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Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach
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The Dutch approach on clinical management of both prepubertal children under the age of 12 and adolescents starting at age 12 with gender dysphoria, starts with a thorough assessment of any vulnerable aspects of the youth's functioning or circumstances and, when necessary, appropriate intervention. In children with gender dysphoria only, the general recommendation is watchful waiting and carefully observing how gender dysphoria develops in the first stages of puberty. Gender dysphoric adolescents can be considered eligible for puberty suppression and subsequent cross-sex hormones when they reach the age of 16 years. Currently, withholding physical medical interventions in these cases seems more harmful to wellbeing in both adolescence and adulthood when compared to cases where physical medical interventions were provided.
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... Young TGD adults are at an increased risk for self-harm, suicidality, and weight-related problems (Peterson et al., 2017). These results show how important it is to help younger TGD people in transition (De Vries & Cohen-Kettenis, 2012). Tatum et al. (2020) also reported differences in age regarding the experiences of trans men, trans women, and nonbinary people; transgender people reported thinking about their gender identity earlier in life than nonbinary people, which may mean they experience problems earlier than nonbinary people. ...
... The Danish health care program for individuals under 18 years of age experiencing gender incongruence was established in 2016 as a multidisciplinary team (MDT) involving Sexological Clinic, Mental Health Services Centre Copenhagen, Rigshospitalet; Department of Growth and Reproduction, Rigshospitalet; and Child and Adolescent Mental Health Centre, Mental Health Services Capital Region, Bispebjerg, all affiliated with the University of Copenhagen. It was based on international experiences and the so-called Dutch protocol [51,52]. However, it has been proposed that the Dutch protocol may need refinement for the contemporary population seeking medical care [32,53] as the composition of the group of help-seeking youngsters has changed in the last 10-15 years. ...
Background/Objectives In recent years, the national Gender Identity Service for individuals under 18 years of age in Denmark has seen a considerable increase in referrals of youngsters during puberty. Given this development, it is important to deepen our understanding of the characteristics of contemporary youngsters seeking help for gender incongruence. This understanding can serve as the foundation for improving current treatment regimens by ensuring optimal individual assessment and care. In this study, we aim to describe the sociodemographic characteristics, health profiles, and treatment trajectories in detail, as well as any changes in these characteristics, of all transgender and gender-diverse youngsters referred to the Gender Identity Service in Denmark from 2016 through 2022. Methods: This is a retrospective observational study of a national cohort comprising all individuals under 18 years of age referred to the Danish Gender Identity Service from 1 January 2016 to 1 January 2023. We will use data from medical records obtained at routine visits from the first assessment through repeated visits. Data on demographics, physical and mental health profiles, and information regarding gender identity will be collected and analyzed. The characteristics of those individuals who progressed to hormone therapy will be compared to those who did not. Results: This study aims to enhance our understanding of the characteristics and needs of contemporary youngsters with gender identity issues. Conclusions: The scientific evidence for the assessment and treatment of gender incongruence in youngsters is limited. The characteristics of youngsters seeking healthcare for gender incongruence today may differ from earlier.
A short article in a Finnish journal Kasvun tuki, a journal publishing both peer-reviewed and non-refereed articles on growth and development of children and young people https://journal.fi/kasvuntuki/article/view/154698
The use of puberty blockers and gender‐affirming hormones by transgender adolescents is the subject of an ongoing public debate. In this paper, we address one central ethical aspect of the debate – the question of what sort of benefits these treatments provide and how to evaluate the significance of these benefits in relation to risks. We argue that the intended benefit of these treatments is best understood as appearance congruence, namely, to create or maintain alignment of physical appearance with one's gender identity. The common focus on the mental health benefits associated with these treatments may obscure a range of experiential benefits sought by young people, such as positive gender experiences and being treated by others as one's identified gender. We also address concern about the risk that young people may revert to their assigned gender (de‐transition) and experience regret. We distinguish between de‐transition and regret, highlighting that regret appears to occur in a minority of instances of de‐transition or discontinuation of hormone treatment.
Pediatric specialty medical settings range from tertiary hospitals to outpatient specialist clinics (i.e., cardiology, rheumatology, and pulmonology) and highly specialized subspecialty clinics such as a sports psychiatry clinic. This chapter provides a foundational understanding of the consult-liaison psychiatry model, as well as an introduction to common diagnoses, situations, and problems that are faced by children with psychiatric and/or behavioral diagnoses who require treatment across specialty medical settings.
gender dysphoria, transsexuality, gender identity disorder, gender reassignment
This paper presents findings of a detailed service audit of cases seen at a specialist service for children and adolescents with gender identity disorders. The audit looked at clinical features, associated features, demographic characteristics and complexity of the cases. Data were extracted from patient files of the first 124 cases seen by the service. Clinical features were assessed based on DSM-IV criteria (American Psychiatric Association, 1994) and associated features were based on the clinical features list of the Association of Child Psychology and Psychiatry (ACPP) data set (Berger et al., 1993). A range of results is presented documenting the occurrence and frequency of different clinical features at different ages. These include the finding that stereotypically gendered clothing (i.e. boys cross-dressing and girls refusing to wear skirts) is more significant in pre-pubertal children, whereas dislike of bodily sexual characteristics becomes more predominant in post-pubertal children. The most common associated features were relationship difficulty with parents/carers (57%), relationship difficulty with peers (52%) and depression/misery (42%). Gender identity problems have wide-reaching implications for children and their families and problems may become more entrenched with the onset of puberty. Although specialist support and co-ordination of services becomes essential particularly at this time, interventions in childhood may have the function of preventing difficulties becoming more severe during adolescence. http://web.archive.org/web/20070525044205/http://www.symposion.com/ijt/ijtvo06no01_01.htm
Empirical studies were evaluated to determine whether Gender Identity Disorder (GID) in children meets the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV, American Psychiatric Association, 1994) definitional criteria of mental disorder. Specifically, we examined whether GID in children is associated with (a) present distress; (b) present disability; (c) a significantly increased risk of suffering death, pain, disability, or an important loss of freedom; and if (d) GID represents dysfunction in the individual or is simply deviant behavior or a conflict between the individual and society. The evaluation indicates that children who experience a sense of inappropriateness in the culturally prescribed gender role of their sex but do not experience discomfort with their biological sex should not be considered to have GID. Because of flaws in the DSM-IV definition of mental disorder, and limitations of the current research base, there is insufficient evidence to make any conclusive statement regarding children who experience discomfort with their biological sex. The concluding recommendation is that, given current knowledge, the diagnostic category of GID in children in its current form should not appear in future editions of the DSM.
Background. We prospectively studied outcomes of sex reassignment, potential differences between subgroups of transsexuals, and predictors of treatment course and outcome. Method. Altogether 325 consecutive adolescent and adult applicants for sex reassignment participated: 222 started hormone treatment, 103 did not; 188 completed and 34 dropped out of treatment. Only data of the 162 adults were used to evaluate treatment. Results between subgroups were compared to determine post-operative differences. Adults and adolescents were included to study predictors of treatment course and outcome. Results were statistically analysed with logistic regression and multiple linear regression analyses. Results. After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes. Conclusions. The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment.
• We evaluated the Children's Global Assessment Scale (CGAS), an adaptation of the Global Assessment Scale for adults. Our findings indicate that the CGAS can be a useful measure of overall severity of disturbance. It was found to be reliable between raters and across time. Moreover, it demonstrated both discriminant and concurrent validity. Given these favorable psychometric properties and its relative simplicity, the CGAS is recommended to both clinicians and researchers as a complement to syndrome-specific scales.