [7]Turban JL, King D, Carswell JM, Keuroghlian AS Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. Pediatrics, 2020.PMID 31974216
  5. [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
  6. [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
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PreviousExplain school refusal and bullying plan to an adolescent and parent — OSCEadolescent-and-young-adult-medicineNextInclusive care OSCE — the affirming consultation and the mother's direct questionadolescent-and-young-adult-medicine