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Abstract

Purpose: Adolescence marks a transition point in the development of gender experience and expression. Although there is growing awareness about various gender identities in health research, only limited data on the prevalence of adolescent gender variance in the general population exists. Methods: German female and male adolescents (n = 940) aged 10–16 participating in the nationally representative “Health Behaviour in School-aged Children” (HBSC) Hamburg survey were asked to report their current gender experience (identification as both feminine and masculine) and gender expression (gender role as girl or boy). Two overall categories and five subcategories on gender experience and expression were established based on previous research. Results: In total, 4.1% of the adolescents’ responses were rated as variant in gender experience and 3.0% as nonconforming in expression. Both variant experiences and nonconforming expression together were present in only 0.9% of adolescents. Gender variance was more strongly present in girls as well as in younger age groups. In detail, 1.6% reported an incongruent, 1.1% an ambivalent, and 1.5% no gender identification. Another 8.0% of the responses could be rated as only somewhat congruent. Conclusions: Fluidity between clearly congruent or incongruent pathways is present in adolescence, including variant as well as possibly still developing (only somewhat clear) gender experiences, whereas clearly incongruent identification and nonconforming expression were less frequent. Understanding adolescent gender development as multidimensional is important in order to identify the needs of those who do not fit into the current understanding of either female or male.

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... From these data, it is clear that there is a female (assigned gender) predominance of transgender self-identification and that adolescent-reported rates are higher than those provided by parent-reports. The German ''Health Behaviour in School-aged Children'' survey involved 940 adolescents between the ages of 10 and 16, living in Hamburg during 2013 and 2014 (Becker et al., 2017). Data showed that 4.1% of adolescents reported a variant in gender experience, and 3.0% a non-conforming gender expression (Becker et al., 2017). ...
... The German ''Health Behaviour in School-aged Children'' survey involved 940 adolescents between the ages of 10 and 16, living in Hamburg during 2013 and 2014 (Becker et al., 2017). Data showed that 4.1% of adolescents reported a variant in gender experience, and 3.0% a non-conforming gender expression (Becker et al., 2017). Moreover, assigned females at birth (AFAB) reported a variant in gender experience more frequently than assigned males at birth (AMAB), and the same occurred in the 11 years age group (Becker et al., 2017). ...
... Data showed that 4.1% of adolescents reported a variant in gender experience, and 3.0% a non-conforming gender expression (Becker et al., 2017). Moreover, assigned females at birth (AFAB) reported a variant in gender experience more frequently than assigned males at birth (AMAB), and the same occurred in the 11 years age group (Becker et al., 2017). Two studies, one Canadian and one Dutch, revealed that since 2006 a shift in sex ratio has taken place in favor of AFAB (1:1.76 among Canadian adolescents; 1:1.72 in the Dutch group) (Zucker, 2017). ...
Article
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Epidemiological research may offer a key to interpreting gender incongruence (GI) and identifying the medical needs of people with GI. Currently, it is difficult to estimate the real prevalence of GI due to the use of different definitions. The data on GI prevalence are influenced by case definition and by the different methodologies applied by researchers to assess cases. Estimations of prevalence therefore vary widely and are estimated between 0.1% and 1.1% among adults, with a male-to-female (MtF) – female-to-male (FtM) sex ratio of 1–6. For children, the literature reports a prevalence ranging from 1% to 4.7%, with a predominance of MtF for children and from 1.2% to 16.1% in adolescents, among whom FtM appears to be predominant. Studies based on access to gender clinics may underestimate GI prevalence while studies focused on self- or parent-reported data may overestimate the phenomenon. The literature describes high rates of affective and anxiety disorders (18–80%) and frequent personality disorders (20–70%), suicide attempts, suicide and self-harm among people with GI. These problems seem to improve after gender affirmation treatment. Some authors report a high prevalence of Autistic Spectrum Disorders (ASD) (6–14%) among youth with GI. Mortality rates, HIV infection and sexually transmitted diseases are high among the transgender population, probably related to lack of prevention. It is crucial to determine the true prevalence of GI in order to deliver adequate medical support. Future studies should be based on large multicenter cohorts or population-based surveys, and should adopt respondent-driven sampling while including individuals who do not seek services offered at gender clinics, to limit the selection bias.
... From these data, it is clear that there is a female (assigned gender) predominance of transgender self-identification and that adolescent-reported rates are higher than those provided by parent-reports. The German ''Health Behaviour in School-aged Children'' survey involved 940 adolescents between the ages of 10 and 16, living in Hamburg during 2013 and 2014 (Becker et al., 2017). Data showed that 4.1% of adolescents reported a variant in gender experience, and 3.0% a non-conforming gender expression (Becker et al., 2017). ...
... The German ''Health Behaviour in School-aged Children'' survey involved 940 adolescents between the ages of 10 and 16, living in Hamburg during 2013 and 2014 (Becker et al., 2017). Data showed that 4.1% of adolescents reported a variant in gender experience, and 3.0% a non-conforming gender expression (Becker et al., 2017). Moreover, assigned females at birth (AFAB) reported a variant in gender experience more frequently than assigned males at birth (AMAB), and the same occurred in the 11 years age group (Becker et al., 2017). ...
... Data showed that 4.1% of adolescents reported a variant in gender experience, and 3.0% a non-conforming gender expression (Becker et al., 2017). Moreover, assigned females at birth (AFAB) reported a variant in gender experience more frequently than assigned males at birth (AMAB), and the same occurred in the 11 years age group (Becker et al., 2017). Two studies, one Canadian and one Dutch, revealed that since 2006 a shift in sex ratio has taken place in favor of AFAB (1:1.76 among Canadian adolescents; 1:1.72 in the Dutch group) (Zucker, 2017). ...
Article
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Résumé La recherche épidémiologique peut fournir une clef d’interprétation de l’incongruence de genre (IG) (Gender Incongruence [GI]) et d’identification des besoins médicaux des sujets avec une incongruence de genre. L’IG faisant l’objet de différentes définitions, il est difficile d’estimer sa véritable prévalence. Les données sur la prévalence de l’IG sont influencées par la définition nosographique et par les différentes méthodologies mises en œuvre par les chercheurs pour évaluer les nombres de cas. Selon les estimations existantes, la prévalence, qui présente de larges variations, se situe entre 0,1 % et 1,1 % chez les adultes, avec un ratio homme vers femme (ratio male-to-female [MtF]), femme vers homme (female-to-male [FtM]) de 1-6. Chez les enfants, la littérature rapporte une prévalence entre 1 % et 4,7 %, avec une prédominance du ratio MtF chez les enfants, et de 1,2 % à 16,1 % chez les adolescents pour lesquels le ratio FtM semble prédominant. Les études basées sur l’accès aux cliniques transgenres sont susceptibles de sous-estimer la prévalence de l’IG alors que les études qui mettent l’accent sur les données auto-déclarées ou déclarées par les parents pourraient surestimer le phénomène. La littérature décrit des taux élevés de troubles affectifs et d’anxiété (18–80 %), de fréquents troubles de la personnalité (20–70 %), des tentatives de suicide et des blessures auto-infligées chez les personnes vivant avec une incongruence de genre. Ces problèmes semblent s’améliorer après un traitement d’affirmation de genre. Certains auteurs font état d’une forte prévalence de troubles du spectre autistique (TSA) (Autistic Spectrum Disorders [ASD]) (6–14 %) chez les jeunes avec une incongruence de genre. Les taux de mortalité, les infections VIH et les maladies sexuellement transmissibles sont élevés chez les transgenres, probablement en raison d’un manque de prévention. Il est essentiel de déterminer la véritable prévalence de l’IG afin d’assurer un soutien médical adéquat. Les futures études devraient être basées soit sur de grandes cohortes multicentriques soit sur la population générale, faisant appel à des échantillonnages fondés sur les répondants et comprenant également des sujets qui n’ont pas recours aux services proposés par les cliniques transgenres, afin de minimiser les biais de sélection.
... Based on their responses, participants were classified into groups; these included 'gender ambivalent', 'gender incongruent' (see Table 1 for definitions of these terms) and 'no gender'; 0.7% of those assigned male at birth (AMAB) and 2.4% of AFAB were classified as gender incongruent. Furthermore, 0.7% of AMAB and 1.4% of AFAB were categorised as gender ambivalent, and 0.9% of AMAB and 2.0% of AFAB as having no gender (Becker, Ravens-Sieberer, Ottová-Jordan, & Schulte-Markwort, 2017). A higher proportion were classified as gender incongruent, compared to those who are seen as gender ambivalent. ...
... Clinical experience, and previous research with a non-clinical population (Becker et al., 2017), led us to predict that more AFAB would report a non-binary identity, compared to AMAB, yet the percentage was the same across the two groups. Thus, it may be the case that AMAB are less likely to disclose a non-binary identity to clinicians, yet it is unclear why this might be. ...
... Thus, it may be the case that AMAB are less likely to disclose a non-binary identity to clinicians, yet it is unclear why this might be. Moreover, only AFAB reported agender identities, which is different to Becker et al. (2017), who found both AFAB and AMAB reporting agender identities. As Becker et al. (2017) was a non-clinical sample, this may indicate that agender AMAB are less likely to attend a specialist gender service, yet the numbers in the present study are too small to draw this conclusion. ...
Article
There has been a recent rise in the number of people who hold a non-binary gender identity. However, the proportion of young people attending gender services who identify as non-binary has not yet been investigated. This article presents the findings from a pilot study of newly designed questionnaire, the Gender Diversity Questionnaire, which included questions about gender identity and gender expression. Responses from 251 adolescents attending the United Kingdom's National Gender Identity Development Service between June 2016 and February 2017 are reported here. The majority, 56.9%, of young people identified as trans, 29.3% identified as a binary gender (male or female), 11% identified as non-binary and 1.2% as agender. There were no significant differences in self-defined identities based on assigned gender or age. However, once young people were separated into these groups, some of them were very small; thus, a larger sample is required. In terms of aspects of gender expression that were important to the young people, the data formed five themes - name and pronouns, external appearance, the body, intrinsic factors and 'other'. Strengths and weaknesses of the research are discussed as well as future work that will be conducted.
... 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]. ...
... The counseling or support provided to young individuals during transition-related health care should seek to improve their overall psychosocial health by helping adolescents and their families identify and reflect on the factors that will contribute to their decision to undergo GA interventions [21]. 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]. ...
Article
Full-text available
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.
... These studies either elicited sex and perceived gender separately or focused directly on gender without eliciting natal sex. Most recently, Becker et al. [19] estimated the prevalence of gender variance in children and adolescents aged 10-16 in a subsample of about nine hundred respondents in a larger health survey. After eliciting the sex of the participants they focused on gender perception and gender expression, asking the respondents to rate to what extent they perceived themselves to be feminine and masculine, and to what extent others found them to behave like a boy / like a girl. ...
... This is clearly more common than transgender identity or gender dysphoric feelings reported in earlier comparable school / college based survey studies with data from 2008 to 2013 [14,15,16,20] and also exceeds the prevalence of 2.7% reported in one more recent school based adolescent data [17]. Our prevalence estimates are very close to those obtained in another recent adolescent population study [19]. However, all those studies are from different countries and used different questionnaires. ...
... There were more adolescents reporting other/ non-binary gender identity than opposite sex identification. This suggests that gender identity development in adolescence is fluid rather than clearly binary ( [19]). Unfortunately, other/ non-binary identity according to our implausibility analysis is also most susceptible to implausible responding. ...
