Norman Spack

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Norman P. Spack is an American pediatric endocrinologist at Boston Children's Hospital, where he co-founded the hospital's Gender Management Service (GeMS) clinic in February 2007. It was America's first clinic to treat transgender children, [1] [2] modeled after a similar Dutch system. [3] He is an internationally known specialist in treatment for intersex and transgender youth, and is one of the first doctors in the United States [4] to advocate prescribing hormone replacement therapy to minors. [5] Spack, who is Jewish, has been an advocate for transgender resources and support groups for the Jewish community. [6]

Contents

Spack has been consulted to discuss trans medical issues, often specifically pediatric, in media outlets such as 20/20, [7] Time , [8] The Atlantic , [9] National Public Radio., [10] [11] [12] and TEDTalk. [13] He wrote the foreword of the 2008 book The Transgender Child: A Handbook for Families and Professionals.

Early life and education

Spack earned his undergraduate degree at Williams College and graduated from Rochester School of Medicine in 1969. [14]

Work with transgender children

In 1985, Spack began working with transgender patients professionally. [13] He argues that instead of being a mental disorder, transgenderism is a medical condition, and has been quoted as saying that "looking at transgenderism from a medical perspective will change the public perception that it is a psychological problem". [15] Spack is also the senior associate in the endocrine division at Boston Children's Hospital. He helped co-found a treatment plan at the clinic called Gender Services Program (GeMS) that aims to slow puberty down for children questioning their gender. [15] According to Spack, "the primary goal of the GeMS clinic is to provide medical treatment to appropriately screen gender-dysphoric adolescents, along with the comprehensive psychological evaluation recommended by the Adolescent Gender Identity Research Group (AGIR) and the Endocrine Society for making this clinical decision. The clinic does not currently provide ongoing mental health services to patients and families, but assists families in finding appropriate mental health therapists in their communities. The current clinic director is Dr. Jeremi Carswell. [16]

Related Research Articles

Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder.

Delayed puberty is when a person lacks or has incomplete development of specific sexual characteristics past the usual age of onset of puberty. The person may have no physical or hormonal signs that puberty has begun. In the United States, girls are considered to have delayed puberty if they lack breast development by age 13 or have not started menstruating by age 15. Boys are considered to have delayed puberty if they lack enlargement of the testicles by age 14. Delayed puberty affects about 2% of adolescents.

Pubarche refers to the first appearance of pubic hair at puberty and it also marks the beginning of puberty. It is one of the physical changes of puberty and can occur independently of complete puberty. The early stage of sexual maturation, also known as adrenarche, is marked by characteristics including the development of pubic hair, axillary hair, adult apocrine body odor, acne, and increased oiliness of hair and skin. The Encyclopedia of Child and Adolescent Health corresponds SMR2 with pubarche, defining it as the development of pubic hair that occurs at a mean age of 11.6 years in females and 12.6 years in males. It further describes that pubarche's physical manifestation is vellus hair over the labia or the base of the penis. See Table 1 for the entirety of the sexual maturity rating description.

<span class="mw-page-title-main">Thelarche</span> Beginning of development of the breasts in the female

Thelarche, also known as breast budding, is the onset of secondary breast development, often representing the beginning of pubertal development. It is the stage at which male and female breasts differentiate due to variance in hormone levels; however, some males have a condition in which they develop breasts, termed gynecomastia. Thelarche typically occurs between the ages of 8 and 13 years with significant variation between individuals. However, the initial growth of breast tissue occurs during fetal development.

<span class="mw-page-title-main">History of intersex surgery</span>

The history of intersex surgery is intertwined with the development of the specialities of pediatric surgery, pediatric urology, and pediatric endocrinology, with our increasingly refined understanding of sexual differentiation, with the development of political advocacy groups united by a human qualified analysis, and in the last decade by doubts as to efficacy, and controversy over when and even whether some procedures should be performed.

Pediatric endocrinology is a medical subspecialty dealing with disorders of the endocrine glands, such as variations of physical growth and sexual development in childhood, diabetes and many more.

<span class="mw-page-title-main">Boston Children's Hospital</span> Hospital in Massachusetts, U.S.

