
Baudewijntje P C KreukelsAmsterdam University Medical Center | VUmc · Department of Medical Psychology
Baudewijntje P C Kreukels
PhD
About
187
Publications
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Introduction
Skills and Expertise
Additional affiliations
March 2017 - present
April 2000 - December 2005
June 2006 - February 2017
Publications
Publications (187)
Background
Although many transmasculine individuals undergo 1 or more gynecological surgeries (ie, hysterectomy, oophorectomy, tubectomy, or colpectomy), little has been published about motivation, subjective experiences, and the effect on dysphoria and quality of life.
Aim
The aim of this study was to acquire an in-depth understanding of patients...
Background
Sexual function in transgender adolescents after puberty suppression has been a topic of recent clinical and scientific questions.
Aim
This study aimed to explore the long-term effects of early treatment with puberty suppression on sexual functioning of transfeminine individuals after vaginoplasty.
Methods
This retrospective cohort stu...
Affect variability is determined by how often and how strongly negative affect changes over time. Cisgender women report greater variability in affect than cisgender men. It has been suggested that sex hormone changes may influence affect variability. Transgender people frequently opt to use sex hormones in the form of gender-affirming hormone ther...
Objective
Transgender women who underwent gonadectomy have lower serum testosterone concentrations than cisgender women. There is uncertainty regarding the dosing and side effects of supplementation of testosterone in transgender women. This study aimed to assess the feasibility of dosing testosterone to the cisgender female physiological range in...
The neurodevelopmental basis of gender incongruence is poorly understood. Histological studies have suggested sex-atypical hypothalamic structures in transgender individuals, forming the basis for the brain sexual differentiation hypothesis. However, existing neuroimaging studies have typically involved small, mostly adult samples, have assessed on...
The present study aimed to investigate whether differences exist between younger and older presenting adolescents at the Center of Expertise on Gender Dysphoria regarding psychological functioning and autistic traits. A total of 1487 consecutively assessed adolescents between 2000 and 2018 were divided in younger presenters (age ≤ 13.9 years) and o...
A formal Gender Dysphoria classification— as outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — is a prerequisite for the reimbursement of both gender‐affirming medical care and transgender mental health care in the Netherlands. Gender Dysphoria and its conceptual precursors have always been moving targets:...
Our author team would first like to thank the authors of the letter to the editor for their reaction to our recent article “Desired Decision-Making Role and Treatment Satisfaction Among Trans People During Medical Transition: Results From the ENIGI Follow-up Study.”¹ In today’s world of Twitter & Co, it is not a given that critical reflection is br...
When seeking gender-affirming care, trans* and gender-diverse individuals often describe experiencing barriers. However, a deeper understanding of what constitutes such barriers is generally lacking. The present research sought to better understand the barriers trans* and gender-diverse individuals experienced, and their effects, when seeking gende...
Objectives
This study is the first to gain insight into long-term effects into adulthood of early gender affirming medical treatment in transgender adolescents on the development of gender identity and sexuality.
Methods
Transgender adolescents who started medical treatment between 1989-2000 and were treated with gender-affirming hormone treatment...
Objective:
Sexual wellbeing is an important aspect of quality-of-life. In transgender individuals who seek gender affirming treatment, various aspects of sexuality have been assessed. However, not much is known on how transgender individuals themselves perceive sexual wellbeing. This study aims to explore the perception of sexual wellbeing in tran...
Objective:
To describe and reflect on the development process of GenderJourney: an ethics support tool that seeks to foster (dialogue and reflection on) shared decision-making (SDM) in gender-affirming medical care (GAMC).
Methods:
Part of a larger project, this study used a participatory design. We included transgender and gender diverse (TGD)...
Study objectives:
Transgender persons can use gender-affirming hormone therapy (GAHT) to align their physical appearance with their identified gender. Many transgender persons report poor sleep, but the effects of GAHT on sleep are unknown. This study examined the effects of a 12 months of GAHT use on self-reported sleep quality and insomnia sever...
This qualitative study aimed to map and provide insight into the ethical challenges and norms of adult transgender and gender diverse (TGD) clients in gender-affirming medical care (GAMC). By doing so, we seek to make an empirical and constructive contribution to the dialogue on and moral inquiry into what good decision-making in GAMC should entail...
