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2. Gender identity emerges prior to puberty and then becomes more stable as puberty begins.
3. Gender identity formation is independent of sex hormone influence. However when gender dysphoria intensifies at the start of puberty, this is predictive of future transgender identity continuing into adulthood.
4. Childrenmeetingcriteriaforgenderdysphoriahavea strong sense of gender identity mismatch and are insistent, consistent and persistent about their true gender identity when it differs from their biologic sex.
5. When gender identity doesn’t match with biological sex, this can cause emotional distress, also called gender dysphoria. Sexual maturation in the face of gender dysphoria – i.e., development of secondary sex characteristics during puberty that do not match gender identity – can be psychologically devastating.
6. Treatment by deferral of puberty is the standard of care. It is much better to prevent mismatched secondary sex characteristics from developing than to try to reverse them later.
7. The Endocrine Society and the World Professional Association for Transgender Health have published standards related to medical management of adolescents with gender dysphoria.
8. Medical options include suppression of puberty starting at Tanner Stage 2, when the earliest
manifestations of sexual development are seen, followed by consideration of cross-sex hormones (testosterone or estrogen) in later adolescence. Transgender adolescents suffering disproportionate anxiety and depression resulting from their dysphoria can improve with appropriate transition- related treatments.
9. Help is available through the Child and Adolescent Gender clinic. A referral can be made to Pediatric Endocrinology at Mott Children’s Hospital.
Dr. Randolph’s important points were that gender identity is a powerful force that continues unabated throughout life and leads patients even in the Medicare age brackets to seek gender reassignment. The preferred term for surgery to correct the mismatch between gender identity and sexual anatomy is “gender reaffirming,”
not sex change. It is covered by Medicare, but by few other insurers.
There is a widespread misunderstanding of this condition, which has unfortunately become politicized by politicians with no understanding or compassion for these individuals, not unlike the profound misunderstandings regarding the LGBT community that prevailed until recently. The least we can do in the medical community is to be aware of the evidence, know the facts, inform others, and counsel and refer patients appropriately.
In Case You Missed It: Changes in
the WCMS Constitution and Bylaws
By Richard E. Burney, MD
County Medical Society members attending the most recent General Session voted to approve revisions of the society’s Constitution and Bylaws. The proposed changes are not dramatic, although they do reflect subtle changes in the relationship between the county and the state societies, the former now being the more subordinate than the latter. If you, like me, hadn’t been paying much attention to this, I will summarize
the main points.
First, the Mission of the society has been broadened from “support(ing) local physicians in their professional commitment” to providing “professional collegial support and understanding,” public health activism,” and “advocacy for excellence in patient care.”
The definition of a “Member,” which was quite long and complicated having tried to encompass and define the wide variety of roles physicians play in our community, has been shortened and simplified to one line: Membership... shall be consistent with categories established by the Michigan State
Medical Society.” MSMS has a wide variety of categories, such as active, active-dues exempt, in- training, etc., so many that it is unlikely we would be devising new ones locally.
The new Article 4 adds the new requirement that the President and President-elect of WCMS “be practicing physicians at the time of election.”
Article 6 now specifies wisely and with frugality that “The Society shall not contract debt.”
Article 8, on the other hand, which is entitled “Conformance,” takes the stand that WCMS, which
as you are well aware has many members of an independent and creative bent, need not feel it has to conform in each and every way with MSMS. This took some wordsmithing. Whereas the old constitution states that “provisions of the MSMS Constitution and Bylaws... shall be an integral part” of our Constitution and Bylaws, the new Article states they are “intended to be generally consistent with the Constitution
and Bylaws of MSMS.” (Continued on page 26) Volume 69 • Number 1 Washtenaw County Medical Society BULLETIN 25

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