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Boogers LS, Wiepjes CM, Staphorsius AS, Klink DT, Ciancia S, Romani A, Stolk THR, van den Boogaard E, Steensma TD, de Vries ALC, van Trotsenburg ASP, den Heijer M, Fisher AD, Cools M, Hannema SE. A European Network for the Investigation of Gender Incongruence in adolescents. J Sex Med 2024; 21:350-356. [PMID: 38427555 DOI: 10.1093/jsxmed/qdae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Knowledge regarding the effects and side effects of gender-affirming hormone therapy (GAHT) in adults is rapidly growing, partly through international research networks such as the European Network for the Investigation of Gender Incongruence (ENIGI). However, data on the effects of puberty suppression (PS) and GAHT in transgender and gender diverse (TGD) youth are limited, although these data are of crucial importance, given the controversies surrounding this treatment. AIM We sought to present a detailed overview of the design of the ENIGI Adolescents study protocol, including the first baseline data. METHODS The ENIGI Adolescents study is an ongoing multicenter prospective cohort study. This study protocol was developed by 3 European centers that provide endocrine care for TGD adolescents and were already part of the ENIGI collaboration: Amsterdam, Ghent, and Florence. OUTCOMES Study outcomes include physical effects and side effects, laboratory parameters, bone mineral density, anthropometric characteristics, attitudes toward fertility and fertility preservation, and psychological well-being, which are measured in the study participants during PS and GAHT, up to 3 years after the start of GAHT. RESULTS Between November 2021 and May 2023, 172 TGD adolescents were included in the ENIGI Adolescents protocol, of whom 51 were assigned male at birth (AMAB) and 121 were assigned female at birth (AFAB); 3 AFAB participants reported a nonbinary gender identification. A total of 76 participants were included at the start of PS, at a median (IQR) age of 13.7 (12.9-16.5) years in AMAB and 13.5 (12.4-16.1) years in AFAB individuals. The remaining 96 participants were included at start of GAHT, at a median (IQR) age of 15.9 (15.1-17.4) years in AFAB and 16.0 (15.1-16.8) years in AMAB individuals. At the time of this report the study was open for inclusion and follow-up measurements were ongoing. CLINICAL IMPLICATIONS In response to the rising demand for gender-affirming treatment among TGD youth, this ongoing study is fulfilling the need for prospective data on the effects and safety of PS and GAHT, thus providing a foundation for evidence-based healthcare decisions. STRENGTHS AND LIMITATIONS This study has a strong multicenter, prospective design that allows for systematic data collection. The use of clinical and self-reported data offers a broad range of outcomes to evaluate. Nevertheless, the burden of additional measurements and questionnaires may lead to withdrawal or lower response rates. Few participants with a non-binary gender identity have been included. CONCLUSION With the ENIGI Adolescents study we aim to create a comprehensive dataset that we can use for a wide range of studies to address current controversies and uncertainties and to improve healthcare for TGD adolescents.
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Affiliation(s)
- Lidewij S Boogers
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1081 HZ, Amsterdam, The Netherlands
| | - Chantal M Wiepjes
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1081 HZ, Amsterdam, The Netherlands
| | - Annemieke S Staphorsius
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Daniel T Klink
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, 9000, Ghent, Belgium
| | - Silvia Ciancia
- Department of Internal Medicine and Pediatrics, Ghent University, 9000, Ghent, Belgium
| | - Alessia Romani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
| | - Tessa H R Stolk
- Department of Obstetrics & Gynaecology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Emmy van den Boogaard
- Department of Obstetrics & Gynaecology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Thomas D Steensma
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HZ, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1081 HZ, Amsterdam, The Netherlands
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
| | - Martine Cools
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, 9000, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, 9000, Ghent, Belgium
| | - Sabine E Hannema
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, 1081 HZ, Amsterdam, The Netherlands
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Bowman SJ, Hakeem A, Demant D, McAloon J, Wootton BM. Assessing Gender Dysphoria: Development and Validation of the Gender Preoccupation and Stability Questionnaire - 2 nd Edition (GPSQ-2). J Homosex 2024; 71:666-690. [PMID: 36286814 DOI: 10.1080/00918369.2022.2132440] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Gender Preoccupation and Stability Questionnaire (GPSQ) is a 14-item measure used to assess the effectiveness of medical, surgical, social, and psychological interventions in trans and gender diverse adults who experience gender dysphoria. One major limitation of the GPSQ is that it was not developed for use with adolescents. This study aims to validate a revised version of the GPSQ, the Gender Preoccupation and Stability Questionnaire-2nd Edition (GPSQ-2) with the aim of adapting the measure to be applicable to individuals aged 13 and above. This research was conducted in three stages: 1) development of the GPSQ-2 to address previously identified issues with validity and comprehensibility of the GPSQ and to increase the applicability of the measure to adolescents; 2) pilot testing, using a purposive sample and semi-structured interviews, to assess the relevance, comprehensibility, and comprehensiveness of the GPSQ-2; and 3) validation using a community sample to assess the psychometric properties of the GPSQ-2. The pilot study was conducted with seven participants (Mage = 28.43, SD = 15.50; age range: 13-59). The GPSQ-2 was found to be easy to understand, relevant to individuals who experienced gender dysphoria, and that it did not have any identifiable omissions. The validation study was conducted with 141 participants (Mage = 36.44; SD = 14.76; age range 14-73). The GPSQ-2 was found to be a reliable and valid 14-item scale with two factors: preoccupation and stability. The GPSQ-2 is a structurally sound measure of gender dysphoria that can be used in populations aged 13 and above.
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Affiliation(s)
- Sarah Joy Bowman
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Az Hakeem
- The Priory Hospital Roehampton, London, UK
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology, Sydney, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - John McAloon
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
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3
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Dierckxsens G, Baron TR. Phenomenological Interview and Gender Dysphoria: A Third Pathway for Diagnosis and Treatment. J Med Philos 2024; 49:28-42. [PMID: 37758478 DOI: 10.1093/jmp/jhad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Gender dysphoria (GD) is marked by an incongruence between a person's biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called "wait-and-see" approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of a "third pathway" for the diagnosis and treatment of GD in youths. To make our case, we draw on a recent development in bioethics: the phenomenological approach. Scholars such as Slatman and Svenaeus have argued that the extent to which the body can (or should be) manipulated or reconstructed through medical intervention is not only determined by consideration of ethical frameworks and social and legal norms. Rather, we must also take account of patients' personal experience of their body, the personal and social values associated with it, and their understanding of its situation in their life: their narrative identities. We apply this phenomenological approach to medicine and nursing to the diagnosis and treatment of GD in youth. In particular, we discuss Zahavi and Martiny's conception of the phenomenological interview, in order to show that narrative techniques can assist in the process of gender identification and in the treatment of youth presenting with GD. We focus on two case studies that highlight the relevance of a narrative-based interview in relations between patients, HCPs, and family, to expose the influence of social ideologies on how young people presenting with GD experience their bodies and gender.
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Affiliation(s)
- Geoffrey Dierckxsens
- Interdisciplinary Research Lab for Bioethics (IRLaB), Institute of Philosophy, Czech Academy of Sciences, Prague, Czech Republic
| | - Teresa R Baron
- Department of Philosophy, University of Nothingham, United Kingdom
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Ghiasi Z, Khazaei F, Khosravi M, Rezaee N. Physical and psychosocial challenges of people with gender dysphoria: a content analysis study. BMC Public Health 2024; 24:16. [PMID: 38166956 PMCID: PMC10759397 DOI: 10.1186/s12889-023-17537-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The mismatch between the gender experienced by a person and the gender attributed to him/her leads to gender dysphoria. It seems that people's perception of gender dysphoria is affected by individual, cultural, and sociological factors and these factors affect different aspects of their biological, psychological, and social health. To this end, this qualitative study aimed to identify the physical, psychological, and social challenges of people with gender dysphoria referring to the Department of forensic medicine in Iran. METHODS This qualitative study was conducted using conventional content analysis on 9 individuals who were selected through purposive sampling. A total of 16 interviews were conducted with 9 participants. Each interview lasted 60-90 min. The participants' gender dysphoria was confirmed by the Department of forensic medicine. The data were collected through face-to-face semi-structured interviews with the participants. RESULTS The data revealed 3 main categories and 10 subcategories. The main categories were living in agony, confusion, and social concerns. The subcategories were annoying physical characteristics, mental suffering, disturbing sexual changes, concerns about public reaction, helplessness, surrender, the final solution, retreating to isolation, stressful family conditions, and lack of public recognition. CONCLUSION The findings showed that people with gender dysphoria suffer from some problems including living in agony, confusion, and social concerns. Each of these problems is associated with several challenges. It seems that most of the challenges faced by people with gender dysphoria are caused by unawareness of their conditions by the family and the public, which in turn is caused by the failure of related organizations and experts in this field to provide adequate information about the conditions of these people. Thus, the findings of the present study can have some implications for resolving the challenges faced by people with gender dysphoria.
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Affiliation(s)
- Zahra Ghiasi
- School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Mohsen Khosravi
- Department of Psychiatry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Nasrin Rezaee
- Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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5
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Littman L, O'Malley S, Kerschner H, Bailey JM. Detransition and Desistance Among Previously Trans-Identified Young Adults. Arch Sex Behav 2024; 53:57-76. [PMID: 38038854 PMCID: PMC10794437 DOI: 10.1007/s10508-023-02716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023]
Abstract
Persons who have renounced a prior transgender identification, often after some degree of social and medical transition, are increasingly visible. We recruited 78 US individuals ages 18-33 years who previously identified as transgender and had stopped identifying as transgender at least six months prior. On average, participants first identified as transgender at 17.1 years of age and had done so for 5.4 years at the time of their participation. Most (83%) participants had taken several steps toward social transition and 68% had taken at least one medical step. By retrospective reports, fewer than 17% of participants met DSM-5 diagnostic criteria for Gender Dysphoria in Childhood. In contrast, 53% of participants believed that "rapid-onset gender dysphoria" applied to them. Participants reported a high rate of psychiatric diagnoses, with many of these prior to trans-identification. Most participants (N = 71, 91%) were natal females. Females (43%) were more likely than males (0%) to be exclusively homosexual. Participants reported that their psychological health had improved dramatically since detransition/desistance, with marked decreases in self-harm and gender dysphoria and marked increases in flourishing. The most common reason given for initial trans-identification was confusing mental health issues or reactions to trauma for gender dysphoria. Reasons for detransition were more likely to reflect internal changes (e.g., the participants' own thought processes) than external pressures (e.g., pressure from family). Results suggest that, for some transgender individuals, detransition is both possible and beneficial.
