More transgender children and teens could be given controversial hormone therapy as young as 13 or 14, under new guidelines published in the Medical Journal of Australia.
International guidelines stipulate that medical intervention should not start until the age of 16 to avoid possible regret over hormone treatment.
The new Australian guidelines published on Monday are the most progressive in the world and emphasise the need for individualised care and more supportive "gender-affirming" management.
One of the key recommendations is that hormone therapy be considered not based on an "inflexible" chronological age but on the child's developmental stage in a bid to reduce the risk of depression and anxiety.
Lead author, Associate Professor Michelle Telfer, director of the Royal Children's Hospital Gender Service in Melbourne and acting President of the Australian and New Zealand Professional Association for Transgender Health said very few patients regretted undergoing the hormone treatment.
"The rate of regret is very low, as low as 0.4 to 0.6 per cent," she said.
Numerous published studies have shown starting intervention as young as 13 or 14 is more beneficial than waiting until 16, Prof Telfer said.
"It's not at all controversial within those with expertise because we all know that we have been doing this for years.
"It may be controversial in terms of people who don't know the area well but it's certainly not controversial within the clinical community," Prof Telfer said.
"The consequence of not treating are known to be severe in terms of depression, self harm, suicide," she said.
"Clinicians need to weigh up the benefits with the risks rather than just sticking to an inflexible age."
With increasing visibility and social acceptance of gender diversity in Australia, Prof Telfer says the guidelines better reflect the progress made in trans medicine.
The international guidelines for transgender children written by the World Professional Association for Transgender Health were last published in 2011.
"The (new Australian) guidelines are the most progressive and clinically relevant guidelines that exist internationally at this point in time," Prof Telfer said.
About 1.2 per cent of Australian adolescents identify as transgender.
The research shows that 80 per cent of transgender people under 24 self harm, while nearly half attempt suicide.
"What we know now is that transgender children and adolescents experience high rates of stigma and discrimination, bullying, social exclusion and abuse and as a consequence of all of those negative experience the mental health outcomes for this population are very poor," Prof Telfer said.
"But with supportive care, affirming care and access to medical interventions at the right times those harms can be reduced and in some cases ameliorated," she said.
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