TIMING OF HORMONAL THERAPY

Endocrinologic therapy administered to avoid an imminent threat to the patient’s health should be provided and explained to the parents and, if of an appropriate age, to the child. The most obvious example would be treatments for classical CAH.

For the following reasons, the emerging approach calls for delaying elective sex hormone treatments until the patients themselves can participate in decision-making:

  1. In general, elective sex hormone treatments can wait until the child is approaching the age of puberty when the patient can and should participate in informed decision-making. The administration of sex hormones can result in physiologic and behavioral changes discordant with the developing self-identity of the patient.[ Warne2005 Cameron1999 ] For this reason, it is best to have qualified mental health professionals assess the patient’s identity and maturity and suggest options. (Psychiatrists and psychologists can do this assessment and then work with the endocrinologist to suggest options.) Allowing a patient to make decisions about elective care also signals to the patient a fundamental valuing of his or her autonomy and personhood.

  2. Exogenous hormones carry risks; for example, testosterone treatments can result in prostatic hypertrophy, reduced fertility, changes in libido, acne, male pattern balding, and high blood pressure. It is best to wait and to allow patients to decide for themselves which risks to assume and when to alter or cease elective treatments.