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Affiliation(s)
- Lisa Littman
- The Institute for Comprehensive Gender Dysphoria Research, 11 S. Angell Street, #331, Providence, RI, 02906, USA.
| | - Stella O'Malley
- The Institute for Comprehensive Gender Dysphoria Research, 11 S. Angell Street, #331, Providence, RI, 02906, USA
| | | | - J Michael Bailey
- Department of Psychology, Northwestern University, Evanston, IL, USA
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Turban JL, Dolotina B, Freitag TM, King D, Keuroghlian AS. Rapid-Onset Gender Dysphoria Is Not a Recognized Mental Health Diagnosis. J Adolesc Health 2023; 73:1163-1164. [PMID: 37980076 DOI: 10.1016/j.jadohealth.2023.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Jack L Turban
- Division of Child & Adolescent Psychiatry, University of California, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California; Gender Psychiatry Program, University of California, San Francisco, California
| | - Brett Dolotina
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | | | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Alex S Keuroghlian
- Harvard Medical School, Boston, Massachusetts; The Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Kahn NF, Sequeira GM, Reyes V, Garrison MM, Orlich F, Christakis DA, Aye T, Conard LAE, Dowshen N, Kazak AE, Nahata L, Nokoff NJ, Voss RV, Richardson LP. Mental Health of Youth With Autism Spectrum Disorder and Gender Dysphoria. Pediatrics 2023; 152:e2023063289. [PMID: 37909059 DOI: 10.1542/peds.2023-063289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Youth with either autism spectrum disorder (ASD) or gender dysphoria (GD) alone have also been shown to be at greater risk for mental health (MH) concerns; however, very little research has considered how cooccurring ASD and GD may exacerbate MH concerns. The purpose of this study was to examine associations between ASD, GD, and MH diagnoses (anxiety, depression, eating disorder, suicidality, and self-harm) among US adolescent populations. METHODS This is a secondary analysis of a large administrative dataset formed by 8 pediatric health system members of the PEDSnet learning health system network. Analyses included descriptive statistics and adjusted mixed logistic regression models testing for associations between combinations of ASD and GD diagnoses and MH diagnoses as recorded in the patient's electronic medical record. RESULTS Based on data from 919 898 patients aged 9 to 18 years, adjusted mixed logistic regression indicated significantly greater odds of each MH diagnosis among those with ASD alone, GD alone, and cooccurring ASD/GD diagnoses compared with those with neither diagnosis. Youth with cooccurring ASD/GD were at significantly greater risk of also having anxiety (average predicted probability, 0.75; 95% confidence interval, 0.68-0.81) or depression diagnoses (average predicted probability, 0.33; 95% confidence interval, 0.24-0.43) compared with youth with ASD alone, GD alone, or neither diagnosis. CONCLUSIONS Youth with cooccurring ASD/GD are more likely to also be diagnosed with MH concerns, particularly anxiety and depression. This study highlights the need to implement developmentally appropriate, gender-affirming MH services and interventions for youth with cooccurring ASD/GD.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Gina M Sequeira
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | | | - Michelle M Garrison
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Felice Orlich
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Tandy Aye
- Stanford School of Medicine, Stanford, California
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
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McPherson S, Freedman DEP. Psychological Outcomes of 12-15-Year-Olds with Gender Dysphoria Receiving Pubertal Suppression in the UK: Assessing Reliable and Clinically Significant Change. J Sex Marital Ther 2023; 50:315-325. [PMID: 38030953 DOI: 10.1080/0092623x.2023.2281986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The evidence base for psychological benefits of GnRHA for adolescents with gender dysphoria (GD) was deemed "low quality" by the UK National Institute of Health and Care Excellence. Limitations identified include inattention to clinical importance of findings. This secondary analysis of UK clinical study data uses Reliable and Clinically Significant Change approaches to address this gap. The original uncontrolled study collected data within a specialist GD service. Participants were 44 12-15-year-olds with GD. Puberty was suppressed using "triptorelin"; participants were followed-up for 36 months. Secondary analysis used data from parent-report Child Behavior Checklists and Youth Self-Report forms. Reliable change results: 15-34% of participants reliably deteriorated depending on the subscale, time point and parent versus child report. Clinically significant change results: 27-58% were in the borderline (subclinical) or clinical range at baseline (depending on subscale and parent or child report). Rates of clinically significant change ranged from 0 to 35%, decreasing over time toward zero on both self-report and parent-report. The approach offers an established complementary method to analyze individual level change and to examine who might benefit or otherwise from treatment in a field where research designs have been challenged by lack of control groups and low sample sizes.
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Affiliation(s)
- Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
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Ludvigsson JF, Adolfsson J, Höistad M, Rydelius PA, Kriström B, Landén M. A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. Acta Paediatr 2023; 112:2279-2292. [PMID: 37069492 DOI: 10.1111/apa.16791] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 04/19/2023]
Abstract
AIM The aim of this systematic review was to assess the effects on psychosocial and mental health, cognition, body composition, and metabolic markers of hormone treatment in children with gender dysphoria. METHODS Systematic review essentially follows PRISMA. We searched PubMed, EMBASE and thirteen other databases until 9 November 2021 for English-language studies of hormone therapy in children with gender dysphoria. Of 9934 potential studies identified with abstracts reviewed, 195 were assessed in full text, and 24 were relevant. RESULTS In 21 studies, adolescents were given gonadotropin-releasing hormone analogues (GnRHa) treatment. In three studies, cross-sex hormone treatment (CSHT) was given without previous GnRHa treatment. No randomised controlled trials were identified. The few longitudinal observational studies were hampered by small numbers and high attrition rates. Hence, the long-term effects of hormone therapy on psychosocial health could not be evaluated. Concerning bone health, GnRHa treatment delays bone maturation and bone mineral density gain, which, however, was found to partially recover during CSHT when studied at age 22 years. CONCLUSION Evidence to assess the effects of hormone treatment on the above fields in children with gender dysphoria is insufficient. To improve future research, we present the GENDHOR checklist, a checklist for studies in gender dysphoria.
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- The Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Malin Höistad
- The Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Per-Anders Rydelius
- Department of Women's and Children's health, Karolinska Institutet, Stockholm, Sweden
| | - Berit Kriström
- Department of Clinical Sciences/Paediatrics, Umeå University, Umeå, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Arnold JC, McNamara M. Transgender and gender-diverse youth: an update on standard medical treatments for gender dysphoria and the sociopolitical climate. Curr Opin Pediatr 2023; 35:423-429. [PMID: 37097294 DOI: 10.1097/mop.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW Transgender and gender-diverse (TGD) youth experience a discordance between their binary sex assigned at birth and gender identity. All TGD youth benefit from compassionate care delivered by clinicians who are informed in matters of gender diversity. Some of TGD youth experience clinically significant distress, termed gender dysphoria (GD), and may benefit from additional psychological support and medical treatments. Discrimination and stigma fuel minority stress in TGD youth and thus many struggle with mental health and psychosocial functioning. This review summarizes the current state of research on TGD youth and essential medical treatments for gender dysphoria. These concepts are highly relevant in the current sociopolitical climate. Pediatric providers of all disciplines are stakeholders in the care of TGD youth and should be aware of updates in this field. RECENT FINDINGS Children who express gender-diverse identities continue to express these identities into adolescence. Medical treatments for GD have a positive effect on mental health, suicidality, psychosocial functioning, and body satisfaction. The overwhelming majority of TGD youth with gender dysphoria who receive medical aspects of gender affirming care continue these treatments into early adulthood. Political targeting and legal interference into social inclusion for TGD youth and medical treatments for GD are rooted in scientific misinformation and have negative impacts on their well being. SUMMARY All youth-serving health professionals are likely to care for TGD youth. To provide optimal care, these professionals should remain apprised of best practices and understand basic principles of medical treatments for GD.
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Affiliation(s)
- Jacob C Arnold
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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Forno N, Lagrange C, Mendes N, Moreau C, Poirier F. [Affirming one's gender: supporting and accompanying trans young people and their families]. Soins Psychiatr 2023; 44:10-13. [PMID: 37479350 DOI: 10.1016/j.spsy.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Support for trans teenagers and young adults is based on a comprehensive approach to care, taking into account the needs and desires of the individual and his or her environment. It involves welcoming their requests and listening to their questions, in order to help them assert themselves. The aim is to be particularly attentive to these young people, sometimes in vulnerable psychological, social and educational situations, as well as to their families, by welcoming them, listening to them and taking charge of them through multidisciplinary networks.
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Affiliation(s)
- Niloufar Forno
- Laboratoire de psychologue clinique, psychopathologie, psychanalyse, université Paris Cité, 71 avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France
| | - Chrystelle Lagrange
- Équipe d'accueil CLIPSYD EA 4430, Connaissance, langage, modélisation (ED 139), université Paris Ouest-Nanterre-La Défense, 200 avenue de la République, 92000 Nanterre, France
| | - Nicolas Mendes
- Service de psychiatrie de l'enfant et de l'adolescent, GH Pitié-Salpêtrière, AP-HP. 47 boulevard de l'hôpital, 75013 Paris, France.
| | - Clément Moreau
- Association Espace santé trans, 88 rue Philippe-de-Girard, 75018 Paris, France
| | - Fanny Poirier
- Service de psychiatrie de l'enfant et de l'adolescent, GH Pitié-Salpêtrière, AP-HP. 47 boulevard de l'hôpital, 75013 Paris, France
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12
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Feigerlova E. [Care pathways for young transgender people]. Soins Psychiatr 2023; 44:35-37. [PMID: 37479356 DOI: 10.1016/j.spsy.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Gender incongruence corresponds to the mismatch between gender identity and gender/sex assigned at birth gender/sex assigned at birth. It can be accompanied by psychological distress. In line with the literature, an increase in consultations for gender incongruence has been observed, especially among young people. Multidisciplinary care should be offered to this population; here we provide an example of healthcare proposed at the university hospital of Nancy.
