Bringing Transparency to the Treatment of Transgender Persons

Quentin Van Meter, M.D., FCP, a pediatric endocrinologist, discusses the medical treatment of patients who identify as transgender. “Transgender” is a term that was coined by Dr. Kenneth Zucker to describe the condition of a biologic male or female person who believes they are born into the body of the wrong sex. This term replaced the term transsexual which was regularly used by sexologists in the 1950’s to refer to the same population. In the 1980’s, the academic medical community in the United States did not accept the concept of medical or surgical treatment to convert the sexual appearance of males to females and vice versa. Today, there are two clearly different approaches to the person with gender incongruence. The first approach is to view the condition as a psychological one that is not determined by biologic factors. The second approach is to view gender incongruence as having an innate biological foundation. These opposing viewpoints dictate what kind of therapy is offered. Entirely new guidelines are necessary. All clinical research on the subject should adhere to the existing principles for protection of human subjects. No treatment protocols should be developed or implemented until there is clear evidence of safety and efficacy in a population of patients treated from young childhood through middle-age adult life.