Boston Children's Hospital is the main pediatric training and research hospital of Harvard Medical School, Harvard University. It is a nationally ranked, freestanding acute care children's hospital located at the centre of Harvard Longwood Medical and Academic Area in Boston, Massachusetts. The hospital is home to the world's largest pediatric research enterprise, and it is the leading recipient of pediatric research funding from the National Institutes of Health. It provides comprehensive pediatric specialties and subspecialties to infants, children, teens, and young adults aged 0–21 throughout Massachusetts, the United States, and the world. The hospital also sometimes treats adults that require pediatric care. The hospital uses the Brigham and Women's Hospital's rooftop helipad and is an ACS verified level I pediatric trauma center, one of three in Boston. The hospital features a regional pediatric intensive-care unit and an American Academy of Pediatrics verified level IV neonatal intensive care unit. Boston Children's Hospital has been ranked as best pediatric medical center by U.S. News & World Report more times than any other hospital and is currently ranked as the best children's hospital in the United States. Its research enterprise is the world's largest and most highly funded pediatric hospital. In the 2022 fiscal year, it received more funding from the National Institutes of Health than any other children's hospital in the nation.

<span class="mw-page-title-main">Triptorelin</span> GnRH-agonist

Triptorelin, sold under the brand name Decapeptyl among others, is a medication that acts as an agonist analog of gonadotropin-releasing hormone, repressing expression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for children who experience significant discontent due to a mismatch between their assigned sex and gender identity. The diagnostic label gender identity disorder in children (GIDC) was used by the Diagnostic and Statistical Manual of Mental Disorders (DSM) until it was renamed gender dysphoria in children in 2013 with the release of the DSM-5. The diagnosis was renamed to remove the stigma associated with the term disorder.

Adolescent medicine, also known as adolescent and young adult medicine, is a medical subspecialty that focuses on care of patients who are in the adolescent period of development. This period begins at puberty and lasts until growth has stopped, at which time adulthood begins. Typically, patients in this age range will be in the last years of middle school up until college graduation. In developed nations, the psychosocial period of adolescence is extended both by an earlier start, as the onset of puberty begins earlier, and a later end, as patients require more years of education or training before they reach economic independence from their parents.

Kenneth J. Zucker is an American-Canadian psychologist and sexologist. He was named editor-in-chief of Archives of Sexual Behavior in 2001. He was psychologist-in-chief at Toronto's Centre for Addiction and Mental Health (CAMH) and head of its Gender Identity Service until December 2015. Zucker is a professor in the departments of psychiatry and psychology at the University of Toronto.

<span class="mw-page-title-main">Transgender youth</span> Children and adolescents who are transgender

Transgender youth are children or adolescents who do not identify with the sex they were assigned at birth. Because transgender youth are usually dependent on their parents for care, shelter, financial support, and other needs, they face different challenges compared to adults. According to the World Professional Association for Transgender Health, the American Psychological Association, and the American Academy of Pediatrics, appropriate care for transgender youth may include supportive mental health care, social transition, and/or puberty blockers, which delay puberty and the development of secondary sex characteristics to allow children more time to explore their gender identity.

Hypergonadotropic hypogonadism (HH), also known as primary or peripheral/gonadal hypogonadism or primary gonadal failure, is a condition which is characterized by hypogonadism which is due to an impaired response of the gonads to the gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and in turn a lack of sex steroid production. As compensation and the lack of negative feedback, gonadotropin levels are elevated. Individuals with HH have an intact and functioning hypothalamus and pituitary glands so they are still able to produce FSH and LH. HH may present as either congenital or acquired, but the majority of cases are of the former nature. HH can be treated with hormone replacement therapy.

Puberty blockers are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens and estrogens. Puberty blockers are used to delay puberty in children with precocious puberty. They are also used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity. The same drugs are also used in fertility medicine and to treat some hormone-sensitive cancers in adults.