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Affiliation(s)
- Eva Feigerlova
- Centre hospitalier régional et universitaire de Nancy, service d'endocrinologie, diabétologie et nutrition, CHRU Brabois adultes, 5 rue du Morvan 54505 Vandœuvre-lès-Nancy, France; Centre universitaire d'enseignement par simulation, hôpital virtuel de Lorraine, 9 avenue de la Forêt-de-Haye 54505 Vandœuvre-lès-Nancy, France; Faculté de médecine, maïeutique et des métiers de la Santé, 9 avenue de la Forêt-de-Haye 54505 Vandœuvre-lès-Nancy, France; Inserm, UMR S 1116 - DCAC, Université de Lorraine, 9 avenue de la Forêt-de-Haye 54505 Vandœuvre-lès-Nancy, France.
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13
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Chao KY, Chou CC, Chen CI, Lee SR, Cheng W. Prevalence and Comorbidity of Gender Dysphoria in Taiwan, 2010-2019. Arch Sex Behav 2023; 52:1009-1017. [PMID: 36692628 PMCID: PMC10102133 DOI: 10.1007/s10508-022-02500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 05/11/2023]
Abstract
Gender dysphoria (GD) is a condition in which a person exhibits marked incongruence between their expressed or experienced gender and their sex assigned at birth. The last survey of individuals with GD in Taiwan was conducted approximately 10 years ago. In this study, we investigated the prevalence of GD in Taiwan within the last 10 years as well as comorbidities. A retrospective medical record review was performed for all patients in the database of the Health and Welfare Data Science Center covered by National Health Insurance in Taiwan from January 2010 until December 2019. The study population of persons with GD was defined as individuals who had been diagnosed with transsexualism (transgender or transsexual) or gender identity disorders. Our review found case numbers and prevalence of GD in 2019 were about twice that of patients in 2010 for both assigned males and assigned females at birth. Case numbers for 2010 versus 2019 were 440 versus 867 for assigned males at birth, and 189 versus 386 for assigned females at birth. The 1-year prevalence for 2010 versus 2019 was 3.8/100,000 versus 7.4/100,000 for assigned males at birth, and 1.6/100,000 versus 3.2/100,000 for assigned females at birth. Comorbidities of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and psychosis were more likely in children with GD younger than 12 years of age; comorbid depression was more likely in adolescents and adults with GD. Improvements in social and mental health support should be provided to help address these comorbidities of ADHD, ASD, and depression among individuals with GD.
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Affiliation(s)
- Kuo-Yu Chao
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chiang Chou
- Department of Psychiatry, Centro Hospitalar Conde de São Januário, Sé, Macau SAR, China
| | - Ching-I Chen
- Department of Psychiatry, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Shu-Ru Lee
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Wei Cheng
- Department of Pathology, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan.
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
- Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan.
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14
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Morandini JS, Kelly A, de Graaf NM, Malouf P, Guerin E, Dar-Nimrod I, Carmichael P. Is Social Gender Transition Associated with Mental Health Status in Children and Adolescents with Gender Dysphoria? Arch Sex Behav 2023; 52:1045-1060. [PMID: 37014582 PMCID: PMC10101898 DOI: 10.1007/s10508-023-02588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 05/11/2023]
Abstract
Social gender transition is an increasingly accepted intervention for gender variant children and adolescents. To date, there is scant literature comparing the mental health of children and adolescents diagnosed with gender dysphoria who have socially transitioned versus those who are still living in their birth-assigned gender. We examined the mental health of children and adolescents referred to the Gender Identity Development Service (GIDS), a specialist clinic in London, UK, who had socially transitioned (i.e., were living in their affirmed gender and/or had changed their name) versus those who had not socially transitioned. Referrals to the GIDS were aged 4-17 years. We assessed mental health correlates of living in one's affirmed gender among 288 children and adolescents (208 birth-assigned female; 210 socially transitioned) and of name change in 357 children and adolescents (253 birth-assigned female; 214 name change). The presence or absence of mood and anxiety difficulties and past suicide attempts were clinician rated. Living in role and name change were more prevalent in birth-assigned females versus birth-assigned males. Overall, there were no significant effects of social transition or name change on mental health status. These findings identify the need for more research to understand how social transition influences mental health, including longitudinal studies that allow for more confident inferences to be made regarding the relationship between social transition and mental health in young people with gender dysphoria.
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Affiliation(s)
- James S Morandini
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Aidan Kelly
- Gender Service Organization, Kelly Psychology, London, UK
| | - Nastasja M de Graaf
- Center of Expertise on Gender Dyphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Pia Malouf
- King Street Psychology Clinic, Newtown, Australia
| | - Evan Guerin
- School of Behavioural and Health Sciences, Australian Catholic University, Sydney, Australia
| | - Ilan Dar-Nimrod
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia
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15
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Genovese AC, Singh SC, Casubhoy I, Hellings JA. Gender Diverse Autistic Young Adults: A Mental Health Perspective. Arch Sex Behav 2023; 52:1339-1343. [PMID: 36287303 DOI: 10.1007/s10508-022-02443-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 05/11/2023]
Abstract
Gender diverse autistic young adults often face mental health challenges which can increase the challenge of obtaining gender-affirming care. Social and communication differences associated with autism compounds the already complex process of navigating a path toward gender affirmation for individuals with these intersecting identities. In this case series of four gender diverse autistic adults, we demonstrate that success in management of their mental health crises was achieved through enlisting family and social support, obtaining effective mental health treatment, and accessing gender-affirming healthcare. These cases selected from two neuropsychiatric outpatient tertiary referral clinics demonstrate that effective mental health treatment supports ultimate success for these individuals in their journeys toward living as the gender with which they identify. We conclude that healthcare practices and treatment recommendations which incorporate internationally recognized standards of care guidelines for gender diverse individuals improve patient outcomes.
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Affiliation(s)
- Ann C Genovese
- Department of Psychiatry and Behavioral Sciences, University of Kansas Health System, 3901 Rainbow Blvd., MS 4015, Kansas City, KS, 66160, USA.
| | - Saras Chen Singh
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Imaima Casubhoy
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jessica A Hellings
- Department of Psychiatry, University of Missouri-Kansas City, Kansas City, MO, USA
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16
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Diaz S, Bailey JM. Rapid Onset Gender Dysphoria: Parent Reports on 1655 Possible Cases. Arch Sex Behav 2023; 52:1031-1043. [PMID: 36991212 PMCID: PMC10102036 DOI: 10.1007/s10508-023-02576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 05/11/2023]
Abstract
During the past decade there has been a dramatic increase in adolescents and young adults (AYA) complaining of gender dysphoria. One influential if controversial explanation is that the increase reflects a socially contagious syndrome: Rapid Onset Gender Dysphoria (ROGD). We report results from a survey of parents who contacted the website ParentsofROGDKids.com because they believed their AYA children had ROGD. Results focused on 1655 AYA children whose gender dysphoria reportedly began between ages 11 and 21 years, inclusive. These youths were disproportionately (75%) natal female. Natal males had later onset (by 1.9 years) than females, and they were much less likely to have taken steps toward social gender transition (65.7% for females versus 28.6% for males). Pre-existing mental health issues were common, and youths with these issues were more likely than those without them to have socially and medically transitioned. Parents reported that they had often felt pressured by clinicians to affirm their AYA child's new gender and support their transition. According to the parents, AYA children's mental health deteriorated considerably after social transition. We discuss potential biases of survey responses from this sample and conclude that there is presently no reason to believe that reports of parents who support gender transition are more accurate than those who oppose transition. To resolve controversies regarding ROGD, it is desirable that future research includes data provided by both pro- and anti-transition parents, as well as their gender dysphoric AYA children.
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Affiliation(s)
| | - J Michael Bailey
- Department of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, IL, 60208, USA.
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17
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Shen WCV, Shen BH. Partial Regret After Gender Affirmation Surgery of a 35-Year-Old Taiwanese Transgender Woman. Arch Sex Behav 2023; 52:1345-1351. [PMID: 36253559 DOI: 10.1007/s10508-022-02442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Gender-affirming surgery (GAS) is often sought after to alleviate the distress of those who suffer from gender dysphoria (GD). While many studies have shown that a significant percentage of people benefit from this procedure, a number of individuals later regret their decision of undergoing surgery. Studies have illustrated what regret depicts, categorizing regret based on intensity, persistency, and sources, in the hopes to prevent an unwanted irreversible intervention. Here, an in-depth interview with a 35-year-old transwoman from Taiwan who underwent feminizing GAS at the age of 31 illustrates her unique cultural upbringing and the course of her regret. Her experience best matches the characteristics of true regret and major regret based on the classifications of Pfäfflin and Wiepjes, respectively, indicating that she expected GAS to be the solution to her personal acceptance issue, but, in retrospect, regretted the diagnosis and treatment as her problems were not solved and worsened to the extent of secondary dysphoria. This case report hopes to shed light on the complexity of GD and regret after GAS, while encouraging the pre-surgical evaluation of psychological comorbidities and post-surgical psychotherapy, and ensuring that patients are informed and give full consent. In addition, more elaborate, long-term, large-scale qualitative research, especially within more conservative cultural settings, is needed.
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Affiliation(s)
- Wei-Chi V Shen
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Bing-Hwei Shen
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei City, 11221, Taiwan.
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18
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Abstract
Opposition to gender-affirmative approaches to care for transgender youths by some clinicians has recently begun to consolidate around "gender exploratory therapy" as a proposed alternative. Whereas gender-affirmative approaches follow the client's lead when it comes to gender, gender-exploratory therapy discourages gender affirmation in favor of exploring through talk therapy the potential pathological roots of youths' trans identities or gender dysphoria. Few detailed descriptions of the approach's parameters have been offered. In this article, I invite clinicians to reflect on gender-exploratory therapy through a series of questions. The questions are followed by an exploration of the strong conceptual and narrative similarities between gender-exploratory therapy and conversion practices. Finally, the ethical dimensions of gender-exploratory therapy are discussed from the lenses of therapeutic neutrality, patient-centered care, loving attention, and therapeutic alliance, suggesting that the approach may be unethical.
