They noted a decrease in suicidal ideation among youth who have access to gender-affirming care and comparable levels of depression to cisgender peers among socially transitioned pre-pubertal youth. In its 2017 guideline on treating those with gender dysphoria, it recommends puberty blockers be started when the child has started puberty ( Tanner Stage 2 for breast or genital development) and cross-sex hormones be started at 16, though they note "there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD/gender incongruence". They recommend a multidisciplinary team of medical and mental health professionals manage the treatment for those under 18. They also recommend "monitoring clinical pubertal development every 3 to 6 months and laboratory parameters every 6 to 12 months during sex hormone treatment".For adolescents, WPATH says that physical interventions such as puberty blockers, hormone therapy, or surgery may be appropriate. Before any physical interventions are initiated, however, a psychiatric assessment exploring the psychological, family, and social issues around the adolescents gender dysphoria should be undertaken.
Periorbital cellulitis, or preseptal cellulitis (not to be confused with orbital cellulitis, which is posterior to the orbital septum), is an inflammation and infection of the eyelid and portions of skin around the eye anterior to the orbital septum. It may be caused by breaks in the skin around the eye, and subsequent spread to the eyelid; infection of the sinuses around the nose (sinusitis); or from spread of an infection elsewhere through the blood. Signs and symptoms
Periorbital cellulitis must be differentiated from orbital cellulitis, which is an emergency and requires intravenous (IV) antibiotics. In contrast to orbital cellulitis, patients with periorbital cellulitis do not have bulging of the eye (proptosis), limited eye movement (ophthalmoplegia), pain on eye movement, or loss of vision. If any of these features is present, one must assume that the patient has orbital cellulitis and begin treatment with IV antibiotics. CT scan may be done to delineate the extension of the infection. Affected individuals may experience: swelling,
redness,
discharge,
pain,
shut eye,
conjunctival infection,
fever (mild), slightly blurred vision, teary eyes, and some reduction in vision. Typical signs include periorbital erythema, induration, tenderness and warmth. Causes
Staphylococcus aureus, Streptococcus pneumoniae, other streptococci, and anaerobes are the most common causes, depending on the origin of the infection.The advent of the Haemophilus influenzae vaccine has dramatically decreased the incidence. Diagnosis
Tests include blood work (CBC) to rule out infectious cause. Also perform a CT scan, x ray of the anterior skull to view the sinuses, MRI scan and finally a soft tissue ultrasound of the orbital region.