Date of Award

January 2018

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Emily R. Christison-Lagay

Abstract

The goal of this study was to identify national trends in the utilization of histrelin acetate (Supprelin) implants among transgender children in the United States. We analyzed demographic, diagnostic, and treatment data from 2004 to 2016 on the use of histrelin acetate reported to the Pediatric Health Information System (PHIS) to determine the temporal trends in its use for transgender-related billing diagnoses, e.g. “Gender Identity Disorder.” Demographic and payer status data on this patient population was also collected.

Between 2004 and 2016, the annual number of implants placed for a transgender related diagnosis increased from 0 to 63. The average age for placement was 14 years. Compared to natal females, natal males were more likely to receive implants (57 versus 46) and more likely to have implants placed at an older age (62% of natal males versus 50% of natal females were >13 years; p<0.04). The majority of children were white non-Hispanic (white: 60, minority: 21). When compared to the distribution of patients treated for precocious puberty (white: 1428, minority: 1421), white non-Hispanic patients were more likely to be treated with a histrelin acetate implant for a transgender related diagnosis than minority patients (p<0.001). This disparity was present even among minority patients with commercial insurance (p<0.001).

Utilization of histrelin acetate implants among transgender children has increased dramatically. Compared to natal females, natal males are more likely to receive implants and also more likely to receive implants at an older age. Treated transgender patients are more likely to be white when compared to the larger cohort of patients being treated with histrelin acetate for central precocious puberty (CPP), thus identifying a potential racial disparity in access to medically appropriate transgender care.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/25/2100

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