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Affiliation(s)
- Florence Ashley
- Florence Ashley, University of Toronto
Faculty of Law and Joint Centre for Bioethics
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19
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Verveen A, van der Miesen AIR, de Graaf NM, Kreukels BPC, de Vries ALC, Steensma TD. Body Image in Adolescents with Gender Incongruence and Its Association with Psychological Functioning. Int J Environ Res Public Health 2023; 20:3349. [PMID: 36834059 PMCID: PMC9963492 DOI: 10.3390/ijerph20043349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
During adolescence, many individuals with gender incongruence (GI) experience distress related to body dissatisfaction. This study aims to describe the body (dis)satisfaction of Dutch adolescents referred for GI and to describe the influence of body image on their psychological functioning. Self-report measures on body satisfaction (Body Image Scale) and psychological functioning (Youth Self-Report) were obtained from 787 adolescents (aged 10-18) who were referred to the Center of Expertise on Gender Dysphoria at the Amsterdam University Medical Centers between 1996 and 2016. First, a general description of body satisfaction in adolescents with GI was developed. Secondly, multiple linear regression analyses were performed to determine the association between body image and psychological functioning, both for total problems and for internalizing and externalizing problems separately. Third, regression analyses are repeated for body area subscales. Adolescents with GI report the greatest dissatisfaction with the genital area, regardless of birth-assigned sex. For all other body areas, there were birth-assigned sex differences in satisfaction. The analyses showed that body satisfaction was significantly related to total psychological problems and both internalizing and externalizing problems. Greater body dissatisfaction is significantly associated with worse psychological functioning in adolescents with GI. Clinicians should monitor the body image of adolescents with GI over time, especially during puberty and medical interventions.
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Affiliation(s)
- Anouk Verveen
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Anna I. R. van der Miesen
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Nastasja M. de Graaf
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Baudewijntje P. C. Kreukels
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Annelou L. C. de Vries
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Thomas D. Steensma
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
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20
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Engel L, Majmudar I, Mihalopoulos C, Tollit MA, Pang KC. Assessment of Quality of Life of Transgender and Gender-Diverse Children and Adolescents in Melbourne, Australia, 2017-2020. JAMA Netw Open 2023; 6:e2254292. [PMID: 36729456 PMCID: PMC9896293 DOI: 10.1001/jamanetworkopen.2022.54292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
IMPORTANCE Transgender and gender-diverse (TGD) children and adolescents may experience not only gender dysphoria but also depression and anxiety, all of which are likely to be associated with reduced quality of life (QOL). Despite this, little is known about QOL in this population. OBJECTIVES To identify demographic, social, and clinical characteristics associated with reduced QOL in TGD children and adolescents; compare their QOL with age-matched population-based norms and that of young people with common mental health problems; and evaluate the association between gender dysphoria and QOL. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, baseline data were derived from questionnaires completed in a prospective cohort study (Trans20) of TGD children aged 6 to 12 years and adolescents aged 13 to 17 years first seen at the Royal Children's Hospital Gender Service (Melbourne, Australia) between February 2017 and February 2020. MAIN OUTCOMES AND MEASURES The main outcome was QOL, measured using the Child Health Utility 9D instrument (CHU-9D). Data collection included demographic information, social factors (eg, bullying, lack of support, and social transition), and clinical characteristics (eg, gender identity, gender dysphoria, and mental health difficulties). Population norms and CHU-9D data for Australian youths with mental health diagnoses were derived from published literature. RESULTS The TGD cohort comprised 525 children and adolescents aged 6 to 17 years (median age, 14 years [IQR, 12-16 years]; 364 [69.33%] presumed female at birth). The mean (SD) CHU-9D score was 0.46 (0.26). Compared with population norms, TGD children (0.58 [0.27] vs 0.81 [0.16]; P < .001) and adolescents (0.41 [0.25] vs 0.80 [0.14]; P < .001) had significantly lower scores. Within the TGD cohort, mean (SD) scores were significantly lower in adolescents (0.41 [0.24] vs 0.62 [0.25]; P < .001), those assigned female at birth (0.43 [0.26] vs 0.55 [0.25]; P < .001), those reporting mental health problems (0.37 [0.23] vs 0.57 [0.25]; P < .001) and physical health problems (0.41 [0.26] vs 0.48 [0.26]; P = .04), and those who were bullied (0.38 [0.24] vs 0.52 [0.25]; P < .001). Gender dysphoria alone was associated with a lower mean (SD) CHU-9D score (0.51 [0.23]) than that in control adolescents with serious mental health conditions such as depression (0.64 [0.26]) and anxiety (0.70 [0.24]) and was an independent factor associated with QOL. CONCLUSIONS AND RELEVANCE In this cohort study of TGD children and adolescents in Australia, QOL was worse in this population than in age-matched, population-based peers. Quality of life associated with gender dysphoria was substantially worse than that seen in young people with common mental health conditions. These findings emphasize the risk of poor QOL among TGD young people and the need to better support them.
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Affiliation(s)
- Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ishani Majmudar
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
| | - Michelle A. Tollit
- The Royal Children’s Hospital, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Ken C. Pang
- The Royal Children’s Hospital, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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21
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Abstract
The aim of this study is to analyze the specific needs of detransitioners from online detrans communities and discover to what extent they are being met. For this purpose, a cross-sectional online survey was conducted and gathered a sample of 237 male and female detransitioners. The results showed important psychological needs in relation to gender dysphoria, comorbid conditions, feelings of regret and internalized homophobic and sexist prejudices. It was also found that many detransitioners need medical support notably in relation to stopping/changing hormone therapy, surgery/treatment complications and reversal interventions. Additionally, the results indicated the need for hearing about other detransitioners' experiences and meeting each other. A major lack of support was reported by the respondents overall, with a lot of negative experiences coming from medical and mental health systems and from the LGBT+ community. The study highlights the importance of increasing awareness and support given to detransitioners.
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Affiliation(s)
- Elie Vandenbussche
- Faculty of Society and Economics, Rhine-Waal University of Applied Sciences, Kleve, Germany
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22
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Guadagnin F, da Silva DC, Schwarz K, Villas Bôas AP, Lobato MIR. The Impact of the COVID-19 Pandemic on the Lives of People With Gender Dysphoria. Front Public Health 2022; 10:878348. [PMID: 35874999 PMCID: PMC9298877 DOI: 10.3389/fpubh.2022.878348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/14/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To analyze the impact on the psychological and social aspects caused by the COVID-19 pandemic in individuals diagnosed with Gender Dysphoria (GD). METHODS Google Forms inventory was sent via WhatsApp, including qualitative and quantitative questions evaluating three life dimensions denominated as Sociodemographic, Economic, and COVID-19 pandemic. It was applied in two periods: At the beginning of the pandemic (June-2020) (P1) and one year later (June-2021) (P2). The inventory also included questions about economic dimensions before the pandemic for individual comparison purposes (P0). 48 individuals (28 transsexual women, 20 transsexual men) participated in both periods. RESULTS 77.1% (n = 37) lived in Rio Grande do Sul, 50.0% (n = 24) refereed incomplete high school; Monthly Income increased significantly between the periods (P0) and (P1). Emergence aid approval was significantly higher in (P2), 56.3% (n = 27), compared to (P1), 39.6% (n = 19). A statistically significant difference was detected in the feeling of depression in the (P2) among the cases that requested Emergency Aid. CONCLUSION The studied population presented deterioration regarding their condition of social vulnerability in relation to formal employment, access to health services, and mental health.
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Affiliation(s)
| | - Dhiordan Cardoso da Silva
- Department of Psychiatry, Gender Identity Program at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Karine Schwarz
- Department of Psychiatry, Gender Identity Program at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Postgraduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Anna Paula Villas Bôas
- Department of Psychiatry, Gender Identity Program at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Inês Rodrigues Lobato
- Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Psychiatry and Behavioral Sciences at the Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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23
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de Vries ALC. Ensuring Care for Transgender Adolescents Who Need It: Response to 'Reconsidering Informed Consent for Trans-Identified Children, Adolescents and Young Adults'. J Sex Marital Ther 2022; 49:108-114. [PMID: 35723081 DOI: 10.1080/0092623x.2022.2084479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Adolescent transgender care is increasingly surrounded by controversies and criticism. One of these concerns expressed in a review article by Levine et al. entitled 'Reconsidering Informed Consent for Trans-Identified Children, Adolescents and Young Adults' is the limited evidence base, especially of the Dutch studies which provided the first and mostly cited basis for medical intervention at a young age. This Response is written by the first author of two of those studies that showed effectiveness of the approach that included puberty blockers. The author rebuts several of the concerns that Levine et al.have regarding these Dutch studies, among which are the limited statistical improvements of psychological measures, the use of the Utrecht Gender Dysphoria and the selection of participants. The author further refers to several shorter term longitudinal follow up studies that have been published, which are not mentioned by Levine et al.. They also show improvement or stable psychological functioning and relief of gender incongruence. Finally, a careful evaluation and informed consent provision has always been recommended in all editions of the WPATH's Standards of Care and are also part of the 8th version as well as the Endocrine Society guidelines. The author agrees therefore with Levine et al. that clinicians in transgender care should follow these international guidelines and provide such an assessment in order to ensure that medical interventions are appropriately provided for those transgender adolescents who need them.
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Affiliation(s)
- Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dyphoria, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
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24
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Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM. Is It Autism? A Critical Commentary on the Co-Occurrence of Gender Dysphoria and Autism Spectrum Disorder. J Homosex 2022; 69:1204-1221. [PMID: 33852376 DOI: 10.1080/00918369.2021.1905385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An increasing amount of literature revealed a link between GD and ASD. Both GD and ASD are complex and heterogeneous conditions characterized by a large variety of presentations. Studies have reported that individuals with GD tend to have higher prevalence rates of autistic traits in comparison to the general population. The purpose of this commentary is to provide, through the description of a clinical case, our reading and a possible interpretation of the correlation of these two conditions in light of the several methodological limitations found in literature. We hypothesize that the traits often classified as autistic could be more accurately related to the distress and discomfort evoked by GD. The autistic traits of individuals with GD as forms of psychological defenses and coping mechanisms aimed at dealing with socio-relational and identity problems are discussed.
