Hematologic and Metabolic Diagnosis, Essay Example

Diagnosis

The diagnosis that would be given for a thirteen year old girl who is thin and manifests breast tanner 2 and public hair tanner 1 would be adolescent gender dysphoria. The categorization of this dysfunction is controversial. It is one of the metabolic disorders which will receive a new classification in the DSM- V. The patient would be considered to have a sub typical manifestation of the adolescent gender dysphoria. The teenager may have a hormonal imbalance which is an outcome of the 46XY chromosome formation and a history of being exposed to androgen during the prenatal stages of development (de Vries et al., 2011; Lescher, 2013; Sheenema & cohen, 2011 & Zucker, 2011).

It is not necessary that the teenager develop a masculine identity in order to be diagnosed with the disorder. The mother has brought the teenager to seek medical counseling as a result of the entry into adolescence. One of the symptoms of gender dysphoria is that the teenager had aversion to their developing genitals. The children may have a tendency to conceal their breasts by binding them and manifest masculine behavior (i.e., urinating in a vertical position instead of sitting down to urinate).  The female teenagers may also pe5rceive sensations of being isolated anxious and depressed (de Vries et al., 2011; Lescher, 2013; Sheenema & Cohen, 2011; Zucker, 2011)

Gender dysphoria is more commonly encountered in boys than girls. I would refer teenager for psychological counseling and if the diagnosis were confirmed by the psychologist. It is probable that the condition would stop as the teenage girl enters puberty. It is important to diagnose if the teenage girl has gender dysphoria due to the potential outcome of the gender dysphoria’s potential of persistence and causing gender dysphoria sexual identification challenges. The treatment plan would be initially composed of additional tests (de Vries et al., 2011; Lescher, 2013; Sheenema & Cohen, 2011 & Zucker, 2011)

Treatment

The initial course of treatment would be to reefer the teenage girl to a psychologist for further evaluation. In the event that the diagnosis from the psychologist is positive, it may be a compensatory response to a sexual trauma. The gender dysphoria may also be genetic in nature. The treatment would be administered by the application of oral consumption of 17- ? estradiol (de Vries et al., 2011; Lescher, 2013; Sheenema & Cohen, 2011;  Zucker, 2011).

The initial dosage which would be administered would be 5 ?g/ kg/ d. This would be increased every six months in increments of 5 ?g/ kg/ d. The oral consumption of 17- ? estradiol is recommended instead of external applications due to the hazard of excessive hormonal modification.  The follow up visits would be composed of assessing her testosterone levels, estradiol levels, FSH, LH, tanner stage, sitting height and weight every three months (de Vries et al., 2011; Lescher, 2013; Sheenema & Cohen, 2011; Zucker, 2011).

In the event that a histrilin implant is used in the metabolic therapy, the testosterone levels would not be assessed. On an annual basis the bone development of the patient’s left hand would be evaluated by means of x- rays, the density of the patient’s bone structure would be assessed by means of DEXA. In addition the patient’s lipids, HbA1c, glucose, insulin would be reviewed on an annual basis. The insulin liver function examinations and the renal function examinations would be conducted every year (de Vries et al., 2011; Lescher, 2013; Sheenema & Cohen, 2011; Zucker, 2011).

Discussion

The hormonal therapy which involve incrementally increased dosages of oral of 17- ? estradiol have been assessed to have no effect on the teenagers future capacity to reproduce. The effects of the schedule of the ovulation and menstruation process would be one of the limitations of this diagnosis.  The patient’s height may not be affected by the therapeutic intervention of oral dosages of 17- ? estradiol (de Vries et al., 2011; Lescher, 2013; Sheenema & Cohen, 2011; Zucker, 2011).

References

De Vries, A. L .C., Doraleijers, T. A. H., Steenema, T. D., & Cohen- Kettenis, P. T. (2011).Puberty suppression in adolescents with gender identity disorder: a prospective follow- up study. Journal of Child Psychology and Psychiatry, 52(11):1195- 1202.

Lescher, R. K. (2013). Gender dysphoria in childhood and adolescence. All Alaska Pediatric Symposium, November 1, 2013.

Steenema, T. D. & Cohen- Kettenis, P. T. (2011). Gender transitioning before puberty? Archives of Sexual Behavior, 40: 649- 650.

Zucker, K. J. (2010). The DSM diagnostic criteria for gender identity disorder in children. Archives of Sexual Behavior, 39(2): 477- 498.