Empowering Tomorrow: Navigating Gender-Affirming Care and Fertility Preservation for Transgender and Gender-Diverse Youth

Transgender and gender-diverse youth seek care to align their biology with their gender identities. In recent years, the prevalence of transgender youth has increased, with 1-2 percent of adolescents reporting they are transgender.

Mount Sinai’s Pediatric and Adolescent Transgender Program collaborates with the Center for Transgender Medicine and Surgery for adults to provide care for transgender and gender-diverse people of all ages. Within the youth program, the multidisciplinary team is led by Mabel Yau, MD, Assistant Professor of Pediatrics (Pediatric Endocrinology and Diabetes), and Matthew Oransky, PhD, Assistant Clinical Professor of Psychiatry. Clinical psychologists provide assessments, parent and caretaker consultations, and psychological direction for other support if needed. Pediatric endocrinologists provide gender-affirming care for youth, including pubertal assessment, pubertal blockade with gonadotropin-releasing hormone agonist (GnRHa), and gender-affirming hormone therapy (GAHT). Management choices are made collaboratively by the patient, the patient’s family, and the multidisciplinary treatment team.

Mount Sinai’s program prioritizes fertility preservation. Patients are counseled on the impact of gender-affirming treatments on future fertility, as well as fertility preservation options prior to the initiation of GnRHa and gender-affirming treatment. Interested patients and parents can consult concurrently with Neha Malhotra, MD, Assistant Professor of Pediatrics (Pediatric Urology), to avoid delays of gender-affirming treatment due to the fertility preservation process. The Center’s interdisciplinary team works together to optimize the chances that a patient will succeed in fertility preservation.

Gender-affirming care is associated with improved quality of life and mental health. A goal of GAHT is better alignment of appearance with the person’s gender identity. Decreases in depression and anxiety symptoms, along with increases in positive affect and life satisfaction, have been associated with GAHT.