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Affiliation(s)
- Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Guido Giovanardi
- Department of Psychology, University of Campania, "Luigi Vanvitelli," University of Caserta, Italy
| | - Eleonora Innocenzi
- Department of Letters and Philosophy, "Tor Vergata," University of Rome, Italy
| | - Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Giorgio Caviglia
- Department of Psychology, University of Campania, "Luigi Vanvitelli," University of Caserta, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza," University of Rome, Italy
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Kennis M, Duecker F, T'Sjoen G, Sack AT, Dewitte M. Sexual Self-Concept Discrepancies Mediate the Relation between Gender Dysphoria Sexual Esteem and Sexual Attitudes in Binary Transgender Individuals. J Sex Res 2022; 59:524-536. [PMID: 34279141 DOI: 10.1080/00224499.2021.1951643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Sexual responding in transgender people has typically been investigated from a medical and functional perspective. Aligning with the biopsychosocial model, it is however equally important to consider psychological aspects of sexuality in this population. We propose that the Sexual Self-Concept (SSC) theory offers a valuable framework to understand (sexual) wellbeing in transgender people, while Self-Concept Discrepancy (SCD) theory could offer an explanation of the mechanisms underlying negative SSCs related to gender dysphoria. We investigated differences in SSC (consisting of sexual esteem, sexual attitudes, and sexual self-efficacy) in 197 binary transgender and 205 cisgender individuals using an online survey and explored the mediating role of actual/ideal self-discrepancies in explaining the relation between gender dysphoria and SSC. Transgender and cisgender individuals differed significantly in seven out of eight components related to sexual esteem and sexual attitudes. Actual/ideal self-discrepancies mediated the relationship between gender dysphoria and the SSC in transgender individuals for the sexual esteem components related to body perception, conduct, and attractiveness, as well as for sexual anxiety. We found no relation between gender dysphoria and the other SSC components in this group. We conclude that SSC discrepancies could be a valuable treatment target to improve transgender individuals' sexual esteem and sexual attitudes.
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Affiliation(s)
- Mathilde Kennis
- Department of Clinical Psychological Science, Maastricht University
- Department of Cognitive Neuroscience, Maastricht University
- Maastricht Brain Imaging Center, Maastricht University
| | - Felix Duecker
- Department of Cognitive Neuroscience, Maastricht University
- Maastricht Brain Imaging Center, Maastricht University
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital
- Center for Sexology and Gender, Ghent University Hospital
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Maastricht University
- Maastricht Brain Imaging Center, Maastricht University
- Department of Psychiatry and Neuropsychology, Maastricht University
- Center for Integrative Neuroscience, Maastricht University
| | - Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University
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Gavazzi G, Fisher AD, Orsolini S, Bianchi A, Romani A, Giganti F, Giovannelli F, Ristori J, Mazzoli F, Maggi M, Viggiano MP, Mascalchi M. The fMRI correlates of visuo-spatial abilities: sex differences and gender dysphoria. Brain Imaging Behav 2022; 16:955-964. [PMID: 35384549 PMCID: PMC9010387 DOI: 10.1007/s11682-022-00638-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
The contribution of brain regions to visuospatial abilities according to sex differences and gender identity is inconsistently described. One potential explaining factor may be the different tasks employed requiring a variable load of working memory and other cognitive resources. Here we asked to 20 cis and 20 transgender participants to undergo functional Magnetic Resonance Imaging during performance of a judgement line of orientation test that was adapted to explore the basic visuospatial processing while minimizing the working memory load. We show that V1 activation may be viewed as a brain area with enhanced activation in males, regardless of participants’ gender identity. On its turn, gender identity exclusively influences the visuospatial processing of extrastriate visual areas (V5) in women with gender dysphoria. They showed enhanced V5 activation and an increased functional connectivity between V5 and V1. Overall our neuroimaging results suggest that the basic visuospatial abilities are associated with different activations pattern of cortical visual areas depending on the sex assigned at birth and gender identity.
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Affiliation(s)
| | - Alessandra Daphne Fisher
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Stefano Orsolini
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Andrea Bianchi
- Neuroradiology Unit, "Careggi" University Hospital, Florence, Italy
| | - Alessia Romani
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Fiorenza Giganti
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Via San Salvi, 12, 50135, Florence, Italy
| | - Fabio Giovannelli
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Via San Salvi, 12, 50135, Florence, Italy
| | - Jiska Ristori
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Francesca Mazzoli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Maria Pia Viggiano
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Via San Salvi, 12, 50135, Florence, Italy.
| | - Mario Mascalchi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Abstract
IMPORTANCE Transgender and nonbinary (TNB) youths are disproportionately burdened by poor mental health outcomes owing to decreased social support and increased stigma and discrimination. Although gender-affirming care is associated with decreased long-term adverse mental health outcomes among these youths, less is known about its association with mental health immediately after initiation of care. OBJECTIVE To investigate changes in mental health over the first year of receiving gender-affirming care and whether initiation of puberty blockers (PBs) and gender-affirming hormones (GAHs) was associated with changes in depression, anxiety, and suicidality. DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study was conducted at an urban multidisciplinary gender clinic among TNB adolescents and young adults seeking gender-affirming care from August 2017 to June 2018. Data were analyzed from August 2020 through November 2021. EXPOSURES Time since enrollment and receipt of PBs or GAHs. MAIN OUTCOMES AND MEASURES Mental health outcomes of interest were assessed via the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales, which were dichotomized into measures of moderate or severe depression and anxiety (ie, scores ≥10), respectively. Any self-report of self-harm or suicidal thoughts over the previous 2 weeks was assessed using PHQ-9 question 9. Generalized estimating equations were used to assess change from baseline in each outcome at 3, 6, and 12 months of follow-up. Bivariate and multivariable logistic models were estimated to examine temporal trends and investigate associations between receipt of PBs or GAHs and each outcome. RESULTS Among 104 youths aged 13 to 20 years (mean [SD] age, 15.8 [1.6] years) who participated in the study, there were 63 transmasculine individuals (60.6%), 27 transfeminine individuals (26.0%), 10 nonbinary or gender fluid individuals (9.6%), and 4 youths who responded "I don't know" or did not respond to the gender identity question (3.8%). At baseline, 59 individuals (56.7%) had moderate to severe depression, 52 individuals (50.0%) had moderate to severe anxiety, and 45 individuals (43.3%) reported self-harm or suicidal thoughts. By the end of the study, 69 youths (66.3%) had received PBs, GAHs, or both interventions, while 35 youths had not received either intervention (33.7%). After adjustment for temporal trends and potential confounders, we observed 60% lower odds of depression (adjusted odds ratio [aOR], 0.40; 95% CI, 0.17-0.95) and 73% lower odds of suicidality (aOR, 0.27; 95% CI, 0.11-0.65) among youths who had initiated PBs or GAHs compared with youths who had not. There was no association between PBs or GAHs and anxiety (aOR, 1.01; 95% CI, 0.41, 2.51). CONCLUSIONS AND RELEVANCE This study found that gender-affirming medical interventions were associated with lower odds of depression and suicidality over 12 months. These data add to existing evidence suggesting that gender-affirming care may be associated with improved well-being among TNB youths over a short period, which is important given mental health disparities experienced by this population, particularly the high levels of self-harm and suicide.
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Affiliation(s)
| | - Jonathon W. Wanta
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Arin Collin
- School of Medicine, University of Washington, Seattle
| | - Cesalie Stepney
- Department of Psychiatry and Behavioral Medicine, Department of Adolescent and Young Adult Medicine, Seattle Children’s Hospital, Seattle, Washington
| | | | - Kym Ahrens
- Division of Adolescent Medicine, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
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Nunes-Moreno M, Buchanan C, Cole FS, Davis S, Dempsey A, Dowshen N, Furniss A, Kazak AE, Kerlek AJ, Margolis P, Pyle L, Razzaghi H, Reirden DH, Schwartz B, Sequeira GM, Nokoff NJ. Behavioral Health Diagnoses in Youth with Gender Dysphoria Compared with Controls: A PEDSnet Study. J Pediatr 2022; 241:147-153.e1. [PMID: 34571022 PMCID: PMC8828680 DOI: 10.1016/j.jpeds.2021.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the odds of a psychiatric or neurodevelopmental diagnosis among youth with a diagnosis of gender dysphoria compared with matched controls in a large electronic health record dataset from 6 pediatric health systems, PEDSnet. We hypothesized that youth with gender dysphoria would have higher odds of having psychiatric and neurodevelopmental diagnoses than controls. STUDY DESIGN All youth with a diagnosis of gender dysphoria (n = 4173 age at last visit 16.2 ± 3.4) and at least 1 outpatient encounter were extracted from the PEDSnet database and propensity-score matched on 8 variables to controls without gender dysphoria (n = 16 648, age at last visit 16.2 ± 4.8) using multivariable logistic regression. The odds of having psychiatric and neurodevelopmental diagnoses were examined using generalized estimating equations. RESULTS Youth with gender dysphoria had higher odds of psychiatric (OR 4.0 [95% CI 3.8, 4.3] P < .0001) and neurodevelopmental diagnoses (1.9 [1.7, 2.0], P < .0001). Youth with gender dysphoria were more likely to have a diagnosis across all psychiatric disorder subcategories, with particularly high odds of mood disorder (7.3 [6.8, 7.9], P < .0001) and anxiety (5.5 [5.1, 5.9], P < .0001). Youth with gender dysphoria had a greater odds of autism spectrum disorder (2.6, [2.2, 3.0], P < .0001). CONCLUSIONS Youth with gender dysphoria at large pediatric health systems have greater odds of psychiatric and several neurodevelopmental diagnoses compared with youth without gender dysphoria. Further studies are needed to evaluate changes in mental health over time with access to gender affirming care.
