Article

Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study

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Abstract

Objective: To examine the factors associated with the persistence of childhood gender dysphoria (GD), and to assess the feelings of GD, body image, and sexual orientation in adolescence. Method: The sample consisted of 127 adolescents (79 boys, 48 girls), who were referred for GD in childhood (<12 years of age) and followed up in adolescence. We examined childhood differences among persisters and desisters in demographics, psychological functioning, quality of peer relations and childhood GD, and adolescent reports of GD, body image, and sexual orientation. We examined contributions of childhood factors on the probability of persistence of GD into adolescence. Results: We found a link between the intensity of GD in childhood and persistence of GD, as well as a higher probability of persistence among natal girls. Psychological functioning and the quality of peer relations did not predict the persistence of childhood GD. Formerly nonsignificant (age at childhood assessment) and unstudied factors (a cognitive and/or affective cross-gender identification and a social role transition) were associated with the persistence of childhood GD, and varied among natal boys and girls. Conclusion: Intensity of early GD appears to be an important predictor of persistence of GD. Clinical recommendations for the support of children with GD may need to be developed independently for natal boys and for girls, as the presentation of boys and girls with GD is different, and different factors are predictive for the persistence of GD.

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... The authors claim in the very beginning of their paper that the 80% desistence rate of gender dysphoria (GD) is a number that is largely drawn on estimates from four follow-up studies: one from Canada (Drummond, Bradley, Peterson-Badali, & Zucker, 2008) and three from the Netherlands (Steensma, Biemond, de Boer, & Cohen-Kettenis, 2011;Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013;Wallien & Cohen-Kettenis, 2008). Unfortunately, the authors do not seem to be entirely aware of the history behind the prevalence numbers. ...
... Later, these numbers were updated in and updated again and further discussed in Ristori and Steensma (2016). Important to mention here is that in the calculation of the overall persistence rate in the literature the two studies by Steensma et al. ( , 2013 were never used. Including the two Steensma et al. studies in the discussion about persistence rates by the authors (particularly in Table 1 in Temple New hook et al. 2018) is in our view an odd choice and a methodologically incorrect one. ...
... In addition to this, we examined psychosexual outcomes, body image, and the intensity of GD at the time of follow-up in adolescence. (Steensma et al., 2013, p Again, because of the purpose and the design of this study we did not report prevalence numbers in the sample under study. Furthermore, the sample in the 2013 study did not include children in the younger age spectrum of the referred population to the Amsterdam clinic. ...
... In contemporary times in the West, a very small number of parents choose to not "gender" their children ("theybies") by not referring to them as boys or girls (and, at times, not even announcing to others the child's biological sex), dressing them in gender-neutral ways, etc. Little is known about the gender identity and gender role patterns of these children (8)(9)(10). of GID (or GD per DSM-5) (44)(45)(46)(47)(48)(49)(50)(51)(52)(53). Across these studies, the year at the time of first evaluation in childhood ranged from 1952 (49) to 2008 (51). ...
... Little is known about the gender identity and gender role patterns of these children (8)(9)(10). of GID (or GD per DSM-5) (44)(45)(46)(47)(48)(49)(50)(51)(52)(53). Across these studies, the year at the time of first evaluation in childhood ranged from 1952 (49) to 2008 (51). For the 9 studies that included boys, the sample sizes (excluding those lost to follow-up) ranged from 6 to 79 (Mean age, 26 years). ...
... For attraction, 32% were classified as gynephilic and 68% were classified as androphilic (total N = 37); for fantasy, 19% were classified as gynephilic, 19% were classified as biphilic, and 62% were classified as androphilic (total N = 21); for behavior, 21% were classified as gynephilic, 16% were classified as biphilic, and 63% were classified as androphilic (total N = 19); lastly, for sexual identity, 19% were classified as gynephilic ("heterosexual"), 19% were classified as biphilic ("bisexual"), and 62% were classified as androphilic ("homosexual") (total N = 27). Steensma et al. (51) used the same metrics as Wallien and Cohen-Kettenis. Depending on the metric, data on sexual orientation were not available for anywhere between 25 and 40 (31.6%-50.6%) ...
Article
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This study reports follow-up data on the largest sample to date of boys clinic-referred for gender dysphoria ( n = 139) with regard to gender identity and sexual orientation. In childhood, the boys were assessed at a mean age of 7.49 years (range, 3.33–12.99) at a mean year of 1989 and followed-up at a mean age of 20.58 years (range, 13.07–39.15) at a mean year of 2002. In childhood, 88 (63.3%) of the boys met the DSM-III, III-R, or IV criteria for gender identity disorder; the remaining 51 (36.7%) boys were subthreshold for the criteria. At follow-up, gender identity/dysphoria was assessed via multiple methods and the participants were classified as either persisters or desisters. Sexual orientation was ascertained for both fantasy and behavior and then dichotomized as either biphilic/androphilic or gynephilic. Of the 139 participants, 17 (12.2%) were classified as persisters and the remaining 122 (87.8%) were classified as desisters. Data on sexual orientation in fantasy were available for 129 participants: 82 (63.6%) were classified as biphilic/androphilic, 43 (33.3%) were classified as gynephilic, and 4 (3.1%) reported no sexual fantasies. For sexual orientation in behavior, data were available for 108 participants: 51 (47.2%) were classified as biphilic/androphilic, 29 (26.9%) were classified as gynephilic, and 28 (25.9%) reported no sexual behaviors. Multinomial logistic regression examined predictors of outcome for the biphilic/androphilic persisters and the gynephilic desisters, with the biphilic/androphilic desisters as the reference group. Compared to the reference group, the biphilic/androphilic persisters tended to be older at the time of the assessment in childhood, were from a lower social class background, and, on a dimensional composite of sex-typed behavior in childhood were more gender-variant. The biphilic/androphilic desisters were more gender-variant compared to the gynephilic desisters. Boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation. The implications of the data for current models of care for the treatment of gender dysphoria in children are discussed.
... 44 The GIDYQ-AA, 34 the RCGI, 35 40 Similarity Test (2016), 41 Gender-Preference and Gender-Identity IATs, and the Explicit Gender Peer Preferences (2015). 27 The construct of gender expression was assessed in isolation by 13 tools (DAP, 15 25,35,50,60 Gender-Preference and Gender-Identity IAT, 27 Similarity Test, 26 and GIGRQ-A 50 ) or gender dysphoria (GIDYQ-AA 25,29,34,50,58,[60][61][62]. Gender dysphoria was assessed in isolation by the four remaining tools (UGDS, 29,58,[63][64][65][66] GFA, 40 BUT, 62 and BIS 29,58,63,65,66 ). ...
... 27 The construct of gender expression was assessed in isolation by 13 tools (DAP, 15 25,35,50,60 Gender-Preference and Gender-Identity IAT, 27 Similarity Test, 26 and GIGRQ-A 50 ) or gender dysphoria (GIDYQ-AA 25,29,34,50,58,[60][61][62]. Gender dysphoria was assessed in isolation by the four remaining tools (UGDS, 29,58,[63][64][65][66] GFA, 40 BUT, 62 and BIS 29,58,63,65,66 ). ...
... 27 The construct of gender expression was assessed in isolation by 13 tools (DAP, 15 25,35,50,60 Gender-Preference and Gender-Identity IAT, 27 Similarity Test, 26 and GIGRQ-A 50 ) or gender dysphoria (GIDYQ-AA 25,29,34,50,58,[60][61][62]. Gender dysphoria was assessed in isolation by the four remaining tools (UGDS, 29,58,[63][64][65][66] GFA, 40 BUT, 62 and BIS 29,58,63,65,66 ). ...