Background
Shared decision making (SDM) is particularly important in transition-related medical interventions (TRMIs) given the nature of treatment and history of gatekeeping in transgender health care. Yet few studies have investigated trans people’s desired decision-making role within TRMI and factors that influence these desires.
Aims
The study...
During adolescence, many individuals with gender incongruence (GI) experience distress related to body dissatisfaction. This study aims to describe the body (dis)satisfaction of Dutch adolescents referred for GI and to describe the influence of body image on their psychological functioning.
Self-report measures on body satisfaction (Body Image Sc...
Objective:
Transgender and gender diverse individuals are individuals whose gender identity differs from their sex assigned at birth. The discordance between gender identity and sex assignment may cause significant psychological distress: gender dysphoria. Transgender individuals may choose to undergo gender-affirming hormone treatment or surgery,...
Background
Twenty years ago, the Dutch Protocol—consisting of a gonadotropin-releasing hormone agonist (GnRHa) to halt puberty and subsequent gender-affirming hormones (GAHs)—was implemented to treat adolescents with gender dysphoria.
Aim
To study trends in trajectories in children and adolescents who were referred for evaluation of gender dysphor...
Background:
Gender-affirming treatments are reported to improve mental health significantly. However, a substantial number of transgender individuals report a relapse in, or persistence of, mental health problems following gender-affirming treatments. This is due to multiple stressors occurring during this period, and in general as a consequence o...
Background
In gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges rel...
Everyone has sexual rights and is entitled to enjoy sex, regardless of gender identity or expression. It is therefore encouraging to witness a recent growth in research on sexuality in transgender individuals. We provide a short overview of extant research on sex and relationships in this population and argue that current research has mostly been c...
Background: Gender clinics are experiencing an increase in non-binary and/or genderqueer (NBGQ) individuals applying for gender affirming medical treatment (GAMT). GAMT is a well-established approach in reducing body dissatisfaction in binary transgender (BT) people, but knowledge on GAMT in NBGQ people is limited. Previous research shows that NBGQ...
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this are...
Purpose
Adolescence is an important period for sexual development, including sexual debut. The purpose of this study was to assess first romantic and sexual experiences and debut age in individuals with differences of sex development (DSD/intersex) and compare these with age-matched and gender-matched population control values.
Methods
Questionnai...
Intersex conditions or disorders/differences of sex development (DSD) are conditions in which the development of chromosomal, gonadal and/or genital characteristics is atypical. Studies in individuals with DSD conditions may provide valuable insights on the roles played by sex chromosomes, sex hormones, sex anatomy and gender of rearing in the deve...
Background:
Concerns exist regarding effects of puberty suppression on neurodevelopment. Intelligence is strongly correlated with educational achievement in the general population. This study aimed to examine the association between pre-treatment intelligence and educational achievement after gender-affirming treatment including puberty suppressio...
Purpose:
Worldwide, transgender women (TGW) bear a high HIV burden. Limited data are available on HIV prevalence and risk factors among TGW in western European countries. Our aim is to assess the prevalence of TGW living with HIV who underwent primary vaginoplasty in an academic reference hospital and to identify high-risk subgroups.
Methods:
Al...
Background
Increasing numbers of adolescents seek help for gender-identity questions. Consequently, requests for medical treatments, such as puberty suppression, are growing. However, studies investigating the neurobiological substrate of gender incongruence (when birth-assigned sex and gender identity do not align) are scarce, and knowledge about...
Sexual-wellbeing is recognized as an important aspect of quality-of-life. Yet, no overview exists of which aspects of sexual-wellbeing have been assessed in trans individuals seeking or undergoing medical treatment, nor is it clear what tools are used to evaluate the effect of medical treatment on sexual-wellbeing. First, to identify which topics p...
Background: While the importance of sexual pleasure for physical and mental health becomes increasingly evident, research on sexual pleasure in transgender persons is lacking. Recently, the first version of the Amsterdam Sexual Pleasure Index (ASPI Vol. 0.1) was validated in cisgender persons. This questionnaire aims to assess the tendency to exper...