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Affiliation(s)
| | - Cindy Buchanan
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Shanlee Davis
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amanda Dempsey
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nadia Dowshen
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Anna Furniss
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Anne E Kazak
- Nemours Children's Health System, Center for Healthcare Delivery Science Wilmington, DE
| | | | | | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Hanieh Razzaghi
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Beth Schwartz
- Nemours Children's Health System, Center for Healthcare Delivery Science Wilmington, DE
| | - Gina M Sequeira
- University of Washington, Department of Pediatrics, Seattle, WA
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29
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Valdés R F, Pacheco P B, Bedregal G P. [Cooccurrence of autism spectrum disorder and gender dysphoria in childhood: Analy sis of the personal identity from a psychodynamic perspective]. Andes Pediatr 2022; 93:99-104. [PMID: 35506782 DOI: 10.32641/andespediatr.v93i1.3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 06/22/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Autism Spectrum Disorder (ASD) is a neurodevelopmental condition with alterations in social inte raction and communication, and restricted and repetitive patterns of behavior and interests. Gender Dysphoria (GD) refers to the incongruence between the gender identity and the sex assigned at birth, together with a strong and persistent desire to be of the opposite sex. During global personal identity construction, the development of sexual identity is essential. OBJECTIVE To analyze an adolescent clinical case of co-occurrence of ASD and GD from a psychodynamic understanding of his identity. CLINICAL CASE A 15-year-old male diagnosed with ASD and borderline intellectual capacity. He mani fested feminine behaviors and interests in girlish games since preschool age, imitating female figures, and verbalizing the desire to be of the opposite sex. A multidisciplinary evaluation of the patient concluded that he presented a diffuse general identity with ambivalent gender identity. Therefore, he did not fulfill the requirements for hormone therapy. Psychological therapy was suggested to favor grea ter exploration and cognitive flexibility to develop a better-defined gender identity. CONCLUSIONS In cases as ASD, where identity development is compromised, the affected subject often delays or does not consolidate sexual identity, leading to a diffusion of identity and gender, as in the reported case. The co-occurrence of ASD and GD requires a multidisciplinary evaluation that includes a complete assessment of the patient's global identity before considering any definitive therapeutic orientation regarding gender.
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Affiliation(s)
| | - Bernardo Pacheco P
- Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Bedregal G
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Cesur E, Yüksel Ş, Başar K, Kaptan S. Clinical Follow-up of Two Adolescents Diagnosed with Gender Dysphoria. Turk Psikiyatri Derg 2022; 33:214-219. [PMID: 36148573 DOI: 10.5080/u26795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Rapid physical, psychological and sexual changes in adolescents due to the developmental process differentiate the approach to adolescents with gender dysphoria (GD) from the approach to adults. In this article, two adolescents who applied for GD and followed up for a long time are presented. The first case was assigned male at birth and defined herself as female. At the age of fifteen, a gonadotropin-releasing hormone analog was started for puberty suppression, and sex hormone was started in the follow-up. The second case's assigned sex was female and defined himself as male. At the age of sixteen years and six months, puberty suppressive treatment was started, followed by sex hormones. Both cases were able to continue their psychosocial development without any problems after the psychiatric and physical treatments they could reach on time. Although GD in adolescents cannot be resolved with puberty suppression alone, it creates time to resolve the acute problems and to search for appropriate treatment approaches in the future. Puberty suppression partially relieves and prevents the exacerbation of the dysphoria experienced by the youth diagnosed as GD, and creates time to search appropriate treatment approaches in the follow-up. Through these two cases, it is aimed to introduce the gender affirmation processes of adolescents with GD, to discuss the medical interventions in adolescence and the psychosocial effects of the process on individuals. Keywords: Gender dysphoria, gender incongruence, adolescence, gender affirmation process, puberty supression, puberty blockers.
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31
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Knudson SA, DeLeon A, Crane CN, Santucci RA. Minimal Impact Double Incision with Free Nipple Graft Technique for Gender-Affirming Top Surgery. Plast Reconstr Surg 2022; 149:152e-153e. [PMID: 34846366 DOI: 10.1097/prs.0000000000008618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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O’Connell MA, Nguyen TP, Ahler A, Skinner SR, Pang KC. Approach to the Patient: Pharmacological Management of Trans and Gender-Diverse Adolescents. J Clin Endocrinol Metab 2022; 107:241-257. [PMID: 34476487 PMCID: PMC8684462 DOI: 10.1210/clinem/dgab634] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/24/2022]
Abstract
Internationally, increasing numbers of children and adolescents with gender dysphoria are presenting for care. In response, gender-affirming therapeutic interventions that seek to align bodily characteristics with an individual's gender identity are more commonly being used. Depending on a young person's circumstances and goals, hormonal interventions may aim to achieve full pubertal suppression, modulation of endogenous pubertal sex hormone effects, and/or development of secondary sex characteristics congruent with their affirmed gender. This is a relatively novel therapeutic area and, although short-term outcomes are encouraging, longer term data from prospective longitudinal adolescent cohorts are still lacking, which may create clinical and ethical decision-making challenges. Here, we review current treatment options, reported outcomes, and clinical challenges in the pharmacological management of trans and gender-diverse adolescents.
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Affiliation(s)
- Michele A O’Connell
- Department of Endocrinology and Diabetes, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia
- Department of Adolescent Medicine, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia
- Correspondence: Michele A. O’Connell, FRACP, MD, Department of Endocrinology and Diabetes, The Royal Children’s Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Thomas P Nguyen
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
| | - Astrid Ahler
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital Basel, Basel, Switzerland
| | - S Rachel Skinner
- Speciality of Child and Adolescent Health, Faculty of Medicine and Health, Sydney University, Children’s Hospital Westmead, NSW 2145, Australia
| | - Ken C Pang
- Department of Adolescent Medicine, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia
- Walter and Eliza Hall Institute for Medical Research, Parkville, VIC 3052, Australia
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33
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Canale D, Martino E, Trimarchi F. The "Ensign Nun" Catalina de Erauso: a clinical endocrinology enigma. J Endocrinol Invest 2021; 44:2527-2528. [PMID: 33675532 DOI: 10.1007/s40618-021-01536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- D Canale
- Unità di Endocrinologia 2, AOU Pisana, Pisa, Italy.
| | | | - F Trimarchi
- Dept of Medicina Clinica E Sperimentale, University of Messina, Messina, Italy
- Accademia Peloritana Dei Pericolanti at the University of Messina, Messina, Italy
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Martin S, Sandberg ES, Shumer DE. Criminalization of Gender-Affirming Care - Interfering with Essential Treatment for Transgender Children and Adolescents. N Engl J Med 2021; 385:579-581. [PMID: 34010528 DOI: 10.1056/nejmp2106314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Simona Martin
- From the University of Michigan Medical School (S.M.) and the Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Michigan Medicine, University of Michigan (E.S.S., D.E.S.) - both in Ann Arbor
| | - Elizabeth S Sandberg
- From the University of Michigan Medical School (S.M.) and the Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Michigan Medicine, University of Michigan (E.S.S., D.E.S.) - both in Ann Arbor
| | - Daniel E Shumer
- From the University of Michigan Medical School (S.M.) and the Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Michigan Medicine, University of Michigan (E.S.S., D.E.S.) - both in Ann Arbor
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Abstract
Transgender males experience a disharmony between their birth sex and their intimate sense of gender belonging. Gender-affirming hormone therapy and gender-affirming surgery (GAS) are often inherently part of the gender-affirming process. In this context, we should ask whether it is better to keep or remove the uterus. Keeping the uterus and ovaries avoids a surgical procedure and a pubic scar that often results and preserves fertility and the possibility of carrying a baby. On the other hand, keeping the uterus is often psychologically unbearable for transgender males and the long-term effects of androgens on the uterus and ovaries remain uncertain. Conversely, hysterectomy and oophorectomy as part of the GAS process are part of gender reassignment. New mini-invasive surgery procedures for hysterectomies decrease the risks and limit the likelihood of scars to a minimum. In practice, the data suggest that very few transgender males carry a pregnancy and/or use their oocytes after gender-reaffirming treatment. Clinicians should counsel their transgender male patients on the definitive infertility consequences of hysterectomy and oophorectomy and discuss fertility preservation options before GAS. Individualized approaches must be preferred to systematic procedures regarding the personal decision to keep or not keep the uterus and ovaries.
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Affiliation(s)
- Marie Carbonnel
- Department of Obstetrics Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medecine Paris Ouest (UVSQ), Suresnes, France.
| | - Lea Karpel
- Department of Obstetrics Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medecine Paris Ouest (UVSQ), Suresnes, France; Department of Psychiatry, Hopital Foch - Faculté de Medecine Paris Ouest (UVSQ), Suresnes, France
| | - Bernard Cordier
- Department of Psychiatry, Hopital Foch - Faculté de Medecine Paris Ouest (UVSQ), Suresnes, France
| | - Paul Pirtea
- Department of Obstetrics Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medecine Paris Ouest (UVSQ), Suresnes, France
| | - Jean Marc Ayoubi
- Department of Obstetrics Gynecology and Reproductive Medicine, Hopital Foch - Faculté de Medecine Paris Ouest (UVSQ), Suresnes, France
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36
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Foster Skewis L, Bretherton I, Leemaqz SY, Zajac JD, Cheung AS. Short-Term Effects of Gender-Affirming Hormone Therapy on Dysphoria and Quality of Life in Transgender Individuals: A Prospective Controlled Study. Front Endocrinol (Lausanne) 2021; 12:717766. [PMID: 34394009 PMCID: PMC8358932 DOI: 10.3389/fendo.2021.717766] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/13/2021] [Indexed: 01/11/2023] Open
Abstract
Background Gender affirming hormone therapy (GAHT), whilst considered the standard of care in clinical guidelines for the treatment of many transgender (trans) people is supported by low quality evidence. In this prospective longitudinal controlled study, we aimed to examine the effect of newly commencing GAHT on gender dysphoria and quality of life (QoL) over a 6 month period. Methods Adult trans (including those with binary and/or non-binary identities) people newly commencing standard full-doses of masculinising (n = 42; 35 = trans masculine, 7 = non-binary) or feminising (n = 35; 33 = trans feminine, 2 = non-binary) GAHT and cisgender participants (n=53 male, n=50 female) were recruited to participate in this longitudinal prospective study. This analysis of gender dysphoria measured by the Gender Preoccupation and Stability Questionnaire and QoL measured by the RAND Short-Form 36 Health survey at baseline, 3 and 6 months after commencement of GAHT was a prespecified secondary outcome. Dysphoria and QoL over time in those starting GAHT compared to cisgender comparison group matched for their presumed sex at birth is reported as the mean difference (95% confidence interval) adjusted for age. Results In trans people initiating masculinising GAHT, there was a decrease in gender dysphoria with adjusted mean difference -6.80 (-8.68, -4.91), p < 0.001, and a clinically significant improvement in emotional well-being [adjusted mean difference 7.48 (1.32, 13.64), p = 0.018] and social functioning [adjusted mean difference 12.50 (2.84, 22.15), p = 0.011] aspects of QoL over the first 6 months of treatment relative to the cisgender female comparison group. No significant differences were observed in other QoL domains. In trans people initiating feminising GAHT, there was a decrease in gender dysphoria [adjusted mean difference -4.22 (-6.21, -2.24), p < 0.001] but no differences in any aspects of QoL were observed. Conclusions In the short-term, our findings support the benefit of initiating masculinising or feminising GAHT for gender dysphoria. Masculinising GAHT improves emotional well-being and social functioning within 6 months of treatment. Multidisciplinary input with speech pathology and surgery to support trans people seeking feminisation is likely needed. Further longitudinal studies controlled for other confounders (such as the presence of social supports) contributing to QoL are needed.
