New Pre-Surgery Protocols for Transgender Teens

by Winnie McCroy
EDGE Editor
Saturday Dec 21, 2013

The Philadelphia Center for Transgender Surgery's founder Dr. Sherman Leis says that as people come to terms with gender dysphoria earlier, new surgery protocols are needed for trans teens.

"Although it may seem as if more teenagers are identifying as transgender people, I doubt that there are any more of them these days, as a percentage of the total population," observed Leis, one of America's leading transgender surgeons. "The fact is that more people are coming to terms with their gender dysphoria earlier in life, because public information is more available and our society is becoming more accepting of transgender people in general."

Leis said that for people identifying as transgender earlier in life is good news, since fewer of them will have to suffer in silence for years before they have surgery, as has been typical behavior for transgender people waiting to transition, until now. There is also an exceptionally high rate of depression and suicide prior to surgical treatment that drops off dramatically after transgender surgery.

"Therefore the younger the patient is who is transitioning, the safer they should be," he said. "However, because many of these transgender teens are in the middle of experiencing puberty, transitioning strategy is not the same as for adult transgender people. Special protocols are necessary for the teens to delay normal early pubertal changes, and then to add hormones appropriate to their true mental and emotional gender in order for them to experience a puberty congruent with their desired gender."

For adult transgender surgery patients, Dr. Leis recommends three requirements prior to surgery:

1) letters of approval from two healthcare professionals who are trained in transgender issues and experienced in working with transgender people,

2) that the patient has been living openly as his/her true sex, and

3) that the patient has been on hormone therapy for an extended period of time.

The time period for those last two issues is becoming more flexible to accommodate individual differences in family, social and economic situations.

Most likely, the transgender teen will be too young to undergo conventional hormone therapy because it will conflict with the natural hormonal dynamics occurring during puberty. As well, enduring the effects of puberty "in the wrong body" only seems to enhance the agony endured.

Therefore, for transgender teens, Dr. Leis recommends that they undergo what is called the "Dutch Protocol." The Dutch Protocol is not a new protocol, but it is somewhat new in its application to transgender teenagers. Its effect is to delay the metamorphosis puberty causes on the body. It uses hormones to suppress the effects of puberty until the person has aged beyond this period.

Males will be treated with anti-androgens at first and then with estrogen to slow muscle and hair growth and the development of secondary sexual characteristics. Females will be treated with progesterone to stop menstruation and then with anti-androgens. To proceed with this protocol, transgender teens’ parents should be involved and supportive of their child having this form of treatment.

According to Dr. Leis, "Administering the Dutch Protocol to transgender teens gives young patients more time to make good decisions. In addition, it can alleviate depression and reduce the number of transgender teens who seek dangerous black market cures for their gender dysphoria, while greatly reducing the transgender depression and suicide rate."

The Philadelphia Center For Transgender Surgery, in Bala Cynwyd, PA, is recognized as one of the leading facilities in the world specializing in gender reassignment surgery. It was founded to be a single source of information and expertise in medical care for the transgender individual. The Philadelphia Center For Transgender Surgery offers a uniquely supportive environment where one can connect with Dr. Leis’ surgical and non-surgical team of dedicated specialists -- surgeons, psychologists, endocrinologists, aestheticians, speech therapists, legal experts and others.

For more information, visit

Winnie McCroy is the Women on the EDGE Editor, HIV/Health Editor, and Assistant Entertainment Editor for EDGE Media Network, handling all women's news, HIV health stories and theater reviews throughout the U.S. She has contributed to other publications, including The Village Voice, Gay City News, Chelsea Now and The Advocate, and lives in Brooklyn, New York.


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