Gender and sexually diverse adolescents have been reported to be at an elevated risk for suicidal thoughts and behaviors. For transgender adolescents, there has been variation in source of ascertainment and how suicidality was measured, including the time-frame (e.g., past 6 months, lifetime). In studies of clinic-referred samples of transgender ad...
Over the past decades, great strides have been made to professionalize and increase access to transgender medicine. As the (biomedical) evidence base grows and conceptualizations regarding gender dysphoria/gender incongruence evolve, so too do ideas regarding what constitutes good treatment and decision-making in transgender healthcare. Against thi...
Transgender people and their next-of-kin may request information on sexual orientation and preferred partners during hormonal affirming process. Although previous research on sexual orientation in transgender people is extensive, this literature may already be outdated and/or the methodology of studies assessing sexual orientation may fall short. T...
Objectives: To evaluate the experienced barriers of care for treatment-seeking trans individuals (TSTG) in three large European clinics.
Methods: An online follow-up questionnaire was filled out by 307 TSTG individuals as part of the research protocol of the European Network for the Investigation of Gender Incongruence (ENIGI). Data was collected...
Background:
Increased mortality in transgender people has been described in earlier studies. Whether this increased mortality is still present over the past decades is unknown. Therefore, we aimed to investigate trends in mortality over five decades in a large cohort of adult transgender people in addition to cause-specific mortality.
Methods:
W...
Background:
While much emphasis has been put on the evaluation of gender-affirming surgery (GAS) approaches and their effectiveness, little is known about the health care needs after completion of these interventions.
Aim:
To assess post-GAS aftercare needs using a mixed-method approach and relate these to participant characteristics.
Methods:...
Background
Previous research indicating that women with differences of sexual development (DSD), namely women with Turner syndrome (TS), women with congenital adrenal hyperplasia (CAH), and women with XY-DSD, have an impaired psychosocial and -sexual well-being and quality of life (QOL), was often limited by small samples and inadequate control gro...
Samenvatting Hoewel transgender personen steeds zichtbaarder worden in onze maatschappij en in de zorgverlening, blijkt er bitter weinig onderzoek uitgevoerd naar hun seksualiteitsbeleving. Oudere, vaak kleinschalige studies hebben het seksueel functioneren na een medische transitie vaak verengd tot het al dan niet kunnen beleven van een orgasme. H...
Gender diverse individuals who do not conform to society’s binary gender expectations are more likely to experience difficulties in acceptance and in recognition of gender, compared to binary-identifying transgender people. This may accentuate the feeling that their gender identity is not socially recognized or validated. This study aimed to invest...
Background
Long-term gender-affirming hormone therapy (GHT) in older transgender individuals could have beneficial effects on cognitive functioning. Cardiovascular risk factors and psychological factors are known determinants of cognition. Despite the rising number of older transgender individuals, only few studies have examined cognitive functioni...
Background
In contrast to cisgender persons, transgender persons identify with a different gender than the one assigned at birth. Although research on the underlying neurobiology of transgender persons has been accumulating over the years, neuroimaging studies in this relatively rare population are often based on very small samples resulting in dis...
Background
In the DSM-5 diagnosis of childhood Gender Dysphoria, two of the eight criteria focus on body satisfaction of the child. Nevertheless, this subject is understudied. This study aims to describe the body image of children with gender incongruence (GI) in relation to birth assigned sex and the intensity of GI.
Method
Self-report and parent...
Purpose:
The World Health Organization general assembly approved the 11th revision of the International Classification of Diseases (ICD) in 2019 which will be implemented in 2022. Gender identity-related diagnoses were substantially reconceptualized and removed from the mental health chapter so that the distress criterion is no longer a prerequisit...
Studies estimate that gender-diverse persons represent 0.1 to 2% of populations investigated, but no such assessment was performed in Latin America. In a representative sample of Brazil’s adult population (n = 6000), we investigated participants' sociodemographic characteristics and possible associations between these and current gender identity, c...
Improving transgender people’s quality of life (QoL) is the most important goal of gender-affirming care. Prospective changes in affect can influence QoL. We aim to assess the impact of initiating gender-affirming hormonal treatment (HT) on affect. In the European Network for the Investigation of Gender Incongruence (ENIGI) study, we prospectively...