Article
Background: Increasing numbers of adolescents are seeking treatment from gender identity services, particularly natal girls. It is known from survey studies some adolescents exaggerate their belonging to minorities, thereby distorting prevalence estimates and findings on related problems. The aim of the present study was to explore the susceptibility of gender identity to mischievous responding, and prevalences of cis-gender, opposite-sex and other/ non-binary gender identities as corrected for likely mischievous responding among Finnish adolescents. Method: The School Health Promotion Survey 2017 data was used, comprising data on 135,760 adolescents under 21 years (mean 15.73, ds 1.3 years), 50.6% females and 49.4% males. Sex and perceived gender were elicited and gender identities classified based thereon. Likely mischievous responding was analysed using inappropriate responses to biodata and handicaps. Results: Of the participants, 3.5% had most likely given facetious responses, boys more commonly than girls, and younger adolescents more commonly than older. This particularly concerned reporting of non-binary gender identity. Corrected prevalence of opposite-sex identification was 0.6% and that of non-binary identification was 3.3%. In boys, displaying non-binary gender identity increased from early to late adolescence, while among girls, opposite-sex and non-binary identifications decreased in prevalence from younger to older age groups. Conclusion: Prevalence of gender identities contrary to one's natal sex was more common than expected.
... Für das Jugendalter ist besonders anzunehmen, dass eine non-binäre oder mit dem Zuweisungsgeschlecht non-konforme Identität stärkerer Flui dität unterliegt, wenn sich junge Menschen noch in der Entwicklung und Exploration der eigenen Identität befinden (vgl. [39]). Für Erwachsene mit GD werden im Rahmen der therapeutischen Praxis offenere Möglichkeiten der eigenen Identität jenseits von eindeutig männlich oder weiblich akzeptiert. ...
... ). Werden junge Menschen im Jugendalter jedoch selbst nach ihrer Selbstzuschreibung zu einem Geschlecht befragt (entweder weiblich, männlich oder trans), so berichten etwa 1,2 und 1,3 % von einer Transgeschlechtlichkeit[37,38]. Eine repräsentative Untersuchung aus Hamburg konnte zeigen, dass insgesamt etwa 4,1 % der Antworten von jugendlichen Schulkindern im Alter zwischen 10 und 16 Jahren als variante Geschlechtsidentität (als inkongruent, ambivalent oder ohne Geschlechtsidentifikation) und somit als Ausdruck von Gendervarianz (nicht jedoch von Transgender) gewertet werden können[39]. Die hohen Zahlen an geschlechtsvarianter Identität aus dem Jugendalter geben Anlass, individuelle und fluide Entwicklungsaspekte von Geschlechtsidentität stärker in der Forschung und Behandlung im Jugendalter mit einzubeziehen. ...
Article
Transgender in adolescence is currently a widely discussed topic, additionally reflected by an increasing prevalence in clinical practice. The present review of the available literature on transgender, trans* , gender dysphoria or gender incongruence in youth reports results on the long-term results of medical interventions for the psychological well-being, prevalence, referral rates and sex ratio, developmental pathways, current developments and the role of the social environment. Finally, implications for clinical care and future research will be discussed. © Georg Thieme Verlag KG Stuttgart · New York.
... 19 In studies from different jurisdictions using general samples of adolescents, rates were found to be higher among youth than among adults, with 1.2% to 4.1% of adolescents reporting a gender identity different from that assigned at birth. 6,8,[20][21][22][23] Similar numbers of adolescents were also found to be variant in their gender expression; that is, in the way they communicated about their gender to others -either consciously or unconsciously -through external means such as clothing, personal appearance or mannerisms. 6,8,[20][21][22][23] Not all children and youth who report gender identities different from their gender assigned at birth will experience persistent gender dysphoria. ...
... 6,8,[20][21][22][23] Similar numbers of adolescents were also found to be variant in their gender expression; that is, in the way they communicated about their gender to others -either consciously or unconsciously -through external means such as clothing, personal appearance or mannerisms. 6,8,[20][21][22][23] Not all children and youth who report gender identities different from their gender assigned at birth will experience persistent gender dysphoria. Retrospective studies suggest gender dysphoria persists from childhood into adulthood in the range of 12%-27%. ...
Article
Adolescents with gender dysphoria present in a variety of health care settings, including primary care. Gender dysphoria is the distress experienced by an individual when their gender identity and their gender assigned at birth are discordant. Many tertiary pediatric centres across Canada and the Unites States have opened gender clinics for adolescents with gender dysphoria.¹ However, high demand often exceeds the capacity of these clinics, and many youth are prevented from accessing such centres for a variety of reasons (e.g., lack of parental or physician support, geographical distance). Primary care providers are well placed to provide critical support for youth with gender dysphoria and their caregivers and families. However, primary care providers often lack exposure to trans health issues in training, and may lack experience in managing gender dysphoria in youth. A recent Canadian national survey found that less than 50% of transgender youth felt comfortable discussing their trans-related health care needs with their family doctor.² We provide an overview of the management of gender dysphoria in postpubertal adolescents, including practical advice on approaches to social and medical transitioning, aimed at supporting primary care practitioners in supporting youth with gender dysphoria in their practices. We use the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria when referring to gender dysphoria. Because definitions and approaches to care have changed over the past 2 decades, we focus mainly on recent research that reflects the current diagnostic criteria, studies that apply contemporary assessment and measurement strategies, and findings that are applicable across multiple clinical settings. Our approach to gathering evidence used in this review is presented in Box 1. Box 2 defines commonly used terms.
... In the adolescents, the average age was 15.8 years old, with an SD of 1.6 years old (values between 13 and 18 years old). Regarding gender, 58.3% of the children identify themselves as females and, in the group of the adolescents, 80.0% identify themselves as males. ...
... Transgenders have lower levels of satisfaction with body image compared to cisgender people. Both transgender women and men exhibit body dissatisfaction in all spheres, not being directly related to male or female genitalia (58) . Although in most cases hormonization or surgery can alleviate this discomfort with the body itself, this modification is not the central solution for the low body image satisfaction experienced by transgender individuals. ...
Article
Full-text available
Objective: to describe attributes associated with the Quality of Life of Brazilian transgender children and adolescents according to their own perception. Method: descriptive study conducted with 32 participants between eight and 18 years old, who were either interviewed or participated in focus groups. The statements were transcribed, grouped with the aid of the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software, version 0.7 alpha 2 and described according to the definition of Quality of Life by the World Health Organization concerning to the mental, physical, and social dimensions. Results: it was possible to identify the family nucleus as the main social support for transgender children and adolescents. However, the experience of prejudice and discrimination were negative attributes associated with Quality of Life. Conclusion: the statements indicate that lives of transgender children and adolescents are impacted by social, physical, and mental factors due to the stigma and discrimination experienced. It is expected to contribute to the formulation of public policies related to transgender children and adolescents and expand the discussion on the citizens’ duties and rights in relation to transsexuality.
... Despite increased attention from researchers in recent years (Turban & Ehrensaft, 2018), GM youth remain underrepresented in extant literature (Grossman & D'Augelli, 2006), perhaps partly due to the dearth of inclusive and validated measures of gender identity (Olson-Kennedy et al., 2016). Research increasingly highlights variability in gender identity and expression across GM individuals and time (Becker et al., 2017;Steensma et al., 2011), and this work has begun to elucidate the concept of gender fluidity (i.e., the idea that gender identity can fluctuate over time; American Psychological Association [APA], 2015). Indeed, conceptions and measurements of GM identities continue to evolve, and the prevalence of GM youth is similarly unclear (Olson-Kennedy et al., 2016). ...
... Indeed, conceptions and measurements of GM identities continue to evolve, and the prevalence of GM youth is similarly unclear (Olson-Kennedy et al., 2016). Emerging studies estimate that 1%-3% of youth may identify as GMs (Johns et al., 2019;Rider et al., 2018), and a study measuring gender variant identities and behaviors in a nationally representative sample found an overall prevalence rate of 6.3%, with more gender variance in younger children (Becker et al., 2017). Prior research also indicates that GM youth might be overrepresented in clinically referred samples (4%-6.5%; ...
Article
Full-text available
Objective: Gender minority youth (i.e., children/adolescents whose gender identity and/or expression is inconsistent with their birth-assigned sex) experience elevated rates of emotional and behavioral problems relative to cisgender youth (who identify with their birth-assigned sex), which are not intrinsic to gender identity but attributable to unique minority stressors. Although empirically supported treatments have proven effective in treating these mental health concerns generally, randomized controlled trials have not examined effects for gender minority youth. Method: To address this gap, we pooled data from clinically referred youth (N = 432; M(SD)age = 10.6(2.2); 55.1% White) assigned to empirically supported treatment conditions across four previous randomized controlled trials of modular psychotherapy. A proxy indicator of gender identity (i.e., youth's wish to be the opposite sex) was used to classify gender minority (n = 64) and cisgender (n = 368) youth. Youth- and caregiver-reported pretreatment internalizing and externalizing problems, treatment effectiveness on these domains, and treatment acceptability were compared across groups. Results: Gender minority youth reported more severe pretreatment internalizing and externalizing problems compared to cisgender youth; in contrast, their caregivers reported less severe problems. Although treatment was equally effective for both groups on most outcomes, gender minority youth's caregiver-reported externalizing problems improved more slowly and less reliably, and their self-reported internalizing problems were more likely to remain clinically elevated. Furthermore, gender minority youth reported lower treatment satisfaction. Conclusions: While findings suggest that empirically supported treatments may effectively address many mental health problems for gender minority youth, they also underscore the need for treatment enhancements that improve acceptability and outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... were coded as being incongruent to their gender assigned at birth in a recent nationally representative study. (10) Demand for assessment for gender reassignment services in youth appears to be increasing in several countries. (11)(12)(13)(14) While it is well known that sexual minority (gay, lesbian and bisexual -LGB) status is a risk factor for both poor mental health and its determinants, (15,16) less is known about the relationship between mental health and gender minority (transgender, gender diverse and nonbinary -TGDNB) status. ...
... (Transgender* or Trans or Transsexual* or Travesti* or Gender identity disorder or Gender non-conform* or Gender dysphoria or Gender incongruen*).mp. 10 4 OR 9 11 ...
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BACKGROUND Global health guidance has identified gender minorities and adolescents, respectively, as being at elevated risk of mental disorders. The aim of this systematic scoping review was to examine the association between mental distress and transgender status in adolescents, to reflect on how global policy might specifically address the mental health of transgender adolescents. METHODS A systematic search was conducted in six databases (Medline, Embase, CINAHL Plus, ADOLEC, PsychINFO and PsychEXTRA) for published quantitative and qualitative studies examining a range of mental disorders, suicidality and non-suicidal selfinjury (NSSI) among adolescents with gender dysphoria or who identify as transgender. The search was limited to original research studies published in Afrikaans, Dutch, English, French and Spanish, but not limited by date. Prevalence estimates of mental disorders, suicidality and NSSI were abstracted from individual studies. The Meyer minority stress model was used as a framework to map risk and protective factors associated with mental distress, grouping by distal stressors, proximal stressors and resilience factors. RESULTS 49 studies met inclusion criteria. 33 observational studies reported prevalence of depression, anxiety, suicide attempt, suicidal ideation, self-harm, eating disorder and/or disorders of neurodiversity among transgender adolescents. Rates of mental distress were higher among transgender than among both cisgender heterosexual and sexual minority adolescents. Identified risk factors for mental distress were bullying; physical and sexual violence; poor relationships with family and peers; stigmatization by health care providers; internalized transphobia; negative self-concept; and substance use. Factors that appeared to protect against distress included parent-connectedness; peer- and teacher-support; safe school environment; consistent use of chosen names and pronouns; hobbies; and gender-affirming medical treatment. CONCLUSIONS Evidence-informed global governance on adolescent health could encourage countries both to strengthen information systems to support research on transgender adolescent health and to adopt a comprehensive, integrated approach to promoting mental health among gender minority adolescents.
... However, sex and gender often have been conflated in this work, and gender viewed through a binary lens. The term 'gender' refers to a range of experiences, both internal and external (Becker et al., 2017;Ehrtmann et al., 2019), and the intricate interplay between social gender and inner gender-related experiences has yet to be articulated in autism (Cooper et al., 2018). In this editorial, written as a collaboration between clinician researchers and autistic advocates (Fletcher-Watson et al., 2019), we explore key topics in the field and offer recommendations for advancing this work through more diversified, sex-and gender-informed lenses, and with a focus on the lived experiences of autistic people. ...
... sex is often perceived as a binary construct, but in fact, its components can be multicategorical or dimensional (Joel & McCarthy, 2017). Gender encompasses experiential, social and cultural components including 'gender norms' (Barnett, 1997), 'gender roles' (Witt, 1997), 'gender-related interests' (Davis & Hines, 2020;Dittmann et al., 1990;Fast & Olson, 2018), 'gender-related expressions' (Becker et al., 2017;Toomey et al., 2010) and 'gender identity' (i.e. the internal gender that a person experiences themselves as; American Psychological Association, 2015). Autism-related characteristics may facilitate greater freedom regarding social gender roles and societal gender expectations; autistic individuals may feel less pressure to conform to such roles (Strang et al., 2018). ...
... Transgender (or trans) adolescents, like their adult counterparts, experience an incongruence between their sex assigned at birth and their gender identity. 1,2 This experienced incongruence is often accompanied by psychological distress and a persistent strong desire for social and physical gender changes, at which point they can be diagnosed with gender dysphoria (GD), as per the diagnostic and statistical manual of mental disorders. 3 Trans youth, being underage, cannot legally consent alone to gender-affirming treatments (transition-related medical interventions [TRMI]), resulting in involvement of parents/ guardians, who also have limited decision-making authority. ...
... 17 This sex ratio also reflects findings in other studies on prevalence rates of gender-incongruent experiences and behaviors. 2,21,41 Nonetheless, the sex ratio meant analyses of the 'GAH þ GAS' group could only explore satisfaction with mastectomy for AFAB participants. ...
Article
Background: The number of adolescents presenting with gender dysphoria (GD) in healthcare services has increased significantly, yet specialized services offering transition-related care (TRC) for trans youth is lacking. Aim: To investigate satisfaction with TRC, regret, and reasons for (dis)satisfaction with transition-related medical interventions (TRMIs) in trans adolescents who had presented to the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS). Methods: Data were collected from a clinical cohort sample of 75 adolescents and young adults diagnosed with GD (81% assigned female at birth) aged 11 to 21 years (M ¼ 17.4) at baseline and follow-up (on a spectrum of ongoing care, on average 2 years after initial consultation). To determine progress of the youth's medical transitions, an individual treatment progress score (ITPS) was calculated based on number of desired vs received TRMIs. Outcomes: Main outcome measures were satisfaction with TRC at the time of follow-up, ITPS, social support, reasons for regret and termination of TRC, and (dis)satisfaction with TRMIs. Results: Participants underwent different stages of TRMIs, such as gender-affirming hormone treatment or surgeries, and showed overall high satisfaction with TRC received at the Hamburg GIS. Regression analysis indicated that a higher ITPS (an advanced transition treatment stage) was predictive of higher satisfaction with TRC. Sex assigned at birth, age, and time since initial consultation at the clinic showed no significant effects for satisfaction with TRC, while degree of social support showed a trend. No adolescents regretted undergoing treatment at follow-up. Additional analysis of free-text answers highlighted satisfaction mostly with the physical results of TRMI. Clinical Implications: Because youth were more satisfied with TRC when their individual transition (ITPS) was more progressed, treatment should start in a timely manner to avoid distress from puberty or long waiting lists. Strengths and Limitations: This study is one of the first to report on treatment satisfaction among youth with GD from Europe. The ITPS allowed for a more detailed evaluation of TRMI wishes and experiences in relation to satisfaction with TRC and may close a gap in research on these treatments in adolescent populations. However, all participants were from the same clinic, and strict treatment eligibility criteria may have excluded certain trans adolescents from the study. Low identification rates with non-binary identities prevented comparisons between non-binary and binary genders. Conclusion: The study highlights the role of TRMI and individual treatment or transition progress for youth's overall high satisfaction with TRC received at the Hamburg GIS. Nieder TO, Mayer TK, Hinz S, et al. Individual Treatment Progress Predicts Satisfaction With Transition-Related Care for Adolescents With Gender Dysphoria: A Prospective Clinical Cohort Study. J Sex Med 2020;XX:XXXeXXX.
... Das bei Geburt zugewiesene Geschlecht (Zuweisungsgeschlecht) kann bei einigen wenigen Individuen bereits im Kindes-und Jugendalter als nicht stimmig erlebt werden und dadurch Leid erzeugen. Dieses Phänomen wird in der klinischen Diagnostik als "Geschlechtsdysphorie" (GD; American Psychiatric Association, 2013) oder auch als "Geschlechtsinkongruenz" bezeichnet (Becker, Ravens-Sieberer, Ottová-Jordan & Schulte-Markwort, 2017). Die klinische Prävalenz von GD-Diagnosen wird im älteren Jugend-und Erwachsenenalter auf 4.6 pro 100 000 Individuen geschätzt (0.0046 %; Arcelus et al., 2015) und Geschlechtsinkongruenz in der jugendlichen Allgemeinbevölkerung für rund 1 % berichtet (Becker et al., 2017). ...
... Dieses Phänomen wird in der klinischen Diagnostik als "Geschlechtsdysphorie" (GD; American Psychiatric Association, 2013) oder auch als "Geschlechtsinkongruenz" bezeichnet (Becker, Ravens-Sieberer, Ottová-Jordan & Schulte-Markwort, 2017). Die klinische Prävalenz von GD-Diagnosen wird im älteren Jugend-und Erwachsenenalter auf 4.6 pro 100 000 Individuen geschätzt (0.0046 %; Arcelus et al., 2015) und Geschlechtsinkongruenz in der jugendlichen Allgemeinbevölkerung für rund 1 % berichtet (Becker et al., 2017). Die Diagnose GD ist durch eine anhaltende Inkongruenz zwischen dem Zuweisungsgeschlecht und dem Geschlechtserleben (oder auch: Gender) gekennzeichnet, welche in der Regel mit klinisch relevantem Leidensdruck einhergeht (American Psychiatric Association, 2013). ...
Article
Zusammenfassung. Fragestellung: Aktuelle Studien weisen auf ein erhöhtes gemeinsames Auftreten von Geschlechtsdysphorie (GD) und Autismus-Spektrum-Störungen (ASS) hin. Diese Studie soll Aufschluss über die klinische Prävalenz von ASS bei Kindern und Jugendlichen in einer deutschen Spezialsprechstunde für GD sowie über personen- und behandlungsbezogene Merkmale bei vorliegender Doppeldiagnose (GD, ASS) geben. Methodik: Angaben zum Zuweisungsgeschlecht, Alter, Diagnosen (GD, ASS) und Behandlungsstatus von 680 Kindern und Jugendlichen (Zeitraum: 2013 bis 2018) wurden erfasst. Die Häufigkeit von ASS-Diagnosen (F84.0, F84.1, F84.5, F84.8 oder F84.9, gesichert und ASS-Verdacht) wurde innerhalb der Stichprobe mit GD-Diagnose (gesichert: F64.0, F64.2; Verdacht: F64.8, F64.9; n = 579) ausgewertet. Personen- und behandlungsbezogene Merkmale wurden vergleichend zwischen 18 Kindern und Jugendlichen mit Doppeldiagnose und 40 Kindern und Jugendlichen mit GD-, aber ohne ASS-Diagnose ausgewertet. Ergebnisse: Die klinische Prävalenz von ASS bei vorliegender GD-Diagnose lag unter Einschluss der Verdachtsfälle bei 3.1 %. Kinder und Jugendliche mit einer Doppeldiagnose erhielten signifikant häufiger eine GD-Verdachtsdiagnose und wurden signifikant seltener körpermedizinisch behandelt als Jugendliche ohne ASS-Diagnose. Schlussfolgerungen: Obwohl die gemeinsame Prävalenz von GD und ASS in dieser Untersuchung geringer als in anderen internationalen Sprechstunden ausfiel, sprechen die Zahlen für ein erhöhtes gemeinsames Auftreten der Phänomene. Die Behandlungsergebnisse verdeutlichen, dass eine ASS-Diagnose die Diagnostik bei GD sowie die Indikation somatischer, geschlechtsangleichender Maßnahmen erschweren kann.
... Prevalence rates for gender identity are provided by the large population-based Health Behaviour in School Aged Children study in Hamburg, Germany. Among 940 children and adolescents (10-16 years of age), 1.6% (n = 15) reported GIC, 1.1% gender variance and 1.5% identified themselves as non-binary [3]. ...
... At birth assigned sex; 2 Age at initial session;3 Poor Peer Relations Scale score; 4 Difference between parent and child report; 5 Regression coefficient;6 Standard error. ...
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Among trans adolescents, increased psychological distress is reported in the literature. The goal of this study was to examine psychological distress, associated peer relations and parent report congruence among the treatment-seeking sample of the Gender Identity Special Consultation (GISC) for youth at the Charité Berlin. Further, differences between the instruments’ binary gender norms were investigated. Retrospectively, we analyzed clinical data derived from the GISC. By initial interviews and using the Youth Self-Report and Child Behavior Checklist, n = 50 trans adolescents aged 12–18 years (M = 15.5) were examined for psychological problems and peer relations. Congruence between self and parent report was analyzed by correlations. Half of the sample reported suicidality, self-harm and bullying. Trans adolescents showed significantly higher internalizing and total problems than the German norm population. The congruence between self and parent report proved to be moderate to high. The level of congruence and poor peer relations were identified as predictors of internalizing problems. Significant differences between the female vs. male gender norms emerged regarding mean scores and the number of clinically significant cases. Data provide valuable implications for intervention on a peer and family level. There are limitations to the suitability of questionnaires that use binary gender norms, and further research on adequate instruments and assessment is needed.
... Auch wurde in Studien nicht immer gleich diagnostiziert und es haben sich die Diagnosesysteme geändert. Selbstauskünfte von Kindern und Jugendlichen in der Allgemeinbevölkerung sind nicht mit diagnostizierten Fällen vergleichbar, können aber Aufschluss darüber geben, wie verbreitet geschlechtsinkongruentes Erleben (um die 1 %) im Vergleich zu anderen Möglichkeiten ist, das eigene Geschlecht als variant wahrzunehmen, also jenseits von kongruent eindeutig weiblich oder männlich (insgesamt ca. 4 % Gendervarianz bei Jugendlichen zwischen 10 und 16 Jahren) [8]. ...
... a. eine Behandlung mit Pubertätsblockern) auf die Entwicklung der Geschlechtsidentität, die Psyche und die Kognitionen auswirkt. Es bedarf weiterer Untersuchungen zu Normvarianten der Geschlechtsidentität in der Allgemeinbevölkerung und damit einhergehenden Entwicklungsverläufen, um einen entwicklungspsychologischen Referenzrahmen zu entwickeln[8] und besser entscheiden zu können, ab wann Kinder oder Jugendliche von dieser Entwicklung abweichen, und wann Behandlungsbedarf entsteht. ...
... Young transgender or gender nonconforming (TGNC) populations are faced with different challenges early in life. Youth with a gender dysphoria (GD) diagnosis (according to the DSM-5) often wish to undergo a social and medical gender transition to alleviate the experienced distress resulting from gender incongruence or a persistent identification with a gender other than the sex assigned at birth (American Psychiatric Association, 2013;Becker et al., 2017;Coleman et al., 2012). According to two population-based studies, between 1.8% and 2.7% of high school students from the US were identified as transgender (Johns et al., 2019;Rider et al., 2018), and in a survey from middle schools, 1.3% of students (grades 6-8) self-identified as transgender (Shields et al., 2013). ...
... According to two population-based studies, between 1.8% and 2.7% of high school students from the US were identified as transgender (Johns et al., 2019;Rider et al., 2018), and in a survey from middle schools, 1.3% of students (grades 6-8) self-identified as transgender (Shields et al., 2013). For Germany, Becker et al. (2017) reported gender incongruence among 0.9% of adolescents aged 10-16 years old in a school-based population. Individuals assigned male at birth (AMAB) and identifying as female are often addressed as transfemale and those assigned female at birth (AFAB) and identifying as male as transmale (Newcomb et al., 2020). ...
Article
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Background Young transgender or gender nonconforming (TGNC) children and adolescents or those with a gender dysphoria (GD) diagnosis show an increased risk of suicidal and nonsuicidal self-harming thoughts and behaviors (STBs). Data from German-speaking regions on this topic and studies comparing self- and parent-reported STBs have been scarce. The study aims were therefore to examine: (a) frequencies of self- and parent-reported STBs in a German clinical sample of children and adolescents with GD and (b) differences between age and gender groups, as well as between self- and parent-reports. Methods Two items from the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR) were used to assess self- and parent-reported STBs in a sample of 343 adolescents and 49 children who presented to the Hamburg Gender Identity Service (Hamburg GIS) between 2013 and 2019. Seventy-eight percent of the analysis sample was assigned female at birth (AFAB), and 22% were assigned male at birth (AMAB). Results Parents reported STBs on the CBCL for 16% and 6% of the cases in childhood and for 20% and 29% of the adolescent cases, respectively. STBs were self-reported by 38% and 45% of the adolescents who could report on the YSR. STBs were higher among adolescents than among children and in self-reports (YSR) compared to parent reports (CBCL). AFAB adolescents reported higher degrees of STBs than AMAB adolescents. Conclusions Children and adolescents with GD are a high-risk population for STBs, especially pubescent and AFAB individuals. Mental health professionals should screen early for STBs to prevent possible suicidal ideation-to-action transitions.
... The rate of adolescents who are referred to mental health service providers because of gender identity concerns has markedly increased over the past two decades (Aitken et al., 2015;Chen, Fuqua, & Eugster, 2016;de Graaf, Carmichael, Steensma, & Zucker, 2018;Olson, Schrager, Belzer, Simons, & Clark, 2015;Olson-Kennedy et al., 2016;Wiepjes et al., 2018;Wood et al., 2013;Zucker, 2017). During the same time, the spectrum of atypical gender presentations has diversified with increasing numbers of individuals developing gender identities in between the binary male and female poles (Becker, Ravens-Sieberer, Ottová-Jordan, & Schulte-Markwort, 2017;Richards et al., 2016). ...
Article
Full-text available
The rate of adolescents with gender-nonconforming behavior and/or gender dysphoria seeking mental health care has dramatically increased in the past decade. Many of these youths also present with co-occurring psychiatric problems, including depression, anxiety, suicidality, substance use, and others. This combination may generate a complex clinical picture that challenges the ability of clinicians to accurately diagnose gender distress and develop suitable treatment recommendations. This article illustrates those challenges with two adolescent patients who developed late-onset gender dysphoria in the course of long-term mental health care for diverse psychiatric problems preceding the emergence of gender dysphoria. One underwent full progression from gender dysphoria as a male through social and medical transition to female, the other a less definitive progression from gender dysphoria as female through social transition to male without deciding for any medical treatment. The report provides details on the assessment procedures and the resulting findings, the rationale for treatment recommendations, and short-term follow-up information.
... Sie weist darauf hin, dass Varianten im Erleben und im Ausdruck von Geschlecht häufig sind und möglicherweise mit mehr Fluidität verbunden als bisher angenommen: 4,1 % der Antworten im Jugendalter zwischen 10 und 16 Jahren konnten als "gendervariant" (also entweder inkongruent, ambivalent oder weder/noch männliche oder weibliche Geschlechteridentifikation; . Tab. 26.1) und 8 % als nur "überwiegend kongruente Geschlechteridentifikation" (und somit noch in der Entwicklung begriffen) eingeordnet werden (Becker et al. 2017b). ...
Chapter
Alltagssprachlich wird für Personen, die ihre geschlechtsbezogene Identität nicht oder nicht vollständig im Einklang mit ihren körperlichen Geschlechtsmerkmalen erleben, häufig der inklusive Begriff trans* verwendet. Die Diskrepanz zwischen Geschlechtsempfinden und körperlichen Geschlechtsmerkmalen kann auch als Geschlechtsinkongruenz (GI) beschrieben werden. Leidet eine Person unter der GI, kann zudem von Geschlechtsdysphorie (GD) gesprochen werden. Für die Behandlung der GD stehen verschiedene therapeutische Möglichkeiten zur Verfügung, somatisch wie psychotherapeutisch. Die häufig multimodale Behandlung sollte vor allem darauf abzielen, den möglichen Leidensdruck zu reduzieren und die Lebensqualität zu fördern. Während für einige trans* Personen ein Leben in der gewünschten Geschlechtsrolle ausreicht, um den Leidensdruck zu lindern, ist für andere eine Veränderung des Körpers durch somatische Behandlungen (z. B. hormonelle und/oder chirurgische Interventionen) nötig, um dem eigenen Geschlecht entsprechend leben zu können.
... Therefore, the conclusions drawn from our sample need to be further investigated in future research to account for possible different needs of adolescent transgender boys and girls. It remains difficult to conclude whether such differences are related to greater societal tolerance or really a result of higher prevalence, although a German study on adolescent school children aged 10-16 years showed that gender variant experiences were more prevalent among birth-assigned female adolescents from the general population, as well [55]. Furthermore, the selection of the sample might have implications for the generalizability of the present findings. ...
Article
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Adolescents with gender dysphoria (GD) often face various associated social, emotional, and behavioral difficulties. In such a marginalized group, it is crucial to identify factors that may impact psychological functioning to better accommodate their needs. Therefore, the present study investigated the impact of two specific risk factors, poor peer relations and general family functioning, on the development of psychological problems in adolescents with GD, and their possible interaction effect. The Youth Self-Report, a Peer Relations Scale, and a General Family Functioning scale were assessed in a sample of n = 180 clinically referred adolescents (mean age 15.5; 146 transgender boys with a female birth-assigned sex, and 34 transgender girls with a male birth-assigned sex) with a complete GD diagnosis (fulfillment of the DSM 5 criteria A and B) at their initial admission to the Hamburg Gender Identity Service. Multiple linear regression analysis was conducted to examine the relationship between peer relations, family functioning, and psychological functioning outcomes. Adolescents with GD presented significantly higher Internalizing and Total Problem scores compared to the German reference norm. Externalizing problems were above the norm for transgender boys, but within the normal range for transgender girls. Multiple regression analysis revealed that, overall, adolescents with an advanced age, a female birth-assigned sex, poorer peer relations, and poorer family functioning showed more behavioral and emotional problems. Consequently, incorporating both the family and social environment in transgender care is of high importance to adequately tend to the needs of adolescents with GD.
... We are not sure why this is the case, but potential factors might include slight wording differences between the measures of gender typicality used in our study and in Egan and Perry's (2001) study. Additionally, our data were gathered 15 years after the publication of Egan and Perry's study; much has changed regarding the visibility and acceptance of gender diversity since then (Becker et al. 2017;Morris 2018;Yu et al. 2017). ...
Article
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Previous research suggested that gender typicality and pressure to conform to gender norms were unrelated; however, this may have been due to how gender typicality was assessed (i.e., by only comparing the self to one’s own gender collective). In the present study, we used a dual identity approach (comparing oneself to both gender collectives: to own-gender and other-gender individuals) to create typologies of gender typicality to examine how similarity to own and other gender collectives might differentially associate with pressure to conform to gender norms. The potentially unique influence of pressure sources (parents, peers, or the self) was also analyzed. Participants were 378 U.S. 6th grade students (48% female; Mage = 11.44 years, range = 10–13). Results indicated that male early adolescents felt more pressure than did female early adolescents and that those who felt more similar to own-gender (and less similar to other-gender) felt significantly higher levels of pressure and that the highest source of pressure was the self rather than peers or parents. We discuss how the present research provides insights into who experiences the highest levels of felt pressure to conform to gender norms and suggests that self-socialization plays a strong role in gender development for many early adolescents.
... Others believe that there is interconnectedness mechanism between personality and cultural underpinnings of self-continuity. Some of researchers have addressed this question in a crosssectional study in different cultures (Schmiedeck, 1979;Anderzén and Arnetz, 1999;Timotijevic and Breakwell, 2000;Becker et al., 2017). They found that members of collectivistic cultures maintain self-continuity more on an awareness of stability and associative links to one's past, while members of individualistic cultures ground self-continuity more on stories or narratives. ...
Article
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Life, whatsoever it is, is a temporal flux. Everything is doomed to change often apparently beyond our awareness. My body appears totally different now, so does my mind. I have gained new attitudes and new ambitions, and a substantial number of old ones have been discarded. But, I am still the same person in an ongoing manner. Besides, recent neuroscientific and psychological evidence has shown that our conscious perception happens as a series of discrete or bounded instants—it emerges in temporally scattered, gappy, and discrete forms. But, if it is so, how does the brain persevere our self-continuity (or continuity of identity) in this gappy setting? How is it possible that despite moment-to-moment changes in my appearance and mind, I am still feeling that I am that person? How can we tackle with this second by second gap and resurrection in our existence which leads to a foundation of wholeness and continuity of our self ? How is continuity of self (collective set of our connected experiences in the vessel of time) that results in a feeling that one’s life has purpose and meaning preserved? To answer these questions, the problem has been comprehended from a philosophical, psychological, and neuroscientific perspective. I realize that first and foremost fact lies in the temporal nature of identity. Having equipped with these thoughts, in this article, it is hypothesized that according to two principles (the principle of reafference or corollary discharge and the principle of a time theory) self-continuity is maintained. It is supposed that there should be a precise temporal integration mechanism in the CNS with the outside world that provides us this smooth, ungappy flow of the Self . However, we are often taken for granted the importance of self-continuity, but it can be challenged by life transitions such as entering adulthood, retirement, senility, emigration, and societal changes such as immigration, globalization, and in much unfortunate and extreme cases of mental illnesses such as schizophrenia.
... For instance, GM youth referred to treatment in specialty gender clinics have exhibited variability in their response to this item in past research (e.g., birth-assigned girls reported a stronger wish to be the opposite sex compared to birth-assigned boys; de Graaf et al., 2018). Variability in gender expression and identification across GM youth, as well as across time, is increasingly supported in research (Becker et al., 2017;Steensma et al., 2011). Thus, in addition to assessing test-retest reliability from pretreatment to 6 months and again from 6 months to one year, we examined variation in responses to YSR #110 by conducting bivariate correlations across assessment periods. . ...
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Objective: Gender minority youth (i.e., children/adolescents whose gender identity and/or expression is inconsistent with their birth-assigned sex) experience elevated rates of emotional and behavioral problems relative to cisgender youth (who identify with their birth-assigned sex), which are not intrinsic to gender identity but attributable to unique minority stressors. Although empirically-supported treatments have proven effective in treating these mental health concerns generally, randomized controlled trials have not examined effects for gender minority youth. Method: To address this gap, we pooled data from clinically-referred youth (N = 432; M(SD)age = 10.6(2.2); 55.1% White) assigned to empirically-supported treatment conditions across four previous randomized controlled trials of modular psychotherapy. A proxy indicator of gender identity (i.e., youth’s wish to be the opposite sex) was used to classify gender minority (n = 64) and cisgender (n = 368) youth. Youth- and caregiver-reported pretreatment internalizing and externalizing problems, treatment effectiveness on these domains, and treatment acceptability were compared across groups. Results: Gender minority youth reported more severe pretreatment internalizing and externalizing problems compared to cisgender youth; in contrast, their caregivers reported less severe problems. Though treatment was equally effective for both groups on most outcomes, gender minority youth’s caregiver-reported externalizing problems improved more slowly and less reliably, and their self-reported internalizing problems were more likely to remain clinically elevated. Further, gender minority youth reported lower treatment satisfaction. Conclusions: While findings suggest that empirically-supported treatments may effectively address many mental health problems for gender minority youth, they also underscore the need for treatment enhancements that improve acceptability and outcomes. Public Significance Statement: This study examined the effectiveness and acceptability of empirically-supported mental health treatments for gender minority youth (who endorsed a wish to be the opposite sex) and cisgender youth. Gender minority youth reported more severe problems before treatment, demonstrated slower improvement in caregiver-reported behavior problems, and endorsed lower treatment satisfaction. Findings support the potential need for provider-focused trainings relevant to gender minority youth.
... The ABCD participants are a US sample and because gender is learned through cultural socialization additional empirical work to assess whether these dimensions could be used to understand youth in other geographical contexts is warranted. A recent study from Germany found that among 10-to 16-year-olds (n = 940), 4.1% had 'variant' gender experience (Becker, Ravens-Sieberer, Ottova-Jordan, & Schulte-Markwort, 2017), which is on par with our 4.7% 'minority' felt-gender. Regardless, the current data provide robust evidence for diversity in the experiences of gender among 10/ 11-year-olds in the United States, well beyond those who identify as transgender. ...
Article
Background: There are known associations between mental health symptoms and transgender identity among adults. Whether this relationship extends to early adolescents and to gender domains other than identity is unclear. This study measured dimensions of gender in a large, diverse, sample of youth, and examined associations between diverse gender experiences and mental health. Methods: The ABCD study is an ongoing, longitudinal, US cohort study. Baseline data (release 2.0) include 11,873 youth age 9/10 (48% female); and the 4,951 1-year follow-up visits (age 10/11; 48% female) completed prior to data release. A novel gender survey at the 1-year visit assessed felt-gender, gender noncontentedness, and gender nonconformity using a 5-point scale. Mental health measures included youth- and parent-reports. Results: Roughly half a percent of 9/10-year-olds (n = 58) responded 'yes' or 'maybe' when asked, 'Are you transgender' at baseline. Recurrent thoughts of death were more prevalent among these youth compared to the rest of the cohort (19.6% vs. 6.4%, χ2 = 16.0, p < .001). At the 1-year visit, when asked about the three dimensions of gender on a 5-point scale, 33.2% (n = 1,605) provided responses that were not exclusively and totally aligned with one gender. Significant relationships were observed between mental health symptoms and gender diversity for all dimensions assessed. Conclusions: Similar to adult studies, early adolescents identifying as transgender reported increased mental health symptoms. Results also point to considerable diversity in other dimensions of gender (felt-gender, gender noncontentedness, gender nonconformity) among 10/11-year-olds, and find this diversity to be related to critical mental health symptoms. These findings add to our limited understanding of the relationship between dimensions of gender and wellness for youth.
... Geschlechtsvariantes Verhalten oder Vorlieben alleine reichen nicht für die Vergabe der Diagnose aus. Jugendlichen (10-16 Jahre) berichteten 1,6 % über eine Geschlechtsinkongruenz, 1,1 % über eine Geschlechtsambivalenz und 1,5 % über keine Identifizierung mit einem Gender (Becker, Ravens-Sieberer, Ottová-Jordan, Schulte-Markwort, 2017). Becker-Hebly et al. (2020) betonen, dass diese Daten auf einen insgesamt hohen Anteil an geschlechtsvarianter Entwicklung im Jugendalter hinweisen und fordern daher eine stärkere Berücksichtigung der Fluidität von Geschlechtsentwicklung in Forschung und Behandlung junger Menschen. ...
Article
Therapeutic Models for Children and Adolescents with Gender Dysphoria: Overview with Focus on Austrian Treatment Reality Young people whose experienced gender differs from their aligned sex are increasingly visible in public life as well as in the medical care system. For those children and adolescents, who can experience a high degree of suffering because of the discrepancy between aligned sex and desired gender, treatment guidelines have been developed. In this short narrative review, classification options, epidemiological data, health-care data and treatment guidelines are presented with an emphasis on the Austrian health care system. Prax. Kinderpsychol. Kinderpsychiat. 69/2020, 590-602
... In the general population, gender experiences may appear more fluctuating during childhood: according to a Germany study on high-school students, a relatively higher degree of younger adolescents (around the age of 11) presented gender variant experiences compared to older adolescents (around the age of 15), and compared to clearly incongruent gender experiences (Becker et al., 2017). 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. ...
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.
... Zahlreiche neuere Studien, die Jugendliche nach einer Selbsteinschätzung ihrer Geschlechtsidentität befragen, zeigen für variante Geschlechtsentwicklungen durchwegs Prävalenzraten im einstelligen Prozentbereich [11]. In einem großen repräsentativen Sample von fast 1000 Jugendlichen aus dem Raum Hamburg berichteten insgesamt 4,2 % der befragten 10-16-Jährigen über eine fallweise von ihrem Geburtsgeschlecht abweichende Geschlechtsidentität; 1,6 % gaben eine Geschlechtsinkongruenz an [12]. Eine weitere Ursache für die große Streuungsbreite der Prävalenzdaten könnte in sich ändernden gesellschaftlichen Rahmenbedingungen liegen, die in den letzten Jahren die Inanspruchnahme für betroffene Jugendliche deutlich erleichterten. ...
Article
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Zusammenfassung Kinder und Jugendliche, deren Geschlechtsempfinden von dem bei der Geburt festgelegten Zuweisungsgeschlecht abweicht und die unter ihren als nicht stimmig empfundenen Geschlechtsmerkmalen leiden, sind heute in der Öffentlichkeit, aber auch im medizinisch-therapeutischen Versorgungssystem wesentlich präsenter als noch vor einigen Jahren. Aufgrund sich daraus ergebender ethischer, rechtlicher, therapeutischer und nicht zuletzt auch medizinischer Herausforderungen wurden Behandlungsrichtlinien und Best-Practice-Modelle entwickelt. Diese kurze Übersichtsarbeit entstand anlässlich eines Vortrags im Rahmen der 3. Österreichischen Jahrestagung für Pädiatrische Psychosomatik am 04.10.2019 in Wien. Neben Begriffsdefinitionen sowie Möglichkeiten zur Klassifikation wird auf Daten zur Prävalenz eingegangen; abschließend werden verfügbare internationale sowie österreichische Behandlungsrichtlinien besprochen.
... Arcelus et al. (2015) argue that increasing numbers of treatment applicants are due to the increased awareness of the availability of information and treatment as well as to increased tolerance towards trans individuals. In Germany, higher levels of gender variance or gender nonconformity have been reported in female adolescents from a representative sample of high school students (Becker, Ravens-Sieberer, Ottova-Jordan, & Schulte-Markwort, 2017), which may be explained by greater social tolerance of gender variance in female youth. Currently, however, we cannot fully explain the high prevalence in trans male adolescents seeking professional support from gender services, or how this may have impacted our findings. ...
Article
Background: Transgender adolescents who apply for treatment often experience a marked increase in body-related distress when entering puberty, accompanied by internalizing problems and poor peer relations. Although adolescence is a time of considerable psychosocial and physical change, generally associated with a decline in health-related quality of life (HRQoL), research on HRQoL in transgender youth and possible predictors is sparse. This study thus aims to explore the predictive value of body image factors and emotional and behavioral problems for HRQoL. Methods: This cross-sectional one-group observational study was carried out at the Child and Adolescent psychiatric department (Gender Identity Service) in Hamburg, Germany. A sample of n = 126 (103 trans male and 23 trans female) adolescents, who were referred for counseling and/or treatment completed different standardized instruments before undergoing any sort of treatment. Firstly, five dimensions of HRQoL were explored in transgender adolescents and secondly, a linear regression model was applied to assess the impact of body image and emotional and behavioral problems on overall HRQoL. Results: HRQoL was generally impaired in transgender adolescents compared to norm scores, especially with regard to aspects of psychological and physical well-being. Linear regression analysis revealed that greater internalizing problems and less body satisfaction significantly predicted lower HRQoL outcomes. Conclusions: Impaired HRQoL may be explained by high degrees of internalizing problems and low body satisfaction. Thus, one important aim of mental health professionals working with youth should be to provide appropriate treatment and counseling options that may contribute to overall well-being in the long-term.
Article
Lay abstract: Gender diversity broadly refers to the way in which an individual experiences (expressions and/or identities) their gender distinctly to that which would be expected based upon social norms for their gender assigned at birth. Recent research has shown a higher representation of gender diversity among autistic youth. Previous research in this area has relied on parent-report based on a single question from the Child Behavior Checklist Item-110, asking whether their child "Wishes to be the opposite sex." The Gender Diversity Screening Questionnaire Self-Report and Parent-Report were used to assess the experience of gender diversity in 244 children (140 autism spectrum disorder and 104 typically developing) between 10 and 13 years. The Item-110 was also collected. Results showed that autistic children endorsed much higher rates of Binary Gender Diversity (less identification with their designated sex and more with the other binary sex) and Nonbinary Gender Diversity (identification as neither male nor female) than typically developing children. Similarly, parents of autistic children reported significantly more gender-body incongruence experienced by their child than parents of typically developing children. Specifically, parents of autistic females-assigned-at-birth reported significantly more gender-body incongruence than autistic males-assigned-at-birth. Parent- and self-report measures were largely related. Moreover, statistical comparisons between and within the groups revealed associations between gender profiles and symptoms of anxiety, depression, and suicidality. Results extend previous reports showing increased rates of gender diversity in autistic children, now based on both self-report and parent-report, and highlight the need to better understand and support the unique and complex needs of autistic children who experience gender diversity.
Article
Dieser Artikel setzt sich mit der Frage auseinander, wo wir als praktizierende Psychoanalytiker*innen und als Mitglieder unserer psychoanalytischen Fachgesellschaften gegenwärtig in unserem Diskurs zu (binärer und nonbinärer) Transgeschlechtlichkeit und in unserem Denken über mögliche Entwicklungslinien der Geschlechtsidentität stehen. Es wird zunächst versucht, anhand zweier Fallvignetten punktuelle Einblicke in die geschichtliche Entwicklung dieses Diskurses bis in die Gegenwart hinein zu gewähren. Daran anknüpfend werden einige wichtige psychoanalytische Konzepte zur „core gender identity“ vs. „core gender ambiguity“ (Stoller; Reiche), zur Geschlechtsidentität als Behältnis oder Hülle (Quindeau), zu rätselhaften Botschaften und dem „sexual“ (Laplanche) sowie zur Geschlechterdifferenz als polysemisches Konzept (Glocer Fiorini) skizziert, um dann beispielhaft und ausführlich eine modifizierte analytische Psychotherapie mit einer nonbinär transgeschlechtlichen Person vorzustellen.
Article
Identity development is one of the most important developmental tasks of adolescence. Adolescents whose gender identity does not correspond to the gender assigned at birth (trangender people) are also faced with this challenge, as are cis-gender adolescents of the same age. This study is the first to examine the personality function of identity in transgender adolescents. Based on the self report of a population of 69 adolescents from the outpatient unit for gender dysphoria the extent of identity diffusion measured by AIDA (Assessment of Identity Development in Adolescence) was compared with the values of the normative sample consisting of German-speaking pupils. Both the overall construct of identity diffusion and the areas of continuity and coherence showed average values in the examined young people, which speaks against pathological identity development. Nevertheless, identity diffusion was found in over a third (36 %). Most notably the aspect of stabilising relationships and roles was above average, which suggests that positive role identification from the areas of culture, family and body-self is present to a lesser extent than in the norm sample. The identity-stabilizing feeling of social anchoring appears to be impaired in the young transidents studied.
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.
Article
Background: Gender diversity in young adolescents is understudied outside of referral clinics. We investigated gender diversity in an urban, ethnically diverse sample of adolescents from the general population and examined predictors and associated mental health outcomes. Methods: The study was embedded in Generation R, a population-based cohort of children born between 2002 and 2006 in Rotterdam, the Netherlands (n = 5727). At ages 9-11 and 13-15 years, adolescents and/or their parents responded to two questions addressing children's contentedness with their assigned gender, whether they (a) 'wished to be the opposite sex' and (b) 'would rather be treated as someone from the opposite sex'. We defined 'gender-variant experience' when either the parent or child responded with 'somewhat or sometimes true' or 'very or often true'. Mental health was assessed at 13-15 years, using the Achenbach System of Empirically Based Assessment. Results: Less than 1% of the parents reported that their child had gender-variant experience, with poor stability between 9-11 and 13-15 years. In contrast, 4% of children reported gender-variant experience at 13-15 years. Adolescents who were assigned female at birth reported more gender-variant experience than those assigned male. Parents with low/medium educational levels reported more gender-variant experience in their children than those with higher education. There were positive associations between gender-variant experience and symptoms of anxiety, depression, somatic complaints, rule-breaking, and aggressive behavior as well as attention, social, and thought problems. Similar associations were observed for autistic traits, independent of other mental difficulties. These associations did not differ by assigned sex at birth. Conclusions: Within this population-based study, adolescents assigned females were more likely to have gender-variant experience than males. Our data suggest that parents may not be aware of gender diversity feelings in their adolescents. Associations between gender diversity and mental health symptoms were present in adolescents.
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Over the past 20 years, the care for transgender adolescents has developed throughout many countries following the "Dutch Approach" initiated in the 90's in pioneer countries as the Netherlands, United States and Canada, with increasing numbers of children and adolescents seeking care in transgender clinics. This medical approach has considerable positive impacts on the psychological outcomes of these adolescents and several studies have been recently published underlining the relative safety of such treatments. This paper reviews the current standards of care for transgender children and adolescents with particular emphasis on disparities among countries and short to medium-term outcomes. Finally it highlights ethical considerations regarding categorization of gender dysphoria, timing of treatment initiation, infertility, and how to deal with the long-term consequences.
Article
International discussion on social and medically supported transition for young people with gender dysphoria has been controversial largely because there is insufficient scientific evidence for adequate predictions of the long-term psychosexual, psychosocial, and physical consequences. The few existing international studies on the developmental pathways in the long-term mainly agree on the following: although the exact prospective prediction of the developmental pathways of so-called "clearly transsexual" developments with treatment indications for gender-affirming hormonal therapy or (in later years) operative interventions still poses a major challenge for clinical practitioners, the outcomes of the few long-term evaluations of treatment options are largely encouraging. The clinical implication to be drawn from this is that treatment for young people with gender dysphoria should pursue a multi-dimensional approach and that treatment decisions should currently be based on the respective adolescent's individual development. With regard to the prevention of psychosocial difficulties, it is important to acknowledge the wide range of gender identifications and to also always include the social environment. An important research target for the future is the detailed investigation of the complex interplay between gender variance, mental health, and the potential consequences of treatment in the long term. © 2018 J.C. Cotta'sche Buchhandlung Nachvolger GmbH. All rights reserved.
Article
Background/aims: To examine characteristics, including mental health comorbidities, among adolescents presenting to a transgender clinic and to compare these data to previous reports. Methods: Retrospective chart review among youth seen at The Hospital for Sick Children between January 2014 and June 2016. Demographic data, clinical characteristics, and mental health comorbidities were assessed. Baseline and repeat blood work were also examined. Results: Charts from 203 adolescents aged 12-18 years were reviewed (156 assigned female at birth [AFAB] (77%) aged 16.3 ± 1.63 years, 47 assigned male at birth [AMAB] aged 16.1 ± 1.70 years). There was no statistically significant difference between gender groups except for Tanner stage (AFAB, mean 4.42 ± 0.8 and AMAB, mean 4.03 ± 1.1, p = 0.040). Individuals from racial/ethnic minority populations were under-represented compared to the background population. Self-report and baseline psychological questionnaires showed high levels of gender dysphoria, mood disorders, and suicidal ideation, with higher levels of anxiety detected on questionnaires among AFAB (p = 0.03). Laboratory abnormalities identified on baseline and repeat testing were minor; on cross-sex hormones, hemoglobin levels increased slightly in AFAB (p = 0.002, highest = 166 g/L) and decreased among AMAB (p = 0.02, lowest = 132 g/L). Conclusion: Our study supports an evolving demographic trend with more AFAB than AMAB youth now presenting to gender clinics. The data also corroborate studies indicating that extensive laboratory testing may not be a necessary part of caring for these youths. Why more AFAB are now presenting to clinic and racial/ethnic minorities are underrepresented is not clear, but these trends have important implications for clinical care and warrant further study.
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In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
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With a national sample of 552 transgender adults, the present study tested hypotheses drawn from minority stress theory and positive psychology research on stress-ameliorating processes. Specifically, the present study examined the relations of minority stressors (i.e., antitransgender discrimination, stigma awareness, and internalized transphobia) and individual- and group-level buffers (i.e., resilience and collective action) of minority stress. As expected, each minority stressor was positively correlated with psychological distress. In terms of buffers, resilience—though not collective action—was negatively correlated with psychological distress. Additionally, stigma awareness—but not internalized transphobia—mediated the relation of antitransgender discrimination with higher psychological distress. Moderation analyses indicated that resilience did not moderate any of the relations of the minority stressors with psychological distress. However, contrary to prediction, collective action strengthened the positive relation of internalized transphobia with psychological distress. Furthermore, at high levels of collective action, internalized transphobia became a significant mediator of the discrimination-distress relation. Strategies for developing individual (e.g., resilience building strategies) and group-level (e.g., engagement in collective action) interventions targeted toward transgender individuals who experience discrimination are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
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In contemporary psychology, normal development is contingent on the establishment of a coherent, universal, stable and unitary ‘core gender identity’. The present study assessed the perception of gender identity in ‘normative’ individuals in Israel using the newly constructed Multi-Gender Identity Questionnaire (Multi-GIQ). The Multi-GIQ includes 32 items assessing gender identity (Feeling like a woman, Feeling like a man, Feeling like both a man and a woman, Feeling like neither), gender dysphoria (Contentment with affirmed gender and the wish to be the ‘other’ gender, Contentment with one’s sexed body) and gender performance (Compliance with gender norms in clothing and language). Of the Men (n = 570) and Women (n = 1585) that participated in the study, over 35% felt to some extent as the ‘other’ gender, as both men and women and/or as neither. Although such feelings were more prevalent and on average stronger in Queers (n = 70), the range of scores for all measures of gender identity was highly similar in Queers and non-Queers. A similar pattern was obtained for measures of gender dysphoria and gender performance. Sexual orientation was not a major contributor to the perception of gender identity in both Men and Women. We discuss our results in view of the current debate around the terminology and diagnostic criteria of gender dysphoria (a substitutive category for Gender Identity Disorder) in DSM-V. We conclude that the current view of gender identity as binary and unitary does not reflect the experience of many individuals, and call for a new conceptualisation of gender, which relates to multiplicity and fluidity in the experience of gender.
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The number of adolescents referred to specialized gender identity clinics for gender dysphoria appears to be increasing and there also appears to be a corresponding shift in the sex ratio, from one favoring natal males to one favoring natal females. We conducted two quantitative studies to ascertain whether there has been a recent inversion of the sex ratio of adolescents referred for gender dysphoria. The sex ratio of adolescents from two specialized gender identity clinics was examined as a function of two cohort periods (2006-2013 vs. prior years). Study 1 was conducted on patients from a clinic in Toronto, and Study 2 was conducted on patients from a clinic in Amsterdam. Across both clinics, the total sample size was 748. In both clinics, there was a significant change in the sex ratio of referred adolescents between the two cohort periods: between 2006 and 2013, the sex ratio favored natal females, but in the prior years, the sex ratio favored natal males. In Study 1 from Toronto, there was no corresponding change in the sex ratio of 6,592 adolescents referred for other clinical problems. Sociological and sociocultural explanations are offered to account for this recent inversion in the sex ratio of adolescents with gender dysphoria. Aitken M, Steensma TD, Blanchard R, VanderLaan DP, Wood H, Fuentes A, Spegg C, Wasserman L, Ames M, Fitzsimmons CL, Leef JH, Lishak V, Reim E, Takagi A, Vinik J, Wreford J, Cohen-Kettenis PT, de Vries ALC, Kreukels BPC, and Zucker KJ. Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J Sex Med **;**:**-**. © 2015 International Society for Sexual Medicine.
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Gender nonconformity refers to the extent to which a person’s gender identity, gender role and/or gender expression differs from the cultural norms prescribed for people of a particular sex, within a certain society and era. Most data on gender nonconformity focus on the prevalence of gender dysphoria (which also includes a distress factor) or on the number of legal sex changes. However, not every gender nonconforming individual experiences distress or applies for treatment. Population-based research on the broad spectrum of gender nonconformity is scarce and more information on the variance outside the gender binary is needed. This study aimed to examine the prevalence of gender incongruence (identifying stronger with the other sex than with the sex assigned at birth) and gender ambivalence (identifying equally with the other sex as with the sex assigned at birth) based on two population-based surveys, one of 1,832 Flemish persons and one of 2,472 sexual minority individuals in Flanders. In the general population, gender ambivalence was present in 2.2% of male and 1.9% of female participants, whereas gender incongruence was found in 0.7% of men and 0.6% of women. In sexual minority individuals, the prevalence of gender ambivalence and gender incongruence was 1.8% and 0.9% in men and 4.1% and 2.1% in women, respectively. With a current Flemish population of about 6 million, our results indicate a total of between 17,150 and 17,665 gender incongruent men and between 14,473 and 15,221 gender incongruent women in Flanders.
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To report the prevalence of students according to four gender groups (i.e., those who reported being non-transgender, transgender, or not sure about their gender, and those who did not understand the transgender question), and to describe their health and well-being. Logistic regressions were used to examine the associations between gender groups and selected outcomes in a nationally representative high school health and well-being survey, undertaken in 2012. Of the students (n = 8,166), 94.7% reported being non-transgender, 1.2% reported being transgender, 2.5% reported being not sure about their gender, and 1.7% did not understand the question. Students who reported being transgender or not sure about their gender or did not understand the question had compromised health and well-being relative to their non-transgender peers; in particular, for transgender students perceiving that a parent cared about them (odds ratio [OR], .3; 95% confidence interval [CI], .2-.4), depressive symptoms (OR, 5.7; 95% CI, 3.6-9.2), suicide attempts (OR, 5.0; 95% CI, 2.9-8.8), and school bullying (OR, 4.5; 95% CI, 2.4-8.2). This is the first nationally representative survey to report the health and well-being of students who report being transgender. We found that transgender students and those reporting not being sure are a numerically small but important group. Transgender students are diverse and are represented across demographic variables, including their sexual attractions. Transgender youth face considerable health and well-being disparities. It is important to address the challenging environments these students face and to increase access to responsive services for transgender youth.
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Family support is protective against health risks in sexual minority individuals. However, few studies have focused specifically on transgender youth, who often experience rejection, marginalization, and victimization that place them at risk for poor mental health. This study investigated the relationships among parental support, quality of life, and depression in transgender adolescents. A total of 66 transgender youth presenting for care at Children's Hospital Los Angeles completed a survey assessing parental support (defined as help, advice, and confidante support), quality of life, and depression. Regression analyses assessed the associations between parental support and mental health outcomes. Parental support was significantly associated with higher life satisfaction, lower perceived burden of being transgender, and fewer depressive symptoms. Parental support is associated with higher quality of life and is protective against depression in transgender adolescents. Interventions that promote parental support may significantly affect the mental health of transgender youth.
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The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts of the world are necessary. The SOC articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, this version of the SOC recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized. Some individuals who present for care will have made significant self-directed progress towards gender role changes or other resolutions regarding their gender identity or gender dysphoria. Other individuals will require more intensive services. Health professionals can use the SOC to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression.
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Purpose: To estimate the size and demographic characteristics of the lesbian, gay, bisexual, and transgender youth populations using data from the 2011 Youth Risk Behavior Survey (YRBS) administered in San Francisco Unified School District middle schools. Methods: The YRBS was administered to a stratified random sample of 2,730 youth (grades 6-8) across all 22 public middle schools in San Francisco. Cross-tabulations using complex samples analyses were used to derive population estimates and confidence intervals. Results and conclusions: Results show that 3.8% of middle school students identify as lesbian, gay, or bisexual, and 1.3% of middle school students identify as transgender. To improve our understanding of the size of these populations across the nation, researchers conclude it is imperative that all YRBS administration sites include items on sexual orientation and gender identity as they would any other demographic item, such as race/ethnicity, sex, or age. The current lack of reliable data on the size and characteristics of the lesbian, gay, bisexual, and transgender youth population limits the capacity of policy makers, administrators, and practitioners to address their needs.
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Transgender subjectivities are paradoxical in that they both undermine the gender binary and ratify it. The contradictions inherent in trans require that we consider trans as more of a process than a thing in itself, a gerund, rather than a noun or adjective, a continuous work in progress, rather than a static fact of the self. But despite cultural upheavals and increasing tolerance, we still want our gender straight up. While we approve and often applaud efforts at excellence in masculinity and femininity (including surgery) that are sex and gender concordant, we are still deeply disturbed by any efforts toward confounding that gender, or crossing over to the “other” one.
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The aim of the HBSC-Study is to collect data on the physical and mental health and health behaviour of children and adolescents and to gain a deeper insight into their situation and the specific environment they grow up in. The HBSC-study is an international school-based cross-sectional survey conducted in collaboration with the World Health Organization (WHO). The survey takes place every 4 years since 1982 and is based on a standardised protocol. In Germany the survey was first conducted in 1994 as a pilot study in North Rhine-Westphalia. The German sample is based on a random sample of classes in all public schools in Germany. 11-, 13-, and 15-year-old pupils are surveyed by means of a paper and pencil questionnaire. The questionnaire comprises a broad selection of -topics, including sociodemographics, health and risk behaviours, family, school and peers. The reported trends in the supplement are based on the data from surveys in 2002 (N=5.650), 2006 (N=7.274) and 2010 (N=5.005). The representative samples for each of the survey years are defined as follows: in 2002 the data is based on information collected in 4 Federal States (Berlin, Hesse, North Rhine-Westphalia, Saxony); in 2006 5 states define the German data file (Berlin, Hamburg, Hesse, North Rhine-Westphalia, Saxony). The data from the 2010 survey comprises data from 15 Federal States. The HBSC-data contributes towards a better understanding of the relationship between health and living conditions of young people. The papers in this supplement deliver important insights into the living context of young people and in doing this they provide important information about their health and the long-term effectiveness of public-health-measures. © Georg Thieme Verlag KG Stuttgart · New York.
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Dichotomous models of gender have been criticized for failing to represent the experiences of individuals who claim neither an unambiguously female nor male identity. In this paper we argue that the feminist theoretical framework of intersectionality provides a generative approach for interpreting these experiences of gender multiplicity. We review our previous research on four young sexual-minority (i.e., nonheterosexual) women who are participants in a 10-year longitudinal study of sexual identity development, applying the framework of intersectionality to understand their exploration of transgendered experience and identification. Our analysis highlights the value of intersectionality as a framework for understanding not only multiplicity across identity constructs (e.g.., race, gender, etc.) but also within identity constructs (i.e., female and male).
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Apart from some general issues related to the Gender Identity Disorder (GID) diagnosis, such as whether it should stay in the DSM-V or not, a number of problems specifically relate to the current criteria of the GID diagnosis for adolescents and adults. These problems concern the confusion caused by similarities and differences of the terms transsexualism and GID, the inability of the current criteria to capture the whole spectrum of gender variance phenomena, the potential risk of unnecessary physically invasive examinations to rule out intersex conditions (disorders of sex development), the necessity of the D criterion (distress and impairment), and the fact that the diagnosis still applies to those who already had hormonal and surgical treatment. If the diagnosis should not be deleted from the DSM, most of the criticism could be addressed in the DSM-V if the diagnosis would be renamed, the criteria would be adjusted in wording, and made more stringent. However, this would imply that the diagnosis would still be dichotomous and similar to earlier DSM versions. Another option is to follow a more dimensional approach, allowing for different degrees of gender dysphoria depending on the number of indicators. Considering the strong resistance against sexuality related specifiers, and the relative difficulty assessing sexual orientation in individuals pursuing hormonal and surgical interventions to change physical sex characteristics, it should be investigated whether other potentially relevant specifiers (e.g., onset age) are more appropriate.
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To describe the methodological development of the HBSC survey since its inception and explore methodological tensions that need to be addressed in the ongoing work on this and other large-scale cross-national surveys. Using archival data and conversations with members of the network, we collaboratively analysed our joint understandings of the survey's methodology. We identified four tensions that are likely to be present in upcoming survey cycles: (1) maintaining quality standards against a background of rapid growth, (2) continuous improvement with limited financial resources, (3) accommodating analysis of trends with the need to improve and adapt questionnaire content, and (4) meeting the differing requirements of scientific and policy audiences. While these challenges are not trivial, the structure of the HBSC network and its long-term experience in working through such challenges renders it likely that HBSC can provide a model of other similar studies facing these tensions.
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This study describes stress as derived from minority status and explores its effect on psychological distress in gay men. The concept of minority stress is based on the premise that gay people in a heterosexist society are subjected to chronic stress related to their stigmatization. Minority stressors were conceptualized as: internalized homophobia, which relates to gay men's direction of societal negative attitudes toward the self; stigma, which relates to expectations of rejection and discrimination; and actual experiences of discrimination and violence. The mental health effects of the three minority stressors were tested in a community sample of 741 New York City gay men. The results supported minority stress hypotheses: each of the stressors had a significant independent association with a variety of mental health measures. Odds ratios suggested that men who had high levels of minority stress were twice to three times as likely to suffer also from high levels of distress.
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In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
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The aim of this study was to investigate the prevalence of cross-gender behavior during childhood, to estimate the influence of genotype and environment on variation in cross-gender behavior, and to explore the association of cross-gender behavior with maternal ratings of behavior problems as indexed by the Internalizing and Externalizing scales of the Child Behavior Checklist (CBCL). Cross-gender behavior was assessed by two items from the CBCL: "behaves like opposite sex" and "wishes to be of opposite sex." As part of an ongoing longitudinal study of the Netherlands Twin Registry, mothers were asked to complete the CBCL for their twins when they were 7 (n approximately 14,000 twins) and 10 years old (n approximately 8,500 twins). The prevalence of cross-gender behavior (as measured by maternal report of behaving like or wishing to be the opposite sex) was 3.2% and 5.2% for 7-year-old boys and girls, respectively, and decreased to 2.4% and 3.3% for 10-year-old boys and girls. Surprisingly, the prevalence rate of cross-gender behavior of girls with a male co-twin was lower than of girls with a female co-twin. At both ages, the similarity for cross-gender behavior was greater in monozygotic than in dizygotic twins pairs. Genetic structural equation modeling showed that 70% of the variance in the liability of cross-gender behavior could be explained by genetic factors, at both ages and for both sexes. Cross-gender behavior was associated with higher scores on Internalizing and Externalizing problems, both in boys and in girls.
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As a research team focused on vulnerable youth, we increasingly need to find ways to acknowledge non-binary genders in health research. Youth have become more vocal about expanding notions of gender beyond traditional categories of boy/man and girl/woman. Integrating non-binary identities into established research processes is a complex undertaking in a culture that often assumes gender is a binary variable. In this article, we present the challenges at every stage of the research process and questions we have asked ourselves to consider non-binary genders in our work. As researchers, how do we interrogate the assumptions that have made non-binary lives invisible? What challenges arise when attempting to transform research practices to incorporate non-binary genders? Why is it crucial that researchers consider these questions at each step of the research process? We draw on our own research experiences to highlight points of tensions and possibilities for change. Improving access to inclusive health-care for non-binary people, and non-binary youth in particular, is part of creating a more equitable healthcare system. We argue that increased and improved access to inclusive health-care can be supported by research that acknowledges and includes people of all genders.
Article
This review provides an update on the growing body of research related to the mental health of transgender youth that has emerged since the 2011 publication of the Institute of Medicine report on the health of lesbian, gay, bisexual, and transgender people. The databases PubMed and Ovid Medline were searched for studies that were published from January 2011 to March 2016 in English. The following search terms were used: transgender, gender nonconforming, gender minority, gender queer, and gender dysphoria. Age limits included the terms youth, child, children, teenager*, and adolescen*. The combined search produced 654 articles of potential relevance. The resulting abstracts went through a tiered elimination system, and the remaining 15 articles, which presented quantitative data related to the prevalence of transgender youth and their mental health, were included in the present review. In addition to providing new estimates of the number of young people who identify as transgender (.17%-1.3%), studies since 2011 have shown that transgender youth have higher rates of depression, suicidality and self-harm, and eating disorders when compared with their peers. Gender-affirming medical therapy and supported social transition in childhood have been shown to correlate with improved psychological functioning for gender-variant children and adolescents. Recent research has demonstrated increased rates of psychiatric morbidity among transgender youth compared to their peers. Future work is needed to understand those youth who identify as gender nonbinary, improve methods to capture and understand diverse gender identities and related health disparities, and delineate the social determinants of such disparities.
Article
This research examined endorsement and timing of sexual orientation developmental milestones. Participants were 1,235 females and 398 males from the Growing Up Today Study, ages 22 to 29 years, who endorsed a sexual minority orientation (lesbian/gay, bisexual, mostly heterosexual) or reported same-gender sexual behavior (heterosexual with same-gender sexual experience). An online survey measured current sexual orientation and endorsement and timing (age first experienced) of five sexual orientation developmental milestones: same-gender attractions, other-gender attractions, same-gender sexual experience, other-gender sexual experience, and sexual minority identification. Descriptive analyses and analyses to test for gender and sexual orientation group differences were conducted. Results indicated that women were more likely than men to endorse same-gender attraction, other-gender attraction, and other-gender sexual experience, with the most gender differences in endorsement among mostly heterosexuals and heterosexuals with same-gender sexual experience. In general, men reached milestones earlier than women, with the most gender differences in timing among lesbian and gay individuals and heterosexuals with same-gender sexual experience. Results suggest that the three sexual minority developmental milestones may best characterize the experiences of lesbians, gay males, and female and male bisexuals. More research is needed to understand sexual orientation development among mostly heterosexuals and heterosexuals with same-gender sexual experience.
Article
As part of the development of the eleventh revision of the International Classification of Diseases (ICD-11), WHO appointed a Working Group on Sexual Disorders and Sexual Health to recommend changes necessary in the classification of mental and behavioural disorders in ICD-10 that are related to sexuality and gender identity. This Personal View focuses on the Working Group’s proposals to include the diagnosis gender incongruence of childhood in ICD-11 and to move gender incongruence of childhood out of the mental and behavioural disorders chapter of ICD-11. We outline the history of ICD and DSM child gender diagnoses, expert consensus, knowledge gaps, and controversies related to the diagnosis and treatment of extremely gender-variant children. We argue that retaining the gender incongruence of childhood category is justified as a basis to structure clinical care and to ensure access to appropriate services for this vulnerable population, which provides opportunities for education and informed consent, the development of standards and pathways of care to help guide clinicians and family members, and a basis for future research efforts.
Article
Objective: Transgender children who have socially transitioned, that is, who identify as the gender "opposite" their natal sex and are supported to live openly as that gender, are increasingly visible in society, yet we know nothing about their mental health. Previous work with children with gender identity disorder (GID; now termed gender dysphoria) has found remarkably high rates of anxiety and depression in these children. Here we examine, for the first time, mental health in a sample of socially transitioned transgender children. Methods: A community-based national sample of transgender, prepubescent children (n = 73, aged 3-12 years), along with control groups of nontransgender children in the same age range (n = 73 age- and gender-matched community controls; n = 49 sibling of transgender participants), were recruited as part of the TransYouth Project. Parents completed anxiety and depression measures. Results: Transgender children showed no elevations in depression and slightly elevated anxiety relative to population averages. They did not differ from the control groups on depression symptoms and had only marginally higher anxiety symptoms. Conclusions: Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group. Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex.
Article
Background: Previous research has reported high levels of non-suicidal self-injury (NSSI) in trans populations and younger age has been identified as a risk factor. Aims: To explore the prevalence of NSSI in a large group of young trans people, and to identify risk factors for this group. Main Outcome Measures: Socio-demographic variables and measures of NSSI (The Self-Injury Questionnaire), Psychopathology (Symptom Checklist 90 Revised), Self-esteem (Rosenberg Self Esteem Scale), victimization (Experiences of transphobic victimization), Interpersonal functioning (Inventory of Interpersonal Problems) and social support (Multidimensional Scale of Perceived Social Support). Methods: Two hundred and sixty eight young people attending a national gender clinic completed questionnaires assessing presence and frequency of NSSI and levels of general psychopathology, depression, anxiety, interpersonal problems, self-esteem, social support, transphobia, and information on hormone treatment. Results: A life-time presence of NSSI was identified in 46.3% of patients and 28.73% reported currently engaging in NSSI (within at least the last few months). Analyses showed that those with a life-time presence of NSSI had significantly greater general psychopathology, lower self-esteem, had suffered more transphobia, and experienced greater interpersonal problems than those without NSSI. Findings were similar when comparing current versus non-current NSSI. Overall, natal males reported less social support than natal females, but current NSSI was more common in natal females. Regression analyses confirmed that natal female gender and greater general psychopathology predicted both current and life-time NSSI. Further analyses confirmed that general psychopathology itself could be predicted by transphobic experiences, low self-esteem, and interpersonal problems, but not by the use of cross sex hormones. Conclusions: These findings confirm that NSSI is common in trans youth and emphasise the need for interventions, which decrease transphobia, increase social support and help trans youth navigate their relationships with others in order to reduce psychopathology and NSSI.
Article
Gender dysphoria (GD) in childhood is a complex phenomenon characterized by clinically significant distress due to the incongruence between assigned gender at birth and experienced gender. The clinical presentation of children who present with gender identity issues can be highly variable; the psychosexual development and future psychosexual outcome can be unclear, and consensus about the best clinical practice is currently under debate. In this paper a clinical picture is provided of children who are referred to gender identity clinics. The clinical criteria are described including what is known about the prevalence of childhood GD. In addition, an overview is presented of the literature on the psychological functioning of children with GD, the current knowledge on the psychosexual development and factors associated with the persistence of GD, and explanatory models for psychopathology in children with GD together with other co-existing problems that are characteristic for children referred for their gender. In light of this, currently used treatment and counselling approaches are summarized and discussed, including the integration of the literature detailed above.
Book
Transgenderism and Intersexuality in Childhood and Adolescence: Making Choices presents an overview of the research, clinical insights, and ethical dilemmas relevant to clinicians who treat intersex youth and their families. Exploring gender development from a cross-cultural perspective, esteemed scholar Peggy T. Cohen-Kettenis and experienced practitioner Friedemann Pfäfflin focus on assessment, diagnosis, and treatment issues. To bridge research and practical application, they include numerous case studies, definitions of relevant terminology, and salient chapter summaries.
Article
Some people have a gender which is neither male nor female and may identify as both male and female at one time, as different genders at different times, as no gender at all, or dispute the very idea of only two genders. The umbrella terms for such genders are 'genderqueer' or 'non-binary' genders. Such gender identities outside of the binary of female and male are increasingly being recognized in legal, medical and psychological systems and diagnostic classifications in line with the emerging presence and advocacy of these groups of people. Population-based studies show a small percentage - but a sizable proportion in terms of raw numbers - of people who identify as non-binary. While such genders have been extant historically and globally, they remain marginalized, and as such - while not being disorders or pathological in themselves - people with such genders remain at risk of victimization and of minority or marginalization stress as a result of discrimination. This paper therefore reviews the limited literature on this field and considers ways in which (mental) health professionals may assist the people with genderqueer and non-binary gender identities and/or expressions they may see in their practice. Treatment options and associated risks are discussed.
Article
Research in various populations has shown that, starting early in childhood, individuals often demonstrate resilience in the face of stress and adversity. Against the experience of minority stress, LGBT people mount coping responses and most survive and even thrive despite stress. But research on resilience in LGBT populations has lagged. In this commentary, I address 2 broad issues that I have found wanting of special exploration in LGBT research on resilience: First, I note that resilience, like coping, is inherently related to minority stress in that it is an element of the stress model. Understanding resilience as a partner in the stress to illness causal chain is essential for LGBT health research. Second, I explore individual- versus community-based resilience in the context of minority stress. Although individual and community resilience should be seen as part of a continuum of resilience, it is important to recognize the significance of community resilience in the context of minority stress.
Article
Background: Over the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, this study aimed to critically and systematically review the available literature measuring the prevalence of transsexualism as well as performing a meta-analysis using the available data. Methods: Databases were systematically searched and 1473 possible studies were identified. After initial scrutiny of the article titles and removal of those not relevant, 250 studies were selected for further appraisal. Of these, 211 were excluded after reading the abstracts and a further 18 after reading the full article. This resulted in 21 studies on which to perform a systematic review, with only 12 having sufficient data for meta-analysis. The primary data of the epidemiological studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies. Risk ratios and 95% confidence intervals (CIs) were calculated. The relative weighted contribution of each study was also assessed. Results: The overall meta-analytical prevalence for transsexualism was 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men. Time analysis found an increase in reported prevalence over the last 50 years. Conclusions: The overall prevalence of transsexualism reported in the literature is increasing. However, it is still very low and is mainly based on individuals attending clinical services and so does not provide an overall picture of prevalence in the general population. However, this study should be considered as a starting point and the field would benefit from more rigorous epidemiological studies acknowledging current changes in the classification system and including different locations worldwide.
Article
Background: In recent years, puberty suppression by means of gonadotropin-releasing hormone analogs has become accepted in clinical management of adolescents who have gender dysphoria (GD). The current study is the first longer-term longitudinal evaluation of the effectiveness of this approach. Methods: A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years). Psychological functioning (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness) well-being were investigated. Results: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being. Conclusions: A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.
Article
This article is part of a Special Issue "Puberty and Adolescence".This article aims to provide an outline of what is currently known on trajectories, and contributing factors to gender identity development in adolescence. We give a historical overview of the concept of gender identity, and describe general identity development in adolescence, gender identity development in the general population and in gender variant youth. Possible psychosocial (such as child and parental characteristics) and biological factors (such as the effects of prenatal exposure to gonadal hormones and the role of genetics) contributing to a gender variant identity are discussed. Studies focusing on a number of psychosocial and biological factors separately, indicate that each of these factors influence gender identity formation, but little is known about the complex interplay between the factors, nor about the way individuals themselves contribute to the process. Research into normative and gender variant identity development of adolescents is clearly lagging behind. However, studies on persons with gender dysphoria and disorders of sex development, show that the period of adolescence, with its changing social environment and the onset of physical puberty, seems to be crucial for the development of a non-normative gender identity.
Article
Several studies estimate the prevalence of gender dysphoria among adults by examining the number of individuals turning to health services. Since individuals might be hesitant to seek medical care related to gender dysphoria, these studies could underestimate the prevalence. The studies also lack information regarding the variance among different aspects of gender dysphoric conditions. Therefore, the current study estimated the prevalence by examining self-reported gender identity and dysphoria in a Dutch population sample (N = 8,064, aged 15-70 years old). Three measures assessed aspects of gender dysphoria: gender identity, dislike of the natal female/male body, and wish to obtain hormones/sex reassignment surgery. Results showed that 4.6 % of the natal men and 3.2 % of the natal women reported an ambivalent gender identity (equal identification with other sex as with sex assigned at birth) and 1.1 % of the natal men and 0.8 % of the natal women reported an incongruent gender identity (stronger identification with other sex as with sex assigned at birth). Lower percentages reported a dislike of their natal body and/or a wish for hormones/surgery. Combining these figures estimated the percentage of men reporting an ambivalent or incongruent gender identity combined with a dislike of their male body and a wish to obtain hormones/surgery at 0.6 %. For women, this was 0.2 %. These novel findings show that studies based on the number of individuals seeking medical care might underestimate the prevalence of gender dysphoria. Furthermore, the findings argue against a dichotomous approach to gender dysphoria.
Article
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.
Article
Dutch sexual minority youth and young adults (106 females and 86 males, 16-24 years old) were assessed to establish whether there was a relation between gender nonconformity and psychological well-being and whether this relation was mediated by perceived experiences of stigmatization due to perceived or actual sexual orientation and moderated by biological sex. The participants were recruited via announcements on Dutch LGBTQ-oriented community websites and then linked to a protected online questionnaire. The questionnaire was used to measure gender nonconformity, perceived experiences of stigmatization, and psychological well-being. Gender nonconformity was found to predict lower levels of psychological well-being and the mediation analysis confirmed that lower levels of psychological well-being were related to the perceived experiences of stigmatization. This mediation was not moderated by biological sex. These findings show that both research and interventions should pay more attention to gender nonconformity among young people in order to create a more positive climate for young sexual minority members.
Article
The study was designed (a) to provide prevalence data on behavioral problems and competencies, (b) to identify differences related to demographic variables, and (c) to compare clinically referred and demographically similar nonreferred children. Data were obtained with the Child Behavior Checklist (CBCL), consisting of 20 social competence items and 118 behavior problems. Parents of 1,300 referred children completed the CBCL at intake into outpatient mental health services, while parents of 1,300 randomly selected nonreferred children completed the CBCL in a home interview survey. Intraclass correlations were in the .90s for interparent agreement, 1-week test-retest reliability, and inter-interviewer reliability. Indices of the reported prevalence of each item are graphically portrayed for children grouped by age, gender, and clinical status. Multiple regressions and ANCOVAs showed minimal racial differences but significant tendencies for lower SES children to have higher behavior problem and lower competence scores than upper SES children. There were numerous gender differences on specific items but no significant gender difference in total behavior problem or competence score. Age showed more and larger differences than the other demographic variables, but these differences were dwarfed by differences related to referral status. Across all demographic groups, referal status accounted for more variance in total behavior problem and social competence scores than in the scores for any single item. However, some behavior problems that have traditionally received little attention were much more strongly associated with referral status than problems that have received much attention. Cutoff points on the distributions of total behavior problem and social competence scores yield good separation between referred and nonreferred samples.
Article
The term "gender role" appeared in print first in 1955. The term "gender identity" was used in a press release, November 21, 1966, to announce the new clinic for transsexuals at The Johns Hopkins Hospital. It was disseminated in the media worldwide, and soon entered the vernacular. The definitions of gender and gender identity vary on a doctrinal basis. In popularized and scientifically debased usage, sex is what you are biologically; gender is what you become socially; gender identity is your own sense or conviction of maleness or femaleness; and gender role is the cultural stereotype of what is masculine and feminine. Causality with respect to gender identity disorder is subdivisible into genetic, prenatal hormonal, postnatal social, and postpubertal hormonal determinants, but there is, as yet, no comprehensive and detailed theory of causality. Gender coding in the brain is bipolar. In gender identity disorder, there is discordancy between the natal sex of one's external genitalia and the brain coding of one's gender as masculine or feminine.
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