Article
Increasing numbers of children and adolescents are being referred to gender services for gender-related concerns. Various instruments are used with these patients in clinical care, but their clinical validity, strengths, and limitations have not been systematically reviewed. In this systematic review, we searched MEDLINE, PubMed, and PsycINFO databases for available tools that assess gender identity, gender expression, or gender dysphoria in transgender and gender-diverse (TGD) children and adolescents. We included studies published before Jan 20, 2020, that used tools to assess gender identity, expression, or dysphoria in TGD individuals younger than 18 years. Data were extracted from eligible studies using a standardised form. We found 39 studies that met the inclusion criteria, from which we identified 24 tools. The nature of tools varied considerably and included direct observation, child and adolescent self-report, and parent-report tools. Many methods have only been used with small samples, include outdated content, and lack evaluation of psychometric properties. In summary, a paucity of studies in this area, along with sparse reporting of psychometric properties, made it difficult to compare the relative use of tools, and current tools have substantial limitations. Future research is required to validate existing measures and create more relevant, culturally appropriate tools.
... [19][20][21] Moreover, little is known about the typical time course from initial presentation of GD behavior in children to initiation of gender-affirming care. 18,[20][21][22][23][24][25][26][27][28] With the knowledge that the GD population is growing and increasing proportions of GD individuals are presenting at an earlier age, there is a need for largescale longitudinal studies investigating patterns and determinants of GD-specific care in children and adolescents. [29][30][31][32][33] The purpose of this study was to examine the likelihood and predictors of receiving a GD-specific diagnosis and GAHT among youth who express gender-variant behavior. ...
... Our results need to be viewed in the context of similar findings reported previously in European research. 21,28 Two similarly designed, but nonoverlapping, studies performed a follow-up assessment of children treated for gender dysphoria at a specialized clinic in the Netherlands. 21,28 The first study included 77 children who had been referred to a genderspecific clinic between 1989 and 2005 for gender dysphoria at age <12 years at initial presentation. ...
... 21,28 Two similarly designed, but nonoverlapping, studies performed a follow-up assessment of children treated for gender dysphoria at a specialized clinic in the Netherlands. 21,28 The first study included 77 children who had been referred to a genderspecific clinic between 1989 and 2005 for gender dysphoria at age <12 years at initial presentation. 21 After an average follow-up of 10 years, 27% of the initial cohort continued experiencing gender dysphoria; however, this result may have been affected by the relatively high (30%) proportion of participants who did not respond to the survey. ...
Article
Background and objectives: The progression of gender-expansive behavior to gender dysphoria and to gender-affirming hormonal treatment (GAHT) in children and adolescents is poorly understood. Methods: A cohort of 958 gender-diverse (GD) children and adolescents who did not have a gender dysphoria-related diagnosis (GDRD) or GAHT at index were identified. Rates of first GDRD and first GAHT prescription were compared across demographic groups. Results: Overall, 29% of participants received a GDRD and 25% were prescribed GAHT during the average follow-up of 3.5 years (maximum 9 years). Compared with youth assigned male sex at birth, those assigned female sex at birth were more likely to receive a diagnosis and initiate GAHT with hazard ratio (95% confidence interval) estimates of 1.3 (1.0-1.7), and 2.5 (1.8-3.3), respectively. A progression to diagnosis was more common among those aged ≥15 years at initial presentation compared with those aged 10 to 14 years and those aged 3 to 9 years (37% vs 28% vs 16%, respectively). By using the youngest group as a reference, the adjusted hazard ratios (95% confidence interval) for a GDRD were 2.0 (1.3-3.0) for age 10 to 14 years and 2.7 (1.8-3.9) for age ≥15 years. Racial and ethnic minorities were less likely to receive a diagnosis or be prescribed GAHT. Conclusions: This study characterized the progression of GD behavior in children and adolescents. Less than one-third of GD youth receive an eventual GDRD, and approximately one-quarter receive GAHT. Female sex at birth, older age of initial GD presentation to medical care, and non-Hispanic white race and ethnicity increased the likelihood of receiving diagnosis and treatment.
... The research question of four of the five quantitative studies focused on ascertaining the gender identity and sexual orientation among participants at followup, 31,33,51,52 whereas one study focused on factors that may predict persistence and desistence. 53 The 4 studies that explored gender identity and sexual orientation outcomes had 251 total participants. Reported desistance rates, with associated DSM diagnostic . is more mandatory than in our treatment of gender, where a genuine respect for the child's desire must include the ability to listen and not act'' ''Until we can reliably predict in whom gender dysphoria will persist, the possibility remains that encouraging puberty blockers will foreclose the potentially organizing experience of development'' Yes (continued) ...
... 31,33,51,52 The remaining quantitative study, by Steensma et al., explored possible predictive factors for persistence versus desistance. 53 It was also ranked as poor quality as items 7, 13, and 14 were not met. Predictive factors found included higher intensity of GD at diagnosis, history of childhood social transition, and stating that one was a sex that was not designated at birth (e.g., a child who was designated male at birth saying she is a woman rather than saying she wished she was a woman). ...
... Fifteen articles referred to desistance as the disappearance of the diagnosis of GD after the start of puberty or during adolescence, not related to social or medical interventions. 5,29,32,52,53,[56][57][58][61][62][63]69,71,74 Only three of these included the absence of GD in adulthood as well, again not related to social or medical interventions. 29,52,61 Eleven articles used desistance to indicate a change in gender identity from TGE to cisgender. ...
... However, they often transition socially from one gender to another during childhood (Coleman et al., 2012). This reversible nonmedical step towards a life in the identified gender may include changing one's name or pronoun, being introduced as the experienced gender in public, as well as gender typical appearance in terms of e.g., hair length and clothing (Steensma et al., 2013;Wong et al., 2019). ...
... To this date, the possible benefits or disadvantages of an "early" social transition for a child's future development are among the most controversially discussed topics in Transgender Health Care (Coleman et al., 2012;Giordano, 2019;Steensma & Cohen-Kettenis, 2015;Wong et al., 2019); especially bearing in mind the developmental trajectories of persistence versus desistence into adolescence and adulthood (Ristori & Steensma, 2016). Children with either a GD diagnosis or so-called gender nonconforming or gender variant experiences often do not continue to experience a clinical GD as adolescents and adults (Ristori & Steensma, 2016;Steensma et al., 2013). This developmental pathway is referred to as a desisting GD ("desisters"), in contrast to "persisters," whose GD continues to persist into adolescence and adulthood . ...
... Because of such possible fluctuations in gender experience during childhood and the assumed relatively lower persistence of GD from childhood into adolescence, many researchers and clinicians have suggested to follow a so-called "supportive watchful-waiting" approach (e.g. Cohen-Kettenis et al., 2008;Steensma et al., 2013). This approach refers to providing a safe place for children to explore their gender, but advises to withhold complete social transitions until puberty. ...
Research provides inconclusive results on whether a social gender transition (e.g. name, pronoun, and clothing changes) benefits transgender children or children with a Gender Dysphoria (GD) diagnosis. This study examined the relationship between social transition status and psychological functioning outcomes in a clinical sample of children with a GD diagnosis. Psychological functioning (Child Behavior Checklist; CBCL), the degree of a social transition, general family functioning (GFF), and poor peer relations (PPR) were assessed via parental reports of 54 children (range 5-11 years) from the Hamburg Gender Identity Service (GIS). A multiple linear regression analysis examined the impact of the social transition status on psychological functioning, controlled for gender, age, socioeconomic status (SES), PPR and GFF. Parents reported significantly higher scores for all CBCL scales in comparison to the German age-equivalent norm population. Peer problems and worse family functioning were significantly associated with impaired psychological functioning, whilst the degree of social transition did not significantly predict the outcome. Therefore, claims that gender affirmation through transitioning socially is beneficial for children with GD could not be supported from the present results. Instead, the study highlights the importance of individual social support provided by peers and family, independent of exploring additional possibilities of gender transition during counseling.
... However, medical interference in a physically healthy body is the subject of controversy and ethical debates (e.g., [4,9,10,[12][13][14]), mainly because evidence to inform best clinical practices for both puberty suppression [9] and gender-affirming (GA) interventions [10] is scarce. Furthermore, there is still a lack of knowledge on adolescent gender identity development [15] and factors associated with adolescent desistence or persistence of childhood GD [16]. Research has shown that gender experiences during adolescence can be diverse [17] and that identity development during adolescence is in progress and consolidates only later in early adulthood [18], highlighting the need to weigh affirmative treatment practices against a developmental perspective of adolescent identity development during clinical decision making. ...