Competing theories have posited roles for foetal androgen exposure in the development of human handedness. However, due to practical and ethical considerations, few studies have used hormonal measures to examine this possibility. The current paper reviews this literature and reveals a generally inconsistent pattern of results. We also present data...
Background: Surgery is performed in many individuals with disorders/differences of sex development (DSD). Irreversibility of some surgical procedures, lack of information about the procedures, and lack of follow-up care for physical and psychological outcomes, lead to wish for more knowledge from both surgeons and patients. After the consensus conf...
Study objective. To extract the sexual health and wellbeing needs of current generations of youth with intersex/Differences of Sex Development (DSD), during transition from pediatric to adult health care.
Design. Qualitative narrative analyses, quantitative descriptives and questionnaires.
Setting. Peer support networks and outpatient clinics.
Part...
Purpose: Pubertal suppression is standard of care for early pubertal transgender youth to prevent the development of undesired and distressing secondary sex characteristics incongruent with gender identity. Preliminary evidence suggests pubertal suppression improves mental health functioning. Given the widespread changes in brain and cognition that...
Introduction: Several steps in the transitioning process may affect sexual desire in transgender people. This is often underexposed by those providing gender affirming care. Testosterone therapy in transgender men (TM) generally leads to increasing frequency of desire, masturbation, sexual fantasies and arousal. Studies in transgender women (TW) ar...
Background: High quality data pertaining to the size of the transgender and gender diverse (TGD) population are scant, however, several recently published studies may provide more reliable contemporary estimates.
Aims: To summarize the estimated number and proportion of TGD individuals overall and across age groups, based on most accurate data.
Met...
Our understanding of the neurobiological basis of gender diversity is limited. Even though more and more neuroimaging studies in adults hint towards sex-atypical and less pronounced sexual differentiation, the picture is far from clear and relatively little is known about the neurobiological correlates of gender incongruence in childhood and youth....
Click-evoked otoacoustic emissions (CEOAEs) are echo-like sounds, generated by the inner ear in response to click-stimuli. A sex difference in emission strength is observed in neonates and adults, with weaker CEOAE amplitudes in males. These differences are assumed to originate from testosterone influences during prenatal male sexual differentiatio...
Introduction:
Several steps in the transitioning process may affect sexual desire in transgender people. This is often underexposed by those providing gender-affirming care.
Aim:
To prospectively assess sexual desire during the first 3 years of hormonal therapy (HT) in transgender people.
Methods:
This prospective cohort study was part of the...
STUDY QUESTION: What are the levels of breast development and satisfaction in women with a Disorder/Difference of Sex Development (DSD)?
SUMMARY ANSWER: Compared with normative data, women with DSD reached lower Tanner stages and reported less breast satisfaction.
WHAT IS KNOWN ALREADY: Women with DSD may have chromosomal and hormonal variations...
Introduction:
Studies about sexual functioning in trans persons have mainly focused on sexual functioning after genital gender-affirming surgery, have had small sample sizes, and have not explored the broad range of possible sexual dysfunctions. Measuring sexual functioning in trans persons during transitioning is important to determine the kind o...
The influence of testosterone on the development of human brain lateralization has been subject of debate for a long time, partly because studies investigating this are necessarily mostly correlational. In the present study we used a quasi-experimental approach by assessing functional brain lateralization in trans boys (female sex assigned at birth...
Accurate estimates of the number and proportion of transgender and gender nonconforming people in a population are necessary for developing data-based policy and for planning and funding of health care delivery and research. The wide range of estimates reported in the literature is attributable primarily to differences in definitions. Other sources...
Objective:
The aim of the study was to evaluate psychiatric symptoms among 1022 persons with various disorders of sex development (DSDs).
Methods:
The study was a European multicenter cross-sectional clinical evaluation in six countries. The mean (SD) age of participants was 32.1 (13.4) years. The cohort consisted of 325 individuals with Turner...
For various reasons, sexuality of individuals with differences/disorders of sex development (DSD) may be affected. The aim of the study was to describe sexual activity, satisfaction with sex life, satisfaction with genital function, and sexual problems in people with different DSD conditions. Data were collected from 1040 participants in Europe.
Ma...