Gender-affirming hormone therapy (GAHT), also called hormone replacement therapy (HRT) or transgender hormone therapy, is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization:

Transgender rights in Australia have legal protection under federal and state/territory laws, but the requirements for gender recognition vary depending on the jurisdiction. For example, birth certificates, recognised details certificates, and driver licences are regulated by the states and territories, while Medicare and passports are matters for the Commonwealth.

A gender identity clinic is a type of specialist clinic providing services relating to transgender health care.

<span class="mw-page-title-main">Arkansas House Bill 1570 (2021)</span> 2021 Arkansas state law

Arkansas House Bill 1570, also known as the Save Adolescents From Experimentation (SAFE) Act or Act 626, is a 2021 law in the state of Arkansas that bans gender-affirming medical procedures for transgender people under 18, including puberty blockers, hormone therapy, and sex reassignment surgery. The law also bans the use of public funds for and prohibits insurance from covering gender transition procedures, while doctors who provide treatment in violation of the ban can be sued for damages or professionally sanctioned. The measure makes Arkansas the first U.S. state to make gender-affirming medical care illegal.

Catherine Mason Gordon is an American pediatrician who is clinical director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.

Laura Edwards-Leeper is an American psychologist and founder of the first pediatric gender clinic of the United States. She also served as head of the Child and Adolescent Committee for the World Professional Association for Transgender Health.

References

  1. ↑ "Transgender At 10". Wweek.com. 2014-08-06. Retrieved 2015-04-26.
  2. ↑ "New clinic addresses intersex and gender issues". Pediatric Views. April 2007. Archived from the original on 12 May 2007. Retrieved 21 December 2008.
  3. ↑ https://publications.aap.org/pediatrics/article/149/6/e2022057475/185685/Caught-in-the-Middle-The-Care-of-Transgender-Youth [ bare URL ]
  4. ↑ Spack, Norman. "Transgenderism overview". www.imatyfa.org. Retrieved 2 March 2015. A model protocol currently employed in the Netherlands begins with a lengthy screening process in gender-variant pubescent teens at the "Tanner 2″ stage of pubertal development: breast budding in girls and testicular volumes of 8 cc, preceding phallic enlargement in boys. At this stage the pubertal manifestations are reversible. GnRH analogues are given for at least two years, potentially until age 16, when adolescents in the Netherlands are capable of giving informed consent to receive crosshormones.
  5. ↑ Kennedy, Pagan (30 March 2008). "Q&A with Norman Spack". The Boston Globe . Retrieved 21 December 2008.
  6. ↑ "Boston doctor finds treating transgender youth a transforming experience". Jewish Telegraphic Agency. 2012-01-20. Retrieved 2019-06-14.
  7. ↑ Goldberg, Alan B. (25 April 2007). "Born in the wrong body". ABC 20/20. Retrieved 21 December 2008.
  8. ↑ Fitzpatrick, Laura (8 November 2007). "The gender conundrum". Time. Archived from the original on November 11, 2007. Retrieved 21 December 2008.
  9. ↑ Rosin, Hanna (November 2008). "A Boy's Life". The Atlantic. Retrieved 21 December 2008.
  10. ↑ Spiegel, Alix (8 May 2008). "Q&A: Doctors on puberty-delaying treatments". National Public Radio. Retrieved 21 December 2008.
  11. ↑ Spiegel, Alix (8 May 2008). "Parents consider treatment to delay son's puberty". National Public Radio. Retrieved 21 December 2008.
  12. ↑ Going Female | WBUR and NPR's On Point with Tom Ashbrook
  13. 1 2 Nichols, James (23 April 2014). "How This Doctor Helps Transgender Teens Become Who They Want To Be". HuffPost. Retrieved 7 May 2024.
  14. ↑ "Medical Degrees". The Jewish News. No. VVIII. 13 June 1969. Retrieved 7 May 2024.
  15. 1 2 Underwood, Alice E. M. "Doctor Promotes Medical View of Transgenderism | News | The Harvard Crimson." Doctor Promotes Medical View of Transgenderism | News | The Harvard Crimson. N.p., 24 Nov. 2009. Web. 15 Mar. 2016.
  16. ↑ "Gender Multispecialty Service (GeMS) | Meet Our Team | Boston Children's Hospital".
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