... However, these data constitute a subject that should be evaluated in future studies [9]. Puberty may start before the age of 12 years [12,21], and predicting an adolescent's short-to mid-term persistence of GD or gender identity development before the start of puberty will remain a difficult endeavor for clinicians [15][16][17][18]. Treatment at the Hamburg GIS generally follows the guidelines of the Standards of Care or the Endocrine Society [6,8]. ...
... Because gender experiences can be diverse during adolescence [17] and gender identity development is a process that consolidates later in early adulthood [18], it is important to keep a balanced perspective in mind when consulting with gender diverse youth and considering medical treatment options. The consequences of medical interventions and the current lack of knowledge on long-term treatment effects should be weighed against the advantages of puberty suppression and early medical interventions [15,16]. Research has shown that it is not early medical intervention alone that determines positive treatment outcomes but rather a comprehensive multidisciplinary approach that also attends to adolescents' overall psychological well-being [6][7][8][9][10][19][20][21]. ...
Article
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Empirical evidence concerning the psychosocial health outcomes after puberty suppression and gender-affirming (GA) medical interventions of adolescents with gender dysphoria (GD) is scarce. The aim of the present study was to describe how dimensions of psychosocial health were distributed among different intervention groups of adolescents with a GD diagnosis from the Hamburg Gender Identity Service before and after treatment. Participants included n = 75 adolescents and young adults from a clinical cohort sample, measured at their initial intake and on average 2 years later (M treatment duration = 21.4 months). All cases were divided into four different intervention groups, three of which received medical interventions. At baseline, both psychological functioning and quality of life scores were significantly below the norm mean for all intervention groups. At follow-up, adolescents in the gender-affirming hormone (GAH) and surgery (GAS) group reported emotional and behavioral problems and physical quality of life scores similar to the German norm mean. However, some of the psychosocial health outcome scores were still significantly different from the norm. Because this study did not test for statistically significant differences between the four intervention groups or before and after treatment, the findings cannot be generalized to other samples of transgender adolescents. However, GA interventions may help to improve psychosocial health outcomes in this sample of German adolescents. Long-term treatment decisions during adolescence warrant careful evaluation and informed, participatory decision-making by a multidisciplinary team and should include both medical interventions and psychosocial support. The present study highlights the urgent need for further ongoing longitudinal research.
... Some children will display signs of gender diversity in early childhood, although this is not true for all persons who later identify as transgender. Studies of children's develop ment have identified some biological (Berenbaum & Beltz, 2011), cognitive (Olson & Selin, 2018), and social (Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013) Subscriber: OUP-Reference Gratis Access; date: 10 July 2020 standing of gender as an individual trait with some essential stability over time in ways that are distinct from peers (Olson & Selin, 2018). In longitudinal studies, children who eventually sought puberty suppression were, at initial childhood assessment, more likely to make statements asserting that they "were" a gender other than their assigned sex rather than they "wished to be" a gender other than their assigned sex (Steensma et al., 2013). ...
... Studies of children's develop ment have identified some biological (Berenbaum & Beltz, 2011), cognitive (Olson & Selin, 2018), and social (Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013) Subscriber: OUP-Reference Gratis Access; date: 10 July 2020 standing of gender as an individual trait with some essential stability over time in ways that are distinct from peers (Olson & Selin, 2018). In longitudinal studies, children who eventually sought puberty suppression were, at initial childhood assessment, more likely to make statements asserting that they "were" a gender other than their assigned sex rather than they "wished to be" a gender other than their assigned sex (Steensma et al., 2013). There are also some social distinctions between assigned sexes. ...
... For transgender and gender-nonconforming youth, a distinction exists between the need for gender-affirmative medical care and gender-supportive mental health support. Early European studies of successful gender-affirmative medical care existed within the context of substantial gender-supportive mental health care for youth and families (de Vries et al., 2014, Steensma et al., 2013. Countries vary with regard to the age of assent for medical care, and in particular for any kind of gender or sexual care (e.g., contraception, sexually transmitted infection testing, abortion). ...
Chapter
Sexual and gender minority (SGM) young people are coming of age at a time of dynamic social and political changes with regard to LGBTQ rights and visibility around the world. And yet, contemporary cohorts of SGM youth continue to evidence the same degree of compromised mental health demonstrated by SGM youth of past decades. The authors review the current research on SGM youth mental health, with careful attention to the developmental and contextual characteristics that complicate, support, and thwart mental health for SGM young people. Given a large and rapidly growing body of science in this area, the authors strategically review research that reflects the prevalence of these issues in countries around the world but also concentrate on how mental health concerns among SGM children and youth are shaped by experiences with schools, families, and communities. Promising mental health treatment strategies for this population are reviewed. The chapter ends with a focus on understudied areas in the SGM youth mental health literature, which may offer promising solutions to combat SGM population health disparities and promote mental health among SGM young people during adolescence and as they age across the life course.
... Research on the well-being of gender variant children and adolescents has lately stirred a debate on this increased amount of referrals, the sex ratio in referrals, the impact of trans care on their psychological well-being, and the amount of children and adolescents who transition or drop-out of treatment [24][25][26]. Few studies contacted the adolescents who were referred to a gender clinic in childhood and evaluated their gender identity and sexual orientation at follow-up [27][28][29][30][31]. The intensity of gender dysphoria (GD) in childhood seems to be a predictor of continuing trans care in adolescence [29,30,32]. ...
... Few studies contacted the adolescents who were referred to a gender clinic in childhood and evaluated their gender identity and sexual orientation at follow-up [27][28][29][30][31]. The intensity of gender dysphoria (GD) in childhood seems to be a predictor of continuing trans care in adolescence [29,30,32]. Steensma et al. (2011) reported that the interval between 10 and 13 years is crucial: changes in social environment, the anticipated and actual body changes during puberty, and the first experiences of romantic and sexual attraction all influence gender incongruence feelings [31]. ...
... Literature regarding drop-out numbers is scarce. Earlier, Dutch research focused on children referred to gender clinics and reported drop-out numbers between 43 and 88% in pre-pubertal children [27,[29][30][31][32]. In our sample of adolescents, we found a drop-out of less than one in five (16.4%). ...
Article
Full-text available
Research on gender variant children and adolescents has stirred debate on the increased amount of referrals, the sex ratio in referrals, the impact of trans care on their psychological well-being, and the amount of children/adolescents who stop treatment. This retrospective study includes the number of referrals, first contacts at the outpatient clinic and the amount of drop-outs between January 1st 2007 to December 31st 2016 from the sole Belgian Pediatric Gender clinic. Emotional and behavioral problems, measured by the Child Behavioral Checklist (CBCL) and the Youth Self-Report (YSR), were screened. The adolescents who ceased the counseling, were contacted for follow-up. We included 235 adolescents, referred to the clinic, and 177 (of 235) who had a first physical appointment with a psychologist. Almost one in four (24.5%) on the YSR and more than half (54.8%) on the CBCL fall within the clinical range on the total problem score. On the YSR, 40.4% reported having suicide thoughts and 32.1% reported self-harm behavior and/or at least one suicide attempt, all in the last six months. Five adolescents committed suicide. According to parents, more difficulties with peers predicts more emotional and behavioral problems (F(5, 36) = 3.539, p = 0.011). In this study group, 29 adolescents ceased the counseling, whereof 7 could be traced back in the adult gender clinic after 2016. Results are indicative of the need for mental support for trans youth and their families and moreover, highlight the need for longitudinal follow-up studies.
... Participants assessed in childhood and adolescence were aged between 3 and 19 years at baseline and 13 to 36 years at follow-up. Three studies reported on child samples (⩽12 years) at baseline (Drummond et al., 2008;Steensma et al., 2013;Wallien et al., 2008), whilst four studies reported on predominantly adolescent samples at baseline (Allen et al., 2019;Costa et al., 2015;de Vries et al., 2011;Smith et al., 2001). Drummond et al. (2008Drummond et al. ( , 2018) investigated a cohort of solely children assigned female at birth (AFAB) whilst all other studies included both children assigned male at birth and children assigned female at birth (see Supplemental Table S2). ...
... In studies whose sample was recruited from consecutive clinical patients who received childhood diagnoses of GID (Drummond et al., 2008;Steensma, et al., 2013;Wallien & Cohen-Kettenis, 2008), the continued experience of GD or discomfort over time was assessed using measures such as the Utrecht Gender Dysphoria Scale (UGDS; Doorn et al., 1996), the Gender Identity Interview for Adolescents and Adults (GIIAA; Zucker et al., 1993) and the Gender Identity Interview for Children (GIIC; Deogracias et al., 2007). The Body Image Scale (BIS; Lindgren & Pauly, 1975) was used in four studies to assess satisfaction with primary and secondary sex characteristics. ...
... In two studies, DSM criteria for GID were adapted by the authors into questionnaires to assess whether a diagnosis would apply at follow-up (Drummond et al., 2008;Wallien & Cohen-Kettenis, 2008). Psychosexual developmental outcomes were a key variable of interest in several of the included studies (deVries et al., 2011;Drummond et al., 2008;Smith et al., 2001;Steensma et al., 2013;Wallien & Cohen-Kettenis, 2008) and were measured using a composite of the following domains: attraction, behaviour, fantasy and self-identified sexual orientation. ...
Background Children are presenting in greater numbers to gender clinics around the world. Prospective longitudinal research is important to better understand outcomes and trajectories for these children. This systematic review aims to identify, describe and critically evaluate longitudinal studies in the field. Method Five electronic databases were systematically searched from January 2000 to February 2020. Peer-reviewed articles assessing gender identity and psychosocial outcomes for children and young people (<18 years) with gender diverse identification were included. Results Nine articles from seven longitudinal studies were identified. The majority were assessed as being of moderate quality. Four studies were undertaken in the Netherlands, two in North America and one in the UK. The majority of studies had small samples, with only two studies including more than 100 participants and attrition was moderate to high, due to participants lost to follow-up. Outcomes of interest focused predominantly on gender identity over time and emotional and behavioural functioning. Conclusions Larger scale and higher quality longitudinal research on gender identity development in children is needed. Some externally funded longitudinal studies are currently in progress internationally. Findings from these studies will enhance understanding of outcomes over time in relation to gender identity development in children and young people.
... Auch hier schwanken die Zahlen, liegen jedoch stets über 40 % (z.B. Steensma et al., 2011;Steensma et al., 2013;Wallien & Cohen-Kettenis, 2008). In der bisher differenziertesten prospektiven Untersuchung von 127 Kindern und Jugendlichen von Steensma (2013) nahmen 22 % der bei Geburt dem männlichen Geschlecht zugewiesenen und 45 % dem weiblichen Geschlecht zugewiesenen Kindern mit partieller sozialer Transition im Kindesalter (Kleidung und Haartracht, keine Änderung von Pronomina und Rufnamen) einen Desisting-Verlauf als Jugendliche. ...
... Bei den Desisters hingegen verliert sich der Leidensdruck im Verlauf. Es liegen wenige Studien(Drummond, Bradley, Peterson-Badali & Zucker, 2008;Singh, 2012;Steensma, Biemond, De Boer & Cohen-Kettenis, 2011;Steensma, McGuire, Kreukels, Beekman & Cohen-Kettenis, 2013;Wallien & Cohen-Kettenis, 2008) vor, die die Verläufe einer geschlechtsdysphorischen Entwicklung prospektiv untersucht haben. Meistens stehen dabei die Faktoren, die eine persistierende Entwicklung vorhersagen, im Fokus (vgl. ...
Article
Trans-Identity in Minors: Basic Ethical Principles for Individual Decision-Making in Healthcare The treatment of minors with gender incongruence has been the subject of controversial discussion for some time. In 2020, the German Ethics Council adopted the ad-hoc recommendation "Trans-identity in children and adolescents: Therapeutic Controversies - Ethical Orientations" with the aim of sensitising to the relevant ethically problematic aspects and of setting out orienting guidelines for medical and psychotherapeutic support and treatment. According to the Ethics Council, every person has the constitutional right to lead a life in accordance with one's own gender identity and to be respected in this identity. Healthcare professionals must assess the consequences of treatment as well as the consequences of refraining to provide treatment. All interactions with the child must be designed in such a way that the child can participate in decision-making and is ultimately enabled to give full informed consent. Stigmatisation and discriminatory pathologisation of gender incongruence must be avoided.
... Although there is little empirical evidence on the risks and benefits of early social transitioning among gender dysphoric youths, preliminary information from Dutch cohort studies in specialty clinics has identified some factors associated with a higher likelihood that prepubertal gender dysphoria will continue into adolescence. These factors include a greater intensity of dysphoria and meeting criteria for a formal diagnosis; a cognitive or affective cross-gender identification (that is, saying "I am" or "I feel like" rather than "I wish I were the other sex"); having a younger age of presentation; having a male birth gender assignment; and having gone through an early social role transition, especially for those assigned male at birth (19,20). ...
... Several clinical cohorts have found that the developmental trajectory of gender dysphoria among children is more variable than that among adults, with a majority not reporting gender dysphoria persisting into adolescence or young adulthood (19)(20)(21)(22)(23). In a number of clinical cohorts, gender dysphoria manifesting in adolescence and adulthood has tended to be stable over time. ...
Article
Lesbian, gay, bisexual, and transgender (LGBT) youths comprise a diverse population with unique developmental experiences and needs. Many experience some form of anti-LGBT stigma. Although most LGBT youths cope well and are free from mental illness, they are at increased risk for a number of psychiatric and other health problems compared with the general population. These problems include depression, anxiety, suicidality, tobacco and substance use, and disordered eating. These disorders are significant sources of morbidity and mortality and are risk factors for other health problems, including HIV and other sexually transmitted infections. Preliminary evidence suggests the same is true for gender dysphoric youths. The minority stress hypothesis holds that exposure to LGBT-specific stigma causes these disparities among LGBT youth. During the past decade, increasing attention has been devoted to developing evidence-based practice guidelines to address the mental health needs of LGBT youths, with an emphasis on core clinical competencies for practitioners working with this population. This review addresses key principles for mental health promotion and care of LGBT youths. Key resources for clinicians and two clinical vignettes are included.
... Furthermore, other studies [28][29][30] suggest that up to 80% of transgender children and adolescents seem to give up, or in other words, they try to identify as cisgender when reaching an older age. We believe this is of the utmost importance, because the reversing desire is only innocuous if a treatment with non-reversible consequences has not been started. ...
... This percentage is quite high if compared with that established by Wiepjes, et al. [31], less than 0.5%. Nonetheless, if we go back to two studies carried out in 2011 and 2013 [28,29], we can see up to 80% desistance; therefore, it is easy to understand the urgent need to continue longitudinal studies that address the disparities of previous articles. ...
... It is though possible that the symptomatology draws back during adolescence or adulthood [38]. Some findings are based on this hypothesis and argue that it is possible that child dysphoria draws back and is expressed as homosexuality [39,21,40]. On the other hand, there are cases where aggravation of dysphoria is observed during adolescence [7,40]. ...
... One of the main reasons against this therapy is the argument that the transition to adolescence might lead to a person's agreement with their biological gender. Based on the findings of the study conducted by Steensma, McGuire, Kreukels, Beekman & Cohen-Kettenis (2013) [39], most children develop a homosexual orientation and gender dysphoria ceases to exist. However, in the cases of re-examination made in people who had been under therapy treatment (GnRH) no long-term consequences hindering their lives were found [53]. ...
Article
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In DSM-5, the American Psychiatry Association changed the diagnosis of gender identity disorder by adopting the term of gender dysphoria (GD). The development of gender identity is a complex and probably multi-factorial procedure relating to genetic, hormone and environmental factors. GD could be traced in two different developmental stages, either during childhood, or during adolescence. Transgenders require safe and effective hormonal support for the development of natural characteristics verifying their gender identity. The main indications for the beginning of the hormonal therapy are verified from the persistent fixation of dysphoria that they experience and the sufficient mental ability to give their consent and accept this irreversible therapy. Health practitioners should act within the framework of their duties, helping people with GD match their external appearance with their internal experience and improve their social functionality. Moreover, the support and proper communication between the family members will contribute to the acceptance of the gender identity, the reinforcement of self-confidence, the reduction of bias, the cause of emotional and behavioural mental disorders and the conquest of a good quality of living.
... Cela peut permettre à une personne de se rendre compte de sa possibilité de fonctionner dans le genre affirmé, de l'adéquation de ses accompagnements et soutiens psychologiques et sociaux et de l'amélioration de sa qualité de vie. A ce titre la transition sociale est recommandée chez les adolescent•e•s qui demandent un traitement, mais elle reste controversée chez les enfants prépubères, du fait de l'évolution naturelle majoritaire vers une identité cisgenre à la puberté [70,71]. Si les études récentes vont dans le sens d'un bénéfice important de la transition sociale chez les jeunes prépubères en termes de bienêtre et de fonctionnement global [71,72] [74]. ...
Thesis
Aujourd'hui, les progrès dans les biotechnologies et dans le champ de la médecine défient les lois de la biologie pour permettre à des hommes et des femmes transgenres d'advenir en tant que sujet et d'accéder à la parentalité. Ces avancées soulèvent dans de nombreux pays de vifs débats sociétaux, mais aussi de vraies questions éthiques l'enjeu majeur in fine étant pour la plupart des auteurs le bien-être des enfants à naître. Nous avons ainsi cherché à comparer le développement cognitif, la santé mentale, l'identité de genre, la qualité de vie et la dynamique familiale à l'aide d'instruments standardisés et de protocoles expérimentaux chez 32 enfants conçu·e·s par IAD en France dont le père est un homme transgenre et la mère une femme cisgenre (identifiée au genre féminin qui lui a été assigné à la naissance), la transition féminin vers masculin du père ayant eu lieu avant la conception. Nous avons constitué deux groupes témoins appariés pour l'âge, le sexe et la situation familiale : le premier composé d’enfants né·e·s de parents cisgenres hétérosexuels ayant eu recours à l’IAD pour concevoir, le second composé d’enfants conçu·e·s par rapport sexuel de parents hétérosexuels cisgenres.Nous n'avons trouvé aucune différence significative entre les groupes en ce qui concerne le développement cognitif, la santé mentale et l'identité de genre, ce qui signifie que ni la paternité transgenre ni l'utilisation des IAD n'ont eu d'impact sur ces caractéristiques. Les résultats de l'analyse descriptive ont montré un développement psycho-affectif positif. De plus, lorsque nous avons demandé à des groupe d’évaluateur·trice·s de différencier les dessins de famille du groupe d'enfants de pères trans’ de celleux qui étaient conçu·e·s par rapport sexuel de parents cisgenres, aucun n'a pu différencier ces groupes au-dessus des niveaux du hasard, ce qui signifie que ce que les enfants ont exprimé à travers le dessin de famille n'indiquait pas d’indices liés à la paternité transgenre. Cependant, lorsque nous avons étudié les émotions exprimées par les mères et les pères à partir d’un extrait de discours de 5 minutes (Five Minute Speech Sample), nous avons constaté que les émotions exprimées par les pères transgenres étaient plus intenses que celles des pères cisgenres qui ont conçu par rapport sexuel ou par IAD.Nous concluons que ces premières données empiriques sur le développement de l'enfant dans le contexte de la trans-parentalité sont rassurantes. Nous pensons que cette recherche améliorera également les soins aux couples transgenres et ceux de leurs enfants dans une société où les projections sociétales comme l'accès aux soins restent difficiles pour cette population. Cependant, des recherches transdisciplinaires complémentaires sont nécessaires, en particulier avec les adolescents, les jeunes adultes et en périnatalité.
... Gender identity development is currently understood as a complex interplay of biological, psychological, and sociocultural factors. [11][12][13][14] In the same way that media have been shown to be influential in other aspects of young people's identity development, it seems plausible that media also play a role in gender identity development. 9,10 Anecdotally, our experience working as clinicians with TGD youth certainly supports this, with many young people identifying specific media items as both a means by which they became aware of other TGD individuals as well as a prompt to explore their often covert yet long-standing feelings of gender diversity. ...
Article
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Importance Specialist gender clinics worldwide have witnessed an increase in referrals of transgender and gender diverse (TGD) children and adolescents, but the underlying factors associated with this increase are unknown. Objective To determine whether increases in TGD young people presenting to specialist gender clinics are associated with related media coverage. Design, Setting, and Participants This cross-sectional study was conducted at 2 publicly funded, pediatric specialist gender services, one located in the UK and the other in Australia. Participants were all children and adolescents aged 0 to 18 years, referred between January 1, 2009, and December 31, 2016, to their respective gender services in the UK and Australia. Data analysis was performed in April 2019. Exposures Media coverage of TGD issues. Main Outcomes and Measures Referral rates from each gender service were compared with local TGD-related media coverage during the study period. Results Referral data for 5242 TGD young people were obtained (4684 in the UK, of whom 1847 [39.4%] were assigned male at birth and 2837 [60.6%] were assigned female at birth; 558 in Australia, of whom 250 [44.8%] were assigned male at birth and 308 [55.2%] were assigned female at birth), and a total of 2614 news items were identified (UK, 2194; Australia, 420). The annual number of TGD young people referred to both specialist gender clinics was positively correlated with the number of TGD-related local media stories appearing each year (Spearman r = 1.0; P < .001). Moreover, weekly referral rates in both the UK for week 1 (β̂ = 0.16; 95% CI, 0.03-0.29; P = .01) and Australia for week 2 (β̂ = 0.12; 95% CI, 0.04-0.20; P = .003) showed evidence of association with the number of TGD-related media items appearing within the local media. There was no evidence of association between referrals and media items appearing 3 weeks beforehand. Media predominantly focused on TGD issues showed some association with increased referral rates. Specifically, TGD-focused stories showed evidence of association with referral numbers at week 1 (β̂ = 0.16; 95% CI, 0.04-0.28; P = .007) and week 2 (β̂ = 0.23; 95% CI, 0.11-0.35; P < .001) in Australia and with referral numbers at week 1 (β̂ = 0.22; 95% CI, 0.01-0.44; P = .04) in the UK. No evidence of association was found between media peripherally related to TGD issues and referral rates. Conclusions and Relevance This study found evidence of an association between increasing media coverage of TGD-related topics and increasing numbers of young people presenting to gender clinics. It is possible that media coverage acts as a precipitant for young people to seek treatment at specialist gender services, which is consistent with clinical experiences in which TGD young people commonly identify the media as a helpful source of information and a trigger to seek assistance.
... En los adolescentes transgéneros la situación es bastante más compleja. El desarrollo y consolidación de la identidad cobra especial protagonismo a estas edades 14 . ...
... For example, the degree of gender nonconformity and whether a child believes they are, as opposed to wishes to be, ''the other'' gender have been proposed as predictors of persistence. 76,77 Those in whom GD persists from childhood into adolescence are likely to experience an exacerbation of dysphoria with the emergence of (or with the anticipation of) undesired secondary sexual characteristics at puberty, in which case pubertal suspension should be considered. 10 Regardless of their initial sexual orientation, during and after transitioning to express their experienced gender, some individuals retain their pretransition sexual attraction patterns, while others change. ...
Article
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Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists William Byne 1 2, Dan H Karasic 3, Eli Coleman 4, A Evan Eyler 5, Jeremy D Kidd 6, Heino F L Meyer-Bahlburg 7, Richard R Pleak 8, Jack Pula 9 PMID: 29756044 PMCID: PMC5944396 DOI: 10.1089/trgh.2017.0053 Free PMC article Abstract Regardless of their area of specialization, adult psychiatrists are likely to encounter gender-variant patients; however, medical school curricula and psychiatric residency training programs devote little attention to their care. This article aims to assist adult psychiatrists who are not gender specialists in the delivery of respectful, clinically competent, and culturally attuned care to gender-variant patients, including those who identify as transgender or transsexual or meet criteria for the diagnosis of Gender Dysphoria (GD) as defined by The Diagnostic and Statistical Manual of Mental Disorders (5th edition). The article will also be helpful for other mental health professionals. The following areas are addressed: evolution of diagnostic nosology, epidemiology, gender development, and mental health assessment, differential diagnosis, treatment, and referral for gender-affirming somatic treatments of adults with GD. Keywords: assessment; gender dysphoria; gender transition; intersex; mental health; psychiatry; transgender.
... Compared with gynephilic males, androphilic males report greater adulthood (Lippa, 2000(Lippa, , 2008Semenyna & Vasey, 2016) and recalled childhood gender nonconformity (Bailey & Zucker, 1995;Bartlett & Vasey, 2006;. Likewise, male children who show more cross-gender characteristics are more likely to exhibit androphilia in adolescence (Li, Kung, & Hines, 2017) and adulthood (Green, 1987;Singh, 2012;Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013;Wallien & Cohen-Kettenis, 2008). At the same time, males who report a feminine transgender identity are more likely to report being androphilic than would be expected based on population base rates, and this appears to especially be the case in collectivistic cultures (Lawrence, 2010). ...
Article
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Previous research has examined handedness and birth order to inform sexual orientation and gender identity/role expression development; however, sexual orientation and gender identity/role expression have rarely been disentangled to provide a more nuanced perspective. In Thailand, we investigated sexual orientation and gender identity simultaneously via comparison of 282 heterosexual men, 201 gay men, and 178 sao praphet song—i.e., androphilic, markedly feminine males recognized as a “third” gender. Handedness was examined as: extremely left-handed, moderately left-handed, ambidextrous, moderately right-handed, or extremely right-handed. Birth order was examined as numbers of older and younger brothers and sisters, by using Berglin’s, fraternal, and sororal indices, and by examining the older brother odds ratio and sibling sex ratio. Compared with heterosexual men, gay men and sao praphet song were more likely to be extremely right-handed. Sao praphet song were also more likely to be extremely left-handed than heterosexual and gay men. Heterosexual men and sao praphet song had later sororal birth order compared with the expected Thai population value, suggesting stopping rules influenced when probands’ mothers ceased having children. These findings provide new insights and replicate previous findings in a non-Western sample. Regarding handedness, in males, mechanisms related to extreme right-handedness likely influence the development of androphilia, whereas mechanisms related to both extreme right- and extreme left-handedness likely explain the combination of androphilia and feminine gender identity/role expression. Regarding birth order, similar to the conclusions of some prior research, stopping rules pose a challenge for testing the fraternal birth order effect.
... This bias is evident in both counts of the cautionary note and the reliance on the studies of persisters and desisters in which most young children in the clinical studies were no longer evidencing gender dysphoria by adolescence. However, some of the persister/desister data have been reanalyzed to indicate that more children than originally cited in the data were found to be persisters (Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013) and reevaluation of the data revealed early childhood indicators that could identify a group of young children who were asserting a gender identity that did not match the sex assigned to them at birth and would remain stable in that identity into adolescence, and beyond. Furthermore, the persister/ desister data which inform the SOC 7 guidelines on social transitions only measured children's gender dysphoria, not their sense of their gender identity or the nature of their gender expressions, the latter two to be differentiated from each other and also measured separately from gender dysphoria (Ehrensaft, 2017). ...
... Rather, we raised specific concerns about false-positive bias in the DSM-IV GIDC criteria that dropped the prior requirement for direct evidence of distress of gender dysphoria and allowed diagnosis based on nonconforming gender expression. We are not surprised by Dr. Zucker's assessment of low specificity rate, 42%, for subthreshold diagnosis at assessment associated with findings of "desistance" at follow-up, in aggregated data from Drummond et al. (2008), Wallien & Cohen-Kettenis (2008), Steensma et al. (2013), andSingh (2012). This is consistent with our concern that a large number of "desisters" who previously met the full GIDC criteria may reflect sample bias introduced by flawed, false positive diagnosis, with respect to distress of gender dysphoria. ...
... The rate of regret, detransition, and desistance from transgender identification is largely unknown (Butler & Hutchinson, 2020). The majority of patients with classical, childhoodonset gender dysphoria (61%-98%) desist from transgender identification some time in adolescence or young adulthood (Korte et al., 2008;Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013;Zucker, 2018). The minority who persist with their transgender identification into adulthood and undergo "gender-affirmative" surgeries have been reported to have low rates of regret (van de Grift, Elaut, Cerwenka, Cohen-Kettenis, & Kreukels, 2018) and detransition (Dhejne, Öberg, Arver, & Landén, 2014). ...
... GD in adolescence is highly likely to continue into adult life where gender dysphoria persists after the onset of puberty. [3] Those with earlier onset or more intense GD and those in whom the development of secondary sexual characteristics in puberty is associated with increasing gender dysphoria or psychological distress are more likely to have persistent GD. [3,7] In adolescents with severe and persistent GD, international [8] and national [9][10][11] guidelines recommend the use of treatments to suppress the rise in sex hormones (oestradiol or testosterone) in young people during puberty. Gonadotropin releasing hormone analogues (GnRHa) are synthetic peptides that work by stimulating gonadotropin release in a tonic fashion which desensitises the gonadotropin receptors, resulting in reversible suppression of sex hormone production. ...
Preprint
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Background In adolescents with severe and persistent gender dysphoria (GD), gonadotropin releasing hormone analogues (GnRHa) are used from early/middle puberty with the aim of delaying irreversible and unwanted pubertal body changes. Evidence of outcomes of pubertal suppression in GD is limited. Methods We undertook an uncontrolled prospective observational study of GnRHa as monotherapy in 44 12-15 year olds with persistent and severe GD. Prespecified analyses were limited to key outcomes: bone mineral content (BMC) and bone mineral density (BMD); Child Behaviour CheckList (CBCL) total t-score; Youth Self-Report (YSR) total t-score; CBCL and YSR self-harm indices; at 12, 24 and 36 months. Semistructured interviews were conducted on GnRHa. Results 44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months. All had normal karyotype and endocrinology consistent with birth-registered sex. All achieved suppression of gonadotropins by 6 months. At the end of the study one ceased GnRHa and 43 (98%) elected to start cross-sex hormones. There was no change from baseline in spine BMD at 12 months nor in hip BMD at 24 and 36 months, but at 24 months lumbar spine BMC and BMD were higher than at baseline (BMC +6.0 (95% CI: 4.0, 7.9); BMD +0.05 (0.03, 0.07)). There were no changes from baseline to 12 or 24 months in CBCL or YSR total t-scores or for CBCL or YSR self-harm indices, nor for CBCL total t-score or self-harm index at 36 months. Most participants reported positive or a mixture of positive and negative life changes on GnRHa. Anticipated adverse events were common. Conclusions Overall patient experience of changes on GnRHa treatment was positive. We identified no changes in psychological function. Changes in BMD were consistent with suppression of growth. Larger and longer-term prospective studies using a range of designs are needed to more fully quantify the benefits and harms of pubertal suppression in GD.
... The prevalence of mental health symptoms tends to increase with age, indicating the importance of early mental health support for TGEY (de Vries et al., 2011;Steensma et al., 2013). Given the severity of mental health concerns with TGEY, it is imperative that counselors and counselor educators have an in-depth understanding of the experiences and gender identities of TGEY. ...
Thesis
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This dissertation presents findings from the first known Interpretative Phenomenological Analysis study of how nine transgender and/or gender expansive youth, aged 13-17, experienced their gender identities and additional intersecting identities. The purpose of this study was to share how transgender and/or gender expansive youth experienced their gender identities, additional intersecting identities, and how they made meaning of these experiences within the contexts of current social, cultural, political, and historical factors. Additionally, this study sought to share the participants’ stories within their own words. The primary research question for this study was: how do transgender and gender expansive youth (TGEY) experience their gender identity? The two guiding subquestions explored how TGEY experienced their gender identity in relation to their additional intersecting identities, and how TGEY made meaning of their experiences, identities, and their experiences within their identities. The participants engaged in two 60-90 minute interviews with a member-checking meeting following data analysis to ensure their own words were at the forefront of the research. Six superordinate themes highlighted the participants’ narratives and experiences: (1) Gender Identity Journey and Coming Out; (2) Identities and Experiences of Oppression; (3) Navigating Mental Health and Physical Health; (4) Interpersonal Relationships; (5) Navigating Contextual Factors;(6) Making Sense of Experiences and Resiliency. These superordinate themes encompassed their gender journeys, experiences of multiple forms of oppression, their interpersonal relationships, mental and physical health concerns, navigating the historical, political, social, and cultural contextual factors within their lives, and their resiliency. Many of the participants’ experiences echoed findings in the literature, while simultaneously strengthening these findings due to the rich qualitative nature of this study. Results from this study have profound implications within the field of counselor education by increasing the knowledge in the field around the complex and nuanced lives of transgender and/or gender expansive youth. The results of this study address an important gap in the counseling literature and provides important implications and conclusions for counselors-in-training, counselors, and counselor educators. The results provide rich narrative of the participants’ lives, intersecting identities and various contextual factors such as historical, social, political, cultural, and historical factors. In addition, counselor educators are able to use these results to help train future counselors and supervisors to engage in transaffirmative approaches with transgender and/or gender expansive youth. Lastly, this study and the results therein are an act of social justice itself by de-centering the researcher’s views and centering that of transgender and/or gender expansive youth.
... A transgender person experiences in congruence between the natal (assigned) sex and the perceived gender identity, which in consequence can lead to gender dysphoria (GD). The onset of GD may be in childhood and can reach into adolescence or adulthood but desist in the majority (70). Often, GD becomes more severe with onset of secondary sex characteristics during puberty. ...
Article
This review aims to cover the subject of sex steroid action in adolescence. It will include situations with too little sex steroid action, as seen in for example, Turners syndrome and androgen insensitivity issues, too much sex steroid action as seen in adolescent PCOS, CAH and gynecomastia, too late sex steroid action as seen in constitutional delay of growth and puberty and too early sex steroid action as seen in precocious puberty. This review will cover the etiology, the signs and symptoms which the clinician should be attentive to, important differential diagnoses to know and be able to distinguish, long-term health and social consequences of these hormonal disorders and the course of action with regards to medical treatment in the pediatric endocrinological department and for the general practitioner. This review also covers situations with exogenous sex steroid application for therapeutic purposes in the adolescent and young adult. This includes gender-affirming therapy in the transgender child and hormone treatment of tall statured children. It gives some background information of the cause of treatment, the patient’s motivation for medicating (or self-medicating), long-term consequences of exogenous sex steroid treatment and clinical outcome of this treatment.
... În evoluţie, DG apărută în copilărie poate sau nu să continue și în adolescenţă, majoritatea remiţânduse, de obicei, până în perioada de adolescenţă (12). Totuşi, formele severe şi persistente şi formele care se accentuează odată cu pubertatea au şanse mari să se menţină pe termen lung (13). Conform DSM V (14), ratele de DG care persistă în adolescenţă şi perioada de adult variază la fenotipul masculin între 2 şi 30%, iar la cel feminin între 12 şi 50%. ...
Article
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Disforia de gen nu este o afecţiune cu care medicul pediatru din România se intâlneşte în mod obişnuit în practica sa. Cu toate acestea, în lumina progreselor care se fac în lume în scopul diagnosticării precoce şi instituirii unui tratament corect, cât şi în contextul evolutiv al societăţii, inclusiv din ţara noastră, cazurile medicale nu vor întârzia să apară. Această lucrare îşi propune să treacă în revistă, pe scurt, principalele caracteristici ale afecţiunii, precum şi rolul pe care pediatrul îl poate juca în viaţa pacientului deja diagnosticat (sau nu încă) cu disforie de gen.
... O que corrobora a sua afirmação é que aqueles tratados com "afirmação de gênero" tiveram persistência em 100% dos casos. 40 Green;Money, 1961;BAKWIN, 1968;GREEN, 1987;Russo, 1979;SINGH, 2012;STEENSMA et al., 2013;Wallien;Cohen-Kettenis, 2008;ZUGER, 1978;ZUGER, 1984. A abordagem que manteve números de superação e permanência da disforia de gênero em crianças e adolescentes concordantes em mais de 50 anos de pesquisa é a "espera vigilante" ("watchful waiting"), como nomeia K. Zucker. ...
Article
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Em 2013, o Conselho Federal de Medicina publicou o Parecer n. 8/2013, autorizando intervenções hormonais em menores de 18 anos com diagnóstico do até então denominado “transtorno de identidade de gênero”. Essas diretrizes foram ampliadas pela Resolução n. 2.265/2019, do mesmo órgão, que autorizou cirurgias irreversíveis a partir dos 18 anos de idade e não mais 21. Em 2018, consonante, o Conselho Federal de Psicologia emitiu a Resolução n. 1/2018, na qual exige, sob pena de punição disciplinar, que os profissionais validem identidades trans e travestis, independentemente de suas idades. Este artigo visa a despertar uma reflexão sobre o impacto da abordagem de “afirmação de gênero” no geral e dessas normas, em particular, nos direitos já conquistados das crianças e adolescentes.
... Cinsel kimlik uyumsuzluğunun gelişiminde herhangi bir psikososyal unsurun etkisi tam olarak kanıtlanamamakla birlikte günümüzde araştırmacılar CH için gelişim boyunca devam eden biyo-psiko-sosyal işlemlere odaklanılması gerektiğini savunmaktadırlar (22)(23)(24)(25). ...
Article
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Gender dysphoria (GD) may be defined as an apparent incongruence between assigned sex and experienced gender. Scholars across the world are attempting to achieve guidelines for a universal approach for children and adolescents experiencing GD. Recent studies have highlighted the importance of the biopsychosocial model as a holistic template for gender dysphoria. Youth with gender dysphoria often evince emotional and behavioral problems resulting from the stress of being marginalized and being forced to inhabit a body that does not match the experienced gender. The assessment processes for young people with GD are complex: numerous crucial factors regarding gender identity and possible psychopathologies must be contemplated by a child and adolescent psychiatrist. Treatment guidelines establish different protocols of beginning treatment for different age groups; however, consensus has not yet been achieved in approaches applied to GD in discrete clinics.
... The latter subgroup was called "persisters", as opposed to the group of "desisters" (Zucker, 2003). Follow-up studies performed in the treatment centres of Amsterdam and Toronto demonstrated that most patients belonged to the group of desisters (Drummond et al., 2008;Steensma et al., 2013;Wallien and Cohen-Kettenis, 2008), between 60 and 88% of initial participants. These numbers have since been heavily debated as they have been used time and again to defend conservative treatment positions or oppose treatment of transgender children altogether. ...
Chapter
In this chapter, we analyse the discourse on the medical treatment of transgender adolescents in the German print media. Using the example of the controversy about puberty blockers, we show how conservative positions portray deviations from the cis-normative gender order as a "fashion" and "zeitgeist phenomenon" and thus attempt to delegitimise accepting treatment that is oriented towards the needs of adolescents and represents the current state of medical research.
... Sin embargo, si la identificación cruzada de género persiste tras la pubertad, la DG suele mantenerse durante la vida adulta (Wallien y Cohen-Kettenis, 2008). En este sentido, la intensidad de la DG de inicio temprano suele ser un predictor significativo de la persistencia de la DG en la vida adulta (Steensma, McGuire, Kreukels, Beekman y Cohen-Kettenis, 2013). ...
Thesis
La disforia de género ha sido definida en los ámbitos psicológico y psiquiátrico como el malestar clínicamente significativo que puede acompañar a la incongruencia entre el género sentido o expresado por una persona y su sexo biológico. Muchas de las personas que experimentan este malestar se identifican como transgénero—o simplemente trans—y buscan atención médica especializada para alinear su cuerpo con su género sentido, un proceso habitualmente conocido como transición de género. En los últimos años, no obstante, han comenzado a surgir diversos testimonios de personas que, después de un período más o menos extenso de tiempo, detienen sus procesos de transición de género y deciden volver a vivir conforme a su sexo natal. Las experiencias de estas personas, conocidas como “destrans,” apenas han sido objeto de atención en la literatura académica hasta tiempos muy recientes. En consecuencia, nuestro conocimiento acerca de los motivos o vivencias que conducen a estas personas a destransicionar es aún muy limitado, y está basado fundamentalmente en evidencia de carácter anecdótico. Por consiguiente, el objetivo principal de este trabajo consiste en explorar, analizar y visibilizar una realidad aún muy desconocida en el contexto español, haciendo hincapié sobre cómo una mejor comprensión de este fenómeno puede contribuir a mejorar los servicios sanitarios de atención para las personas con disforia de género. Para ello, después de un recorrido por la literatura más relevante sobre identidad y disforia de género, presentaré el relato de vida de M., una mujer destrans española, el cual irá acompañado por su respectiva línea de vida. Ambas herramientas permiten comprender el proceso de destransición desde una perspectiva subjetiva e íntima, así como las redes de significados culturales, sociales y políticos que se encuentran encarnados en los cuerpos destrans.
... GD in adolescence is highly likely to continue into adult life where gender dysphoria persists after the onset of puberty [3]. Those with earlier onset or more intense GD and those in whom the development of secondary sexual characteristics in puberty is associated with increasing gender dysphoria or psychological distress are more likely to have persistent GD [3,7]. In adolescents with severe and persistent GD, international [8] and national [9][10][11] guidelines recommend the use of treatments to suppress the rise in sex hormones (oestradiol or testosterone) in young people during puberty. ...
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... A relatively small yet growing body of research suggests that, like sexual orientation, gender identity is affected by prenatal hormones and possibly genes (Swaab and Garcia-Falgueras, 2009;Smith et al., 2015;Saraswat et al., 2015;Yarhouse, 2015;Legato, 2018, Roselli, 2018. This view accords with the findings that deep-seated gender dysphoria in children tends to persist into adulthood (Steensma et al., 2013;(Ristori and Steensma, 2016) and that gender dysphoria and autism co-occur at elevated rates (Ristori and Steensma, 2016;Strang et al., 2014;Van Der Miesen et al., 2016). ...
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... In evolution, childhood-related GD may or may not continue into adolescence, with the majority usually resolving into adolescence (12). However, severe and persistent forms, as well as forms that worsen with puberty, are likely to be maintained for the long term (13). According to DSM V (14), the rates of GD that persist in adolescence and adulthood vary in the male phenotype between 2 and 30% and in the female between 12 and 50%. ...
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The present study reports on the construction of a dimensional measure of gender identity (gender dysphoria) for adolescents and adults. The 27-item gender identity/gender dysphoria questionnaire for adolescents and adults (GIDYQ-AA) was administered to 389 university students (heterosexual and nonheterosexual) and 73 clinic-referred patients with gender identity disorder. Principal axis factor analysis indicated that a one-factor solution, accounting for 61.3% of the total variance, best fits the data. Factor loadings were all >or= .30 (median, .82; range, .34-.96). A mean total score (Cronbach's alpha, .97) was computed, which showed strong evidence for discriminant validity in that the gender identity patients had significantly more gender dysphoria than both the heterosexual and nonheterosexual university students. Using a cut-point of 3.00, we found the sensitivity was 90.4% for the gender identity patients and specificity was 99.7% for the controls. The utility of the GIDYQ-AA is discussed.
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This research used interview and questionnaire data from homosexual (n = 177), bisexual (n = 157), and heterosexual (n = 544) men between 20 and 30 years of age among lower class men and university students in three countries: Brazil, Thailand, and Turkey. The main goal of the study was to examine the recalled childhood sex-typed behavior and adult sports preferences that distinguish homosexuals from bisexuals and heterosexuals. In all three cultures and both social groups, homosexual men were almost always more likely as children to have wanted to be a girl, to cross-dress, to play with girls, to do girls' tasks, and to practice fewer sports. They were also less likely to bully others or to engage in physical fights. As children, homosexual men were more likely to prefer swimming and playing volleyball rather than soccer and, as adults, they preferred watching gymnastics and swimming over soccer. The bisexuals scored intermediate mostly in "desire to be a girl" and "cross-dressing," although they were much closer to the heterosexuals. These results, coupled with previous cross-cultural research, suggest that cross-gender behavior in childhood may characterize most male homosexuals regardless of their cultural milieu.
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Thesis (M.A.)--University of Toronto, 2006. Includes bibliographical references.
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Gender identity-one's sense of being a man or a woman-is a fundamental perception experienced by all individuals that extends beyond biological sex. Yet, what contributes to our sense of gender remains uncertain. Since individuals who identify as transsexual report strong feelings of being the opposite sex and a belief that their sexual characteristics do not reflect their true gender, they constitute an invaluable model to understand the biological underpinnings of gender identity. We analyzed MRI data of 24 male-to-female (MTF) transsexuals not yet treated with cross-sex hormones in order to determine whether gray matter volumes in MTF transsexuals more closely resemble people who share their biological sex (30 control men), or people who share their gender identity (30 control women). Results revealed that regional gray matter variation in MTF transsexuals is more similar to the pattern found in men than in women. However, MTF transsexuals show a significantly larger volume of regional gray matter in the right putamen compared to men. These findings provide new evidence that transsexualism is associated with distinct cerebral pattern, which supports the assumption that brain anatomy plays a role in gender identity.
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Body image has come to mean not only the way one perceives his body but also how one feels about these perceptions. It is an important part of one's total self-concept. As such, it can present a significant problem for many individuals. For individuals with gender identity problems, such as transsexuals, body image dissatisfaction and distortion are a fundamental aspect of their condition. It is possible to more fully understand this condition by appreciating the distinction between the reality of the transsexual's body and his preferred body image. The Body Image (BI-I) scale presented here representa an effort to quantify the transsexual's body attitude. It consists of 30 body features which the subject is asked to rate on a 5-point scale of satisfaction. This test, as part of a larger seven-test battery, was administered to 16 male and 16 female transsexuals. The data have been analyzed for comparisons between males and females, for the effects of endocrinological and surgical treatment on body attitude, and for the common denominators which characterize the transsexual's body attitude. This instrument is being used as an additional tool in evaluating the transsexual's request for sex-reassignment surgery and in following those individuals who have been accepted for treatment as they progress through the evaluation and treatment program.
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Prenatal exposure to androgens has been implicated in transsexualism but the etiology of the condition remains unclear. The ratio of the 2nd to the 4th (2D:4D) digit lengths has been suggested to be negatively correlated to prenatal androgen exposure. We wanted to assess differences in 2D:4D ratio between transsexuals and controls. Sixty-three male-to-female transsexuals (MFT), 43 female-to-male transsexuals (FMT), and 65 female and 58 male controls were included in the study. Photo copies of the palms and digits of the hands were taken of all subjects and 2D:4D ratios were measured, according to standard published procedures. Comparison between right-handed individuals revealed that the right-hand 2D:4D in MFT is higher than in control males but similar to that observed in control females. In FMT we found no differences in 2D:4D relative to control females. Our findings support a biological etiology of male-to-female transsexualism, implicating decreased prenatal androgen exposure in MFT. We have found no indication of a role of prenatal hormone exposure in female-to-male transsexualism.
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