Gender dysphoria in adolescents: The need for a shared assessment protocol and proposal of the AGIR protocol

In the Center of Expertise on Gender Dysphoria at the VU University Medical Center in Amsterdam, a structured assessment and treatment protocol for adolescents with atypical gender identities is used. This multidimensional approach includes specific phases: psychological assessment, medical evaluation, possible psychotherapy, gonadotropin-releasing hormone (GnRH) analogues and cross-sex hormone therapy, which are differentiated according to age and specific requirements of each individual case. Recently, a collaborative study called AGIR (Adolescent Gender Identity Research) has been proposed by the Dutch clinic to allow international and cross-clinic comparisons with regards to referral background and psychological functioning, and to evaluate the treatment of gender dysphoric adolescents. An extensive assessment and timely treatment of adolescents with gender dysphoria seems essential to support the process of awareness and structuring of the dimensions of sexual identity, to prevent frequent associated psychopathologies and to improve quality of life by promoting more adequate psychosocial adaptation. Currently, transgender health care in Italy is characterized by isolated practitioners. Thus, it is particularly important to create specialised services that use a common protocol and that are coordinated at both the national and international levels in order to respond to the increasing number of requests in this age group.