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However, obtaining supervised treatment for a transsexual boy-to-girl is difficult, arguing that height is not a disease; endocrinologists are becoming increasingly reluctant to treat even a genetically female "XX" adolescent unless bone growth X-rays show that excessive adult height for a female over 71" appears likely. In recent years the growth in reported GID cases among teenagers , particularly boys , has been extraordinary.

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The threshold of 18 should be seen as an eligibility criterion and not an indication in itself for active intervention.

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