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Affiliation(s)
- Lucas Foster Skewis
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
| | - Ingrid Bretherton
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, VIC, Australia
| | - Shalem Y. Leemaqz
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jeffrey D. Zajac
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, VIC, Australia
| | - Ada S. Cheung
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, VIC, Australia
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Grabski B, Pliczko M, Żołądek S, Kasparek K. Characteristics and expectations of patients seeking help for gender dysphoria in one of the sexological outpatient clinics in Poland. Psychiatr Pol 2021; 56:1237-1251. [PMID: 37098196 DOI: 10.12740/pp/onlinefirst/136449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The aim of the study was to present the characteristics of the convenience sample of the transgender people who registered in one of the sexological outpatient clinics, with particular emphasis on the needs of those seeking assistance. The division into persons with binary and non-binary identities was included. METHODS A statistical analysis of the data obtained from the medical records of a group of 49 patients, including 35 patients declaring binary identity and 14 patients declaring non-binary identity, was conducted. The data included, among others, the reported gender identity, the process of its emergence and the range of expectations towards the outpatient clinic (hormone therapy, qualification for gender confirmation procedures, support in obtaining legal recognition of gender reassignment, assistance in the coming-out process, treatment of co-occurring psychiatric problems or psychological assistance). RESULTS The results indicate a great diversity of the examined group in terms of the declared gender identity. In the group of non-binary persons, a different than in binary persons course of the emergence and consolidation of gender identity is noticeable. The expectations reported in terms of hormone therapy, surgical treatment, legal recognition, assistance in the coming-out process and mental health indicate that there are differences and heterogeneous needs in the study group. The results indicate that expectations for hormone therapy, gender confirmation surgeries and legal recognition are more common in binary patients. CONCLUSIONS Despite the frequent perception of transgender people as a homogeneous group with similar experiences and expectations, the results indicate considerable diversity in the given range.
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Affiliation(s)
- Bartosz Grabski
- Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Psychiatrii, Pracownia Seksuologii
- Szpital Uniwersytecki w Krakowie, Poradnia Seksuologiczna
| | - Mateusz Pliczko
- Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Psychiatrii, Pracownia Seksuologii
| | - Stanisław Żołądek
- Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Psychiatrii, Pracownia Seksuologii
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Wang Y, Khorashad BS, Feusner JD, Savic I. Cortical Gyrification in Transgender Individuals. Cereb Cortex 2021; 31:3184-3193. [PMID: 33718960 PMCID: PMC8324983 DOI: 10.1093/cercor/bhaa412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 12/26/2022] Open
Abstract
Gender incongruence (GI) is characterized by a feeling of estrangement from the own body in the context of self. GI is often described in people who identify as transgender. The underlying mechanisms are unknown. Data from MRI measurements and tests of own body perception triggered us to pose a model that GI in transgender persons (TGI) could be associated with a disconnection within the brain circuits mediating the perception of own body as self. This is a departure from a previous model of sex atypical cerebral dimorphism, introducing a concept that better accords with a core feature of TGI. The present MRI study of 54 hormone naive transmen (TrM), 38 transwomen (TrW), 44 cismen and 41 ciswomen show that cortical gyrification, a metric that reflects early maturation of cerebral cortex, is significantly lower in transgender compared with cisgender participants. This reduction is limited to the occipito-parietal cortex and the sensory motor cortex, regions encoding own body image and body ownership. Moreover, the cortical gyrification correlated inversely with own body-self incongruence in these regions. These novel data suggest that GI in TGI may originate in the neurodevelopment of body image encoding regions. The results add potentially to understanding neurobiological contributors to gender identity.
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Affiliation(s)
- Yanlu Wang
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm 171 77, Sweden
- MR Physics, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm 171 76, Sweden
| | - Behzad S Khorashad
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Jamie D Feusner
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm 171 77, Sweden
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ivanka Savic
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm 171 77, Sweden
- Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095-6975, USA
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Castelo-Branco C, RiberaTorres L, Gómez-Gil E, Uribe C, Cañizares S. Psychopathological symptoms in Spanish subjects with gender dysphoria. A cross-sectional study. Gynecol Endocrinol 2021; 37:534-540. [PMID: 33904350 DOI: 10.1080/09513590.2021.1913113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Most people with gender dysphoria have to face various stressful conditions, which make them more vulnerable to the development of psychopathological symptoms. AIMS The main goal was to compare psychopathological symptoms between individuals with gender dysphoria and those from the general population. Other secondary aims were to determine if there were differences between gender [male to females (MtFs) and female to males (FtMs)] and also according to cross-sex hormone therapy. METHOD Symptom Checklist 90 Revised (SCL-90-R) questionnaire was administered to a sample of 205 subjects with gender dysphoria (MtFs = 129 and FtMs = 76). The control group included 530 individuals from the general population who took part in the Spanish validation of the SCL-90-R questionnaire. RESULTS Overall, individuals with gender dysphoria had higher scores on all SCL-90-R dimensions than the general population, except in the dimension of somatization, in which MtF and FtM subjects scored statistically higher than control males but not than control females. The mean scores of all dimensions except Depression (mean score of 1.17) were below 1, that is, between 0 (not at all) and 1 (occasionally). All dimensions did not differ when comparing MtFs and FtMs nor when comparing gender dysphoric subjects with or without cross-sex hormonal therapy. CONCLUSIONS The results suggested that most subjects with gender dysphoria attending a gender unit reported higher levels of psychopathology than the general population. However, the scores were indicative of the lack of any clinically relevant psychopathological symptoms.
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Affiliation(s)
- Camil Castelo-Branco
- Clinical Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura RiberaTorres
- Clinical Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Esther Gómez-Gil
- Gender Identity Unit, Clinical Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Carme Uribe
- Department of Medicine, Medical Psychology Unit, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Silvia Cañizares
- Department of Clinical Psychology and Psychobiology, Section of Clinical Health Psychology, Clinical Institute of Neurosciences, Hospital Clinic., University of Barcelona, Barcelona, Spain
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Turan Ş, Boysan M, Tarakçıoğlu MC, Sağlam T, Yassa A, Bakay H, Demirel ÖF, Tosun M. 2D:4D Digit Ratios in Adults with Gender Dysphoria: A Comparison to Their Unaffected Same-Sex Heterosexual Siblings, Cisgender Heterosexual Men, and Cisgender Heterosexual Women. Arch Sex Behav 2021; 50:885-895. [PMID: 33694048 DOI: 10.1007/s10508-021-01938-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
We compared gender dysphoria (GD) patients and their same-sex siblings in terms of their 2D:4D ratios, which may reflect prenatal exposure to androgen, one of the possible etiological mechanisms underlying GD. Sixty-eight GD patients (46 Female-to-Male [FtM]; 22 Male-to-Female [MtF]), 68 siblings (46 sisters of FtMs; 22 brothers of MtFs), and 118 heterosexual controls (62 female; 56 male) were included in the study. FtMs were gynephilic and MtFs were androphilic. We found that 2D:4D ratios in the both right hand (p < .001) and the left hand (p = .003) were lower in male controls than in female controls. Regarding right hands, FtM GD patients had lower 2D:4D ratios than female controls (p < .001) but their ratios did not differ from those of their sisters or male controls. FtM GD patients had no significant difference in their left-hand 2D:4D ratios compared to their sisters or female and male controls. While there was no significant difference in right hands between FtM's sisters and male controls, left-hand 2D:4D ratios were significantly higher in FtM's sisters (p = .017). MtF GD patients had lower right-hand 2D:4D ratios than female controls (p <.001), but their right-hand ratios did not differ from those of their brothers and male controls. There was no significant difference in left-hand 2D:4D ratios between MtF GD patients, and their brothers, or female and male controls. FtM GD patients showed significantly masculinized right-hand 2D:4D ratios, while there was no evidence of feminization in MtF GD patients.
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Affiliation(s)
- Şenol Turan
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey.
| | - Murat Boysan
- Department of Psychology, Faculty of Social Sciences and Humanities, Ankara Social Sciences University, Ankara, Turkey
| | - Mahmut Cem Tarakçıoğlu
- Department of Child and Adolescent Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tarık Sağlam
- Department of Psychiatry, Halil Şıvgın Çubuk State Hospital, Ankara, Turkey
| | - Ahmet Yassa
- Department of Psychiatry, Yozgat State Hospital, Yozgat, Turkey
| | - Hasan Bakay
- Department of Psychiatry, Nizip State Hospital, Gaziantep, Turkey
| | - Ömer Faruk Demirel
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey
| | - Musa Tosun
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey
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41
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Mavromati M. [Endocrine care of gender-incongruent persons]. Rev Med Suisse 2021; 17:24-28. [PMID: 33443826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health care of gender-incongruent persons deserves optimization. The new World Health Organization ICD-11, introduced this year, classifies gender-incongruence to « conditions related to sexual health », and not anymore to « mental and behavioral disorders ». From an endocrine perspective, gender-affirming hormonal treatment induces physical changes consistent with gender identity, but good-quality, long follow-up studies concerning efficacy and safety are needed. Improvements in training of medical professionals as well as a specialized multidisciplinary approach are important measures to be taken.
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Affiliation(s)
- Maria Mavromati
- Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, HUG, 1211 Genève 14
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42
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Pamfile D, Soldati L, Brovelli S, Pécoud P, Ducommun I, Micali N, Stiefel F, Plessen KJ, Morisod M, Typaldou S. [Role of the psychiatrist-psychotherapist in the assessment and treatment of gender dysphoria]. Rev Med Suisse 2020; 16:1877-1880. [PMID: 33026731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article is the result of the joint work of psychiatrists-psychotherapists working with patients with gender dysphoria (children, adolescents and adults) in Lausanne and Geneva university hospitals. It emphasizes the importance of their clinical interventions when hormone therapy and sex reassignment surgery are requested.
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Affiliation(s)
- Dana Pamfile
- Consultation dysphorie de genre, Service de psychiatrie de liaison, Département de psychiatrie, CHUV, 1011 Lausanne
| | - Lorenzo Soldati
- Consultation spécialisée de sexologie, Service des spécialités psychiatriques, HUG, 1211 Genève 14
| | - Sebastien Brovelli
- Consultation dysphorie de genre, Service de psychiatrie de liaison, Département de psychiatrie, CHUV, 1011 Lausanne
| | - Pascale Pécoud
- Consultation dysphorie de genre, Service de psychiatrie de liaison, Département de psychiatrie, CHUV, 1011 Lausanne
| | - Isaline Ducommun
- Service de psychiatrie de l'enfant et de l'adolescent, HUG, 1211 Genève 14
| | - Nadia Micali
- Service de psychiatrie de l'enfant et de l'adolescent, HUG, 1211 Genève 14
| | - Friedrich Stiefel
- Consultation dysphorie de genre, Service de psychiatrie de liaison, Département de psychiatrie, CHUV, 1011 Lausanne
| | - Kerstin Jessica Plessen
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, Département de psychiatrie, CHUV, 1011 Lausanne
| | - Mathilde Morisod
- Pédopsychiatrie de liaison, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Département de psychiatrie, CHUV, 1011 Lausanne
| | - Sophia Typaldou
- Pédopsychiatrie de liaison, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Département de psychiatrie, CHUV, 1011 Lausanne
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Abstract
Over the last decade, we have witnessed considerable progress in gender dysphoria (GD) terminology in an attempt to better describe the condition based on certain criteria. The ever-increasing social acceptance and destigmatization of children and adolescents with GD have resulted in an increased number of transgender individuals seeking endocrine care. In addition to terminology and diagnostic criteria, the tremendous progress of genetics and neuroimaging has enabled us to have a deeper understanding of the complex pathogenesis of GD. Although helpful guidelines for treatment with GnRH analogs and gender-affirming hormones have been proposed, several challenges and controversies still exist. In this article, the current knowledge about GD in adolescents is reviewed, with particular emphasis on terminology, clinical manifestations, and epidemiologic data. The neurobiological basis of the condition is presented, and both hormonal treatment and mental issues of transgender individuals are discussed. Undoubtedly, further research will optimize the diagnostic and therapeutic approach of children and adolescents with GD.
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Affiliation(s)
- Nicos Skordis
- Division of Pediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus.
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus.
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK
| | - Shai Dror
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Avital Mushailov
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Nicolas C Nicolaides
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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44
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Kameg B. Gender Dysphoria in United States Veterans and Military Personnel: Historical Context and Current Policies. J Psychosoc Nurs Ment Health Serv 2020; 58:5-8. [PMID: 32286667 DOI: 10.3928/02793695-20200403-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/04/2020] [Indexed: 11/20/2022]
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45
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Latack K, Adidharma W, Nolan IT, Crowe CS, Sowder LL, Satterwhite T, Morrison SD. Staying on Top of Breast Implant Illness: An Analysis of Chest Feminization Experiences. Plast Reconstr Surg 2020; 145:885e-886e. [PMID: 32221263 DOI: 10.1097/prs.0000000000006691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kyle Latack
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Widya Adidharma
- Section of Plastic Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Mich
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, N.Y
| | - Christopher S Crowe
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | | | | | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
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46
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Meyer G, Mayer M, Mondorf A, Herrmann E, Bojunga J. Increasing normality-persisting barriers: Current socio-demographic characteristics of 350 individuals diagnosed with gender dysphoria. Clin Endocrinol (Oxf) 2020; 92:241-246. [PMID: 31821578 DOI: 10.1111/cen.14140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The number of individuals requesting medical treatment for gender dysphoria has increased significantly within the past years. Our purpose was to examine current biographic and socio-demographic characteristics and aspects of legal gender reassignment. DESIGN Medical files from n = 350 individuals of a German Endocrine outpatient clinic were collected from 2009 to 2017 and analysed retrospectively. RESULTS Ratio of transwomen to transmen equates to 1:1.89 with a remarkable increase of transmen by the year 2013, showing a reversal of gender distribution compared with previous studies for the first time. Use of illegal substances or self-initiated hormone therapy was rare (4.6 and 2.1%). Satisfaction with gender-affirming hormone therapy was significantly higher in transmen than in transwomen (100% vs 96.2%, P = .005). Use of antidepressants declined significantly after onset of hormone treatment in transmen (13% vs 7%; P = .007). The number of individuals with a graduation diploma was only about half as high as in the general population (14.3% vs 27.3%), whereas unemployment rate was more than twice as high (14% vs 6.9%). Median latency between application for legal gender reassignment and definitive court decision was 9 months. CONCLUSIONS Our data provide possible indications for a decline of psychosocial burden in individuals diagnosed with gender dysphoria over the last years. However, affected individuals are still limited in their occupational and financial opportunities as well as by a complex and expensive procedure of legal gender reassignment in Germany.
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Affiliation(s)
- Gesine Meyer
- Division of Endocrinology, Department of Internal Medicine 1, Goethe-University Hospital, Frankfurt, Germany
| | - Moritz Mayer
- Division of Endocrinology, Department of Internal Medicine 1, Goethe-University Hospital, Frankfurt, Germany
| | - Antonia Mondorf
- Division of Endocrinology, Department of Internal Medicine 1, Goethe-University Hospital, Frankfurt, Germany
| | - Eva Herrmann
- Institute for Biostatistics and Mathematic Modelling, Goethe-University, Frankfurt, Germany
| | - Jörg Bojunga
- Division of Endocrinology, Department of Internal Medicine 1, Goethe-University Hospital, Frankfurt, Germany
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Abstract
As a matter of ethics and law, adults enjoy wide berth in securing hormonal and surgical interventions to align their bodies with their desired gender appearance. In contrast, the exercise of choice by minors is more constrained, because they can be less well situated to grasp the nature and consequences of interventions having life-long effects. Even so, some minors hope for body modifications prior to adulthood. Starting very young, some minors may assert atypical gender identity: those with female-typical bodies assert a male identity and those with male-typical bodies assert a female identity. This assertion of identity is atypical only in a descriptive sense, because it is uncharacteristic, not because it is normatively unacceptable. Not all minors persist in their atypical gender identities, but some do. For those who do, it is desirable to minimize unwanted secondary sex characteristics and to maximize desired secondary sex characteristics. I outline here a theory of respect for decisions by minors in regard to hormonal and surgical interventions that help align their bodies with their gender identity. Of particular ethical interest here are body modifications for fertility preservation since certain interventions in the body can leave people unable to have genetically related children. In general, I will show that the degree of respect owed to minors in regard to body modifications for gender identity expression should be scaled according to their decision-making capacities, in the context of robust practices of informed consent.
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Affiliation(s)
- Timothy F Murphy
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL, USA
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48
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Holt NR, Huit TZ, Shulman GP, Meza JL, Smyth JD, Woodruff N, Mocarski R, Puckett JA, Hope DA. Trans Collaborations Clinical Check-In (TC 3): Initial Validation of a Clinical Measure for Transgender and Gender Diverse Adults Receiving Psychological Services. Behav Ther 2019; 50:1136-1149. [PMID: 31735248 PMCID: PMC7405917 DOI: 10.1016/j.beth.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 01/07/2023]
Abstract
One key aspect of evidence-based psychological services is monitoring progress to inform treatment decision making, often using a brief self-report measure. However, no such measure exists to support measurement-based care, given the distinct needs of transgender and gender diverse people (TGD), a group facing large documented health disparities and marginalization in health care. The purpose of the present study was to develop and provide initial psychometric validation of a short, behavioral health progress monitoring self-report measure, the Trans Collaborations Clinical Check-in (TC3). TGD communities, providers identified as TGD-affirmative, and relevant academic experts contributed to item and scale development. The final 18-item version was administered to 215 TGD adults (75 transfeminine, 76 transmasculine, 46 nonbinary, 18 unknown; mean age of 30 with a range of 19 to 73), who were recruited for an online study, with other questionnaires assessing negative affect, well-being, gender dysphoria, gender minority stressors, and resilience. Higher scores on the TC3 (indicating better adjustment and comfort with gender) were generally associated with lower depression, anxiety, minority stress, and gender dysphoria and greater life satisfaction, body congruence, and positive aspects of being TGD such as pride in identity and community belongingness. These results support the validity of the TC3 as a brief measure to be used as a clinical tool for TGD people receiving mental health services. Additional research is needed on the reliability and validity of the TC3 across multiple time points to determine utility as a progress monitoring measure. The TC3 should also be further validated with more culturally diverse samples.
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Rydelius PA, Frisén L, Halldin-Stenlid M, Söder O, Dhejne C, Arver S. [Not Available]. Lakartidningen 2019; 116:FR6P. [PMID: 31613371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Per-Anders Rydelius
- Karolinska Institutet - Institutionen för kvinnors och barns hälsa Stockholm, Sweden -
| | - Louise Frisén
- Karolinska Institutet - Institutionen för klinisk neurovetenskap Stockholm, Sweden - Department of Clinical Neuroscience Stockholm, Sweden
| | - Maria Halldin-Stenlid
- Karolinska Institutet - Womens' and Children's Health Stockholm, Sweden Karolinska Institutet - Womens' and Children's Health Stockholm, Sweden
| | - Olle Söder
- Karolinska Institutet - Institutionen för kvinnors och barns hälsa Stockholm, Sweden - Stockholm, Sweden
| | - Cecilia Dhejne
- Karolinska Universitetssjukhuset - ANOVA Stockholm, Sweden - , Sweden
| | - Stefan Arver
- