Diane Chen

Verified

Diane verified their affiliation via an institutional email.

Learn more

Verified

Diane verified their affiliation via an institutional email.

Learn more

• PhD in Clinical Psychology
• Professor (Full) at Ann & Robert H. Lurie Children's Hospital of Chicago

Importance Transgender and nonbinary (TGNB) adolescents and young adults (AYA) designated female at birth (DFAB) experience chest dysphoria, which is associated with depression and anxiety. Top surgery may be performed to treat chest dysphoria. Objective To determine whether top surgery improves chest dysphoria, gender congruence, and body image i...

Background: Limited prospective outcome data exist regarding transgender and nonbinary youth receiving gender-affirming hormones (GAH; testosterone or estradiol). Methods: We characterized the longitudinal course of psychosocial functioning during the 2 years after GAH initiation in a prospective cohort of transgender and nonbinary youth in the...

Objective To develop a patient- and family-centered Aid For Fertility-Related Medical Decisions (AFFRMED) interactive website targeted for transgender and nonbinary (TNB) youth/young adults and their parents to facilitate shared decision-making about fertility preservation interventions through user-centered participatory design. Method TNB youth/...

Sexual and gender minority (SGM) communities experience an increased risk for sexual victimization. Because these rates are reported in aggregate, little is known about the unique experiences of sexual violence among individuals with differences of sex development/intersex variations (DSD/I). The purpose of this study is to describe the experiences...

Objective To examine the relationships between gender minority stressors and mental health outcomes among transgender and gender diverse (TGD) youth and explore the moderating role of positive affect. Method Baseline data of 315 TGD youth (ages 12–20 years old) from the Trans Youth Care—United States study comprised the analytic sample. Youth comp...

Purpose Individuals with obesity and binge eating face weight stigma, which can lead to internalized weight bias (IWB), reinforce eating disorder (ED) pathology, and promote unrealistic weight loss expectations (WLE). Greater understanding of pathways between IWB, ED pathology, and WLE could inform interventions to promote healthy WLE and reduce IW...

Background: In the U.S. and worldwide, there is a significant number of young people acquiring and living with HIV. Antiretroviral therapy (ART) has led to significant reductions in HIV-related illnesses and deaths, allowing young people living with HIV to manage their condition as a chronic disease. Ensuring high levels of ART adherence is vital...

Objective Family functioning influences various psychosocial outcomes for individuals with pediatric chronic health conditions (e.g., Leeman, J., Crandell, J. L., Lee, A., Bai, J., Sandelowski, M., & Knafl, K. (2016). Family Functioning and the Well-Being of Children With Chronic Conditions: a Meta-Analysis. Research in Nursing & Health, 39, 229–24...

Purpose Individuals with obesity and binge eating face weight stigma, which can lead to internalized weight bias (IWB), reinforce eating disorder (ED) pathology, and promote unrealistic weight loss expectations (WLE). Greater understanding of pathways between IWB, ED pathology, and WLE could inform interventions to promote healthy WLE and reduce IW...

Objective Digital health tools (e.g., apps, text messaging, telehealth, and social media) have been employed with pediatric populations for approximately two decades. As such, digital health is a scientifically mature field, ready for critical evaluation of the challenges and opportunities of using technology to equitably improve child health and h...

Transgender/non-binary (TNB) adolescents are at increased risk for mental health concerns, and caregiver awareness is important to facilitate access to care. Yet, limited research has examined caregiver awareness of TNB mental health. Thus, we examined (1) the prevalence of internalizing symptoms (depression, generalized anxiety, separation anxiety...

Purpose: Mixed gonadal dysgenesis is a difference of sex development that is often confused with other conditions. Individuals have a 45,X/46,XY karyotype. Gonads are characterized by a streak gonad and a dysgenetic testis at varying levels of descent. Persistent Müllerian structures are typical (eg, hemi-uterus). There is significant phenotypic h...

Objective Differences of sex development (DSD) can affect the physical health, appearance, and psychosocial functioning of affected individuals, but little is known about how subjective appearance perceptions (body image) impact psychosocial outcomes. This study evaluated body image and its associations with psychosocial outcomes including quality...

In brief Transgender and gender diverse (TGD) youth demonstrate low utilization of fertility preservation before medical and surgical gender-affirming interventions. However, a significant number of TGD youth have goals for parenthood and/or recognize that their attitude toward future family-building goals may change over time. In this narrative re...

Objective This article aims to explore ethical tensions in pediatric gender-affirming care and illustrate how these tensions arise in the clinical setting. Method This article utilizes two de-identified cases of transgender youth—Emma and Jayden—as a framework for discussing ethical principles in pediatric gender-affirming care. Case summaries det...

Minority stress is an important contributor to mental health disparities among sexual and gender minority communities. Adolescents and young adults (AYA) with intersex variations/differences of sex development (I/DSD) frequently experience mental health symptoms which may be influenced by minority stressors. This study explored minority stress and...

In 2023, the incoming Editors of the Journal of Pediatric Psychology (JPP) and Clinical Practice in Pediatric Psychology (CPPP), Drs. Avani Modi and Christina Duncan, respectively, both identified enhancing reporting practices for diversity, equity, and inclusion (DEI) in pediatric psychology as a top priority (Duncan, 2023; Modi, 2023). These effo...

Background Prepubertal transgender, nonbinary, and gender-diverse (TGD) children (ie, those asserting gender identity, expressing gender-role behavior outside of culturally defined norms for their sex registered at birth, or both) are presenting in greater numbers to pediatric gender clinics across the United States and abroad. A large subset of TG...

BACKGROUND Prepubertal transgender, nonbinary, and gender-diverse (TGD) children (ie, those asserting gender identity, expressing gender-role behavior outside of culturally defined norms for their sex registered at birth, or both) are presenting in greater numbers to pediatric gender clinics across the United States and abroad. A large subset of TG...

Increasing numbers of youth are identifying as transgender or gender diverse (TGD), meaning their gender identity or expression do not conform to culturally defined expectations for their designated sex at birth. The mental health needs of TGD youth are diverse, and to effectively address these needs requires knowledgeable general pediatric provide...

Objective Cell-free DNA (cfDNA) prenatal screening is a commercially available noninvasive test that detects fetal genetic material in maternal blood. While expectant parents often use it for “gender” determination, there is little information about unintended consequences of testing, such as revelation of a difference of sex development (DSD). The...

Purpose: To compare baseline mental health symptoms and gender affirmation between Black/Latine versus White transgender/nonbinary youth (BLTY vs. WTY) and examine relationships between gender affirmation and mental health symptoms, and whether associations differed by race/ethnicity subgroup. Methods: Baseline data were analyzed from the gender...

Objective: Transgender/non-binary (TNB) youth are at increased risk for anxiety, depression, and suicidality compared to cisgender youth. Gender affirming hormone therapy (GAHT, i.e., testosterone or estrogen) is a standard of care option for TNB youth, and we have recently shown that GAHT (testosterone) in transgender youth assigned a female sex...

We draw on 37 interviews with a racially diverse group of 21 trans and queer teenagers to consider how they used social media to navigate dominant ideologies amid rapidly accelerating white supremacy, anti-Blackness, xenophobia, anti-transness, and anti-queerness in 2019-2020. The analysis emerges from a humanizing qualitative study of lgbtq + yout...

Purpose: Prior studies have identified a significant relationship between internalized transphobia and poor mental health among transgender and gender-diverse (TGD) adults; however, this relationship has not been extensively examined among youth. Further, little research has sought to explore protective factors, such as identity pride, and their i...

Transgender and gender diverse (TGD) youth and their families are seeking medical and mental health care at increasing rates. As the number of multidisciplinary pediatric gender programs expands, we consider the history and evidence base for gender affirmative care and highlight existing models of care that can flexibly accommodate the diverse need...

Gender identity is a core component of human experience, critical to account for in broad health, development, psychosocial research, and clinical practice. Yet, the psychometric characterization of gender has been impeded due to challenges in modeling the myriad gender self-descriptors, statistical power limitations related to multigroup analyses,...

This comprehensive and authoritative book is written by over seventy of the foremost experts working with the care of transgender and gender expansive patients for gynecologists and those working in neighboring disciplines. Among medical specialists, understanding of the complex reality and medical needs of transgender and gender diverse individual...

Changes in gonadal hormones during puberty are thought to potentiate adolescents’ social re-orientation away from caregivers and towards peers. This study investigated the effect of testosterone on neural processing of emotional (vocal) stimuli by unfamiliar peers vs. parents, in transgender boys receiving exogenous testosterone as a gender-affirmi...

Transgender and gender diverse (TGD) youth receiving pubertal suppression treatment may be at risk for future infertility if they progress on to gender-affirming hormones. Little is known about whether and how parents of TGD youth consider fertility-related implications when making medical decisions about pubertal suppression treatment. We conducte...

Objectives: Prenatal diagnoses of differences of sex development (DSD) are increasing due to availability of cell-free DNA screening (cfDNA). This study explores first-hand experiences of parents whose children had prenatal findings of DSD. Methods: Eligible parents were identified through chart review at a pediatric center and interviewed about...

Mental and physical health disparities for transgender and gender diverse (TGD) communities have been well-documented. While advancements have been made in the development of guidelines when providing mental health care to TGD clients, gaps remain, particularly related to concrete applications of cognitive behavior therapy (CBT) approaches to addre...

Background Surgical intervention in youth with differences of sex development (DSD) is a controversial topic. Historically, evidence suggests that genital surgery in DSD is associated with mixed patient satisfaction. However, less is known about surgical outcomes under therapeutic advancements in the past several decades. Objective The purpose of...

Objective Infertility is common among individuals with differences of sex development (DSD) and affected individuals and families desire fertility counseling. This survey sought to assess fertility knowledge and experiences with fertility counseling among DSD specialists for DSD conditions excluding congenital adrenal hyperplasia. Design, Setting...

Objective: Parents of children with differences of sex development (DSD) may be at risk for general parenting stress, but little is known about their experience of stress specific to caring for a child with a chronic illness, known as pediatric parenting stress. This study describes pediatric parenting stress in parents of youth with DSD by examini...

Purpose: Top surgery (i.e. mastectomy) has been shown to improve gender dysphoria and quality of life in adult transmasculine patients. However, even as an increasing number of adolescents and young adults present for gender-affirming surgery, the impact of top surgery on this population is not well described. Minor patients require parental consen...

Objective Many transgender adolescents experience clinically elevated anxiety and depression. Testosterone (T), used as a gender affirming treatment, may reduce symptoms of anxiety and depression. We assessed the effect of gender affirming T treatment on internalizing symptoms, body image dissatisfaction, and activation patterns within the amygdala...

Executive function (EF) underlies broad health and adaptive outcomes. For transgender youth, navigating gender discernment and gender affirmation demand EF. Yet, factors associated with transgender youth EF are unknown. We investigate hypothesized predictors of EF: over-represented conditions among transgender youth (anxiety and depression symptoms...

Background Reproductive health counseling is essential for adolescents and young adults (AYAs). Transgender and gender diverse (TGD) AYAs would benefit from tailored counseling given concerns about iatrogenic infertility and sexual dysfunction, and high rates of interpersonal violence, unplanned pregnancies and sexually transmitted infections, yet...

Purpose The purpose of this study was to determine the existence and strength of association between chest dysphoria and mental health in transmasculine and nonbinary adolescents. Methods This is a cross-sectional cohort study of transmasculine and nonbinary adolescents designated female at birth between 12 and 18 years old. None had undergone pri...

Transgender and nonbinary (TNB) people who also identify as black, indigenous, and/or people of color (BIPOC) may experience compounding stress related to their racial and gender minority identities. This case study describes supporting pride, activism, resiliency, and community (SPARC), a brief five-session telemedicine-based process group for TNB...

Objective: Parental acceptance and support are associated with positive psychosocial outcomes among transgender and gender expansive (TGE) adolescents. Understanding the degree of parental acceptance and support of gender identity and expression is an important component of gender affirmative pediatric assessment and can inform intervention. Altho...

Mastectomy for chest masculinization is a commonly performed gender-affirming surgery in minor patients, a vulnerable population with unique developmental and psychosocial needs. We aimed to use principles of medical ethics (eg, autonomy, beneficence, nonmaleficence, and justice) as a framework to analyze preoperative clinical decision making by pe...

Purpose Today, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium. Methods The Oncofer...

Objective: Fertility-related health care and decision-making needs for youth with differences of sex development (DSD) are complex and vary by condition and the values and preferences of each individual and their partner and/or family. Discussing fertility implications can be a challenging aspect of clinician and family communication about a DSD di...

Purpose No educational and decision support tools exist to aid transgender and non-binary (TNB) adolescents and young adults (AYA) in making decisions about fertility preservation in the context of initiating gender-affirming medical care that can impair fertility. This study identified critical content areas and learning objectives to include in a...

Purpose This study examined whether transmasculine, transfeminine, and nonbinary adolescents and young adults (AYA) experience different levels of gender minority stress and resilience. Methods Demographic and clinical information were abstracted from medical charts from AYA initiating gender-affirming care. Group comparisons between transgender a...

Purpose: To characterize demographics, psychosocial functioning, and gender-related experiences in transgender youth enrolling versus declining participation in a multisite research study. Methods: Clinical data were abstracted from patient charts at two study sites. Continuous variables were compared using t-tests, and categorical variables were c...

Purpose This study aimed to examine transgender adolescents and young adults’ (AYA) and their parents’ preferences regarding fertility preservation (FP) information provision and discussion timing. Methods Data were derived from two separate studies: an online survey and semistructured qualitative interviews. Survey data were analyzed using descri...

Purpose This study aimed to characterize two developmental cohorts of transgender and nonbinary youth enrolled in the Trans Youth Care Network Study and describe their gender identity–related milestones and baseline mental health and psychosocial functioning. Methods Trans Youth Care participants were recruited from four pediatric academic medical...

Mental health disparities between transgender and non-binary (TNB) youth and their cisgender peers are widely documented; however, evidence-based interventions designed to address these disparities do not yet exist. In this article, we outline the mental health needs of TNB youth by identifying relevant treatment targets grounded in developmental a...

Objective: To present a topical review of minority stressors contributing to psychosocial and physical health disparities in transgender and gender expansive (TGE) adolescents. Methods: We conducted a topical review of original research studies focused on distal stressors (e.g., discrimination; victimization; rejection; nonaffirmation), proximal...

Objective: Discrepancies between cfDNA and ultrasound predicted fetal sex occur, possibly indicating disorders/differences of sex development (DSDs). Among expectant/recent parents, this study assessed: cfDNA knowledge/use, fetal sex determination attitudes/behaviors, general knowledge of DSD, and possible psychological impact of discrepancy betwe...

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...

Title: 17β-hydroxysteroid dehydrogenase type 3 deficiency: An under-recognized cause of 46,XY DSD in the United States? Introduction: The 17β-hydroxysteroid dehydrogenase type 3 (17BHSD3) enzyme, expressed in the testes, converts androstenedione (A) to testosterone (T). 17BHSD3 deficiency causes a 46,XY difference of sex development (DSD), or inter...

Objectives: Differences/disorders of sex development (DSD) medical terminology has been viewed negatively by some affected individuals. A clinical population of patients with DSD and their caregivers were surveyed regarding DSD nomenclature, hypothesizing that those unaffiliated with support groups would have more favorable attitudes toward DSD no...

Purpose: The aim of the study was to examine reproductive health attitudes and behaviors related to contraception use, provider counseling, parenthood goals, and fertility preservation (FP) in TNB adolescents. Methods: A 24-item survey was administered to 44 TNB adolescents aged 12-19 years. Results: Contraceptive use was variable even among t...

Purpose: This article outlines the process of establishing the Trans Youth Care Research Network, composed of four academic clinics providing care for transgender and gender-diverse (TGD) youth. The Network was formed to design and implement research studies to better understand physiologic and psychosocial outcomes of gender-affirming medical care...

Introduction: Differences/disorders of sex development (DSD) can be detected at different ages, including prenatally. The recent implementation of prenatal genetic testing (including cell-free DNA) may affect the frequency and impact of prenatal diagnosis of DSD. Our aims were to (1) describe prenatal detection and evaluation of differences of sex...

This retrospective chart review aims to address gaps in the literature regarding the efficacy and interaction of gonadotropin-releasing hormone agonists (GnRHa) and gender-affirming hormone therapies in medical transition regimens in transgender adolescents. We abstracted and reviewed data from 83 patients at our pediatric gender clinic, and found...

Introduction: Infertility is common for individuals with differences of sex development (DSD) and is a significant concern to these individuals. Fertility potential in many DSD conditions is poorly understood. Gonadal tissue cryopreservation (GTC) for fertility preservation (FP) is offered to children with cancer undergoing gonadotoxic therapy. Ou...

Objective: The purpose of this study is to describe psychological functioning, parenting stress, and parental support of gender expansiveness in prepubertal gender expansive children presenting to a specialized pediatric gender clinic and examine relations between parenting factors and child psychological functioning. Methods: Standard-of-care q...

Objective: Minority stress contributes to several physical and psychological problems in sexual and gender minorities but is largely understudied in transgender/gender-nonconforming (TGNC) individuals, particularly TGNC adolescents. The availability of psychometrically sound measures of adolescent minority stress can help improve assessment and tr...

Gender-affirming hormones may compromise gonadal function leading to subfertility or infertility. Fertility preservation (FP; i.e., egg and sperm "freezing") before starting hormones offers future options to transgender individuals. In the United States, FP is extremely expensive and rarely covered by medical insurance; state-specific laws govern r...

Background: Transgender children and adolescents (ie, those who experience incongruence between assigned sex at birth and internal gender identity) are poorly understood and an understudied population in the United States. Since 2008, medical care for transgender youth has generally followed guidelines developed by professional consensus, given th...

Objectives Consumers rely on online health information, particularly for unusual conditions. Disorders of Sex Development (DSD) are complex with some aspects of care controversial. Accurate web-based DSD information is essential for decision-making, but the quality has not been rigorously evaluated. The purpose of the present study was to assess th...

Disorders of sex development (DSD) often lead to infertility or sterility because of abnormal gonadal development or prophylactic gonadectomy, yet fertility preservation has rarely been considered for these patients. While infertility or sterility is a risk, fertility preservation represents a complicated decision-making consideration for parents o...

BACKGROUND Transgender children and adolescents, those who experience incongruence between assigned sex at birth and internal gender identity, are a poorly understood and understudied population in the United States. Since 2008, medical care for transgender youth has generally followed guidelines developed by professional consensus given the paucit...

Purpose: This study aimed to identify factors affecting transgender adolescents' and young adults' (AYA) decisions to pursue fertility preservation (FP). Methods: Participants completed a semistructured interview between December 2016 and June 2017 to inform improvements in fertility counseling and the development of a fertility decision aid tar...

Individuals with differences/disorders of sex development (DSD) have increased rates of infertility. For children and youth undergoing prophylactic gonadectomy for malignancy risk, our institution offers gonadal tissue cryopreservation, an experimental technique to preserve fertility cryopotential. An 11 year old girl with partial androgen insensit...

Purpose To examine provider perceptions of practice behaviors and barriers related to fertility counseling, fertility preservation, and family building among transgender patients. Methods Participants were medical and mental health professionals who treat adult and youth transgender patients. Recruitment occurred online and in person, via professi...

Per minority stress theory, sexual and gender minorities are susceptible to bias-related social stressors that can internalize and increase their susceptibility to poor physical and mental health. Parents of transgender/gender-expansive (TGE) children may also encounter a number of stressors on account of their child’s gender experience. No known r...

Background: The medical community is paying increasing attention to the healthcare needs of adolescents diagnosed with gender dysphoria who desire medical interventions to bring their bodies and gender identity into alignment. Transgender (i.e. trans) youth initiating gender-affirming hormone treatment (estrogen for birth-assigned males, testostero...

Purpose: Transgender individuals may experience impaired fertility due to gender-affirming hormonal interventions (e.g., pubertal suppression treatment and/or exogenous hormones). Clinical practice guidelines recommend providers discuss fertility implications and options for fertility preservation. The goal of this study was to examine fertility k...

Purpose: Transgender and gender-nonconforming (TGNC) adolescents and young adults experience mental health problems, including anxiety and depression, at an elevated rate as compared to their cisgender counterparts. A growing literature suggests that vulnerability to psychiatric problems in TGNC individuals results from social discrimination and m...