Endocrine Abstracts

We describe the development of a new adolescent gender identity dysphoria (GID) service in Northern Ireland (population 1.8 million). Historically patients with GID <18 years were referred to The London joint Tavistock UCH adolescent GID service on a case by case basis. Following the commissioning of a GID service in Northern Ireland, a team of clinical psychologists, paediatric endocrinology nurse specialists, psychiatrist and paediatric endocrinologists, the first GID clinic was held in January 2013 at the Royal Belfast Hospital for Sick Children (RBHSC) with four patients. The number of new referrals has increased and to date there are 12 patients.

Patient’s aged 15–18 years are referred from GPs or Local CAMHS services to the clinical psychologist within the GID service becoming the patient’s key worker. After ensuring the diagnosis of persistent GID through at least six sessions over 6 months, new cases are discussed with the Tavistock Team in a biannual meeting held in Northern Ireland. Patients diagnosed with GID are referred to the Paediatric Endocrinology service at the RBHSC and are seen within 1–3 months, in a clinic with the key worker, paediatric endocrinology nurse specialist and endocrinologist. Each new patient undergoes physical examination and investigations to ensure no underlying health conditions. Subsequently, patients are seen 3 monthly and commenced on GnRH analogues. After a year on treatment patients are considered for cross-sex hormones and referred to the local adult services once >18 years.

Several challenges were faced during the development of the service such as staff recruitment, finding appropriate space for clinics, training of the GID team, setting up the referral pathway, awareness of service users, smooth transition to Adult GID services, developing local information leaflets and consent forms for cross-sex hormones. Clinical audit and patient feedback will help shape the future of this new exciting service.