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".A review published in Child and Adolescent Mental Health found that puberty blockers are fully reversible, and that they are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.More rigorous studies are needed to assess the effectiveness, safety, and long-term benefits and risks of hormonal and surgical treatments. For instance, a 2020 Cochrane review found insufficient evidence to determine whether feminizing hormones were safe or effective. Several studies have found significant long-term psychological and psychiatric pathology after surgical treatments.In 2021, a review published in Plastic And Reconstructive Surgery found that less than 1% of people who undergo gender-affirming surgery regret the decision.
Macrotia refers to an ear that is larger than would be expected. The normal auricular axis length is 58–62 mm (2.3–2.4 in) among females and 62–66 mm (2.4–2.6 in) among males. The average width of an adult ear, specifically the distance between the helix root (inner front edge) and the posterior auricle (outer front edge), is between 30 and 40 mm (1.2 and 1.6 in). Treatment for Macrotia
Macrotia is an external ear malformation and is not known to cause any hearing impairment on its own, although it may occasionally occur simultaneously with other developmental disorders that do affect hearing. Treatment is typically not necessary, although patients may seek cosmetic treatment. In some cases, surgery (otoplasty) is performed to reduce the ear size. While generally considered a cosmetic procedure, otoplasty for macrotia can improve overall quality of life, especially for young patients who may be able to avoid reduced self-esteem and social avoidance behavior due to large ears. Otoplasty for macrotia typically focuses on reducing the size of the scapha, which is the concave region of the ear between the helix and antihelix ridge, while preserving ear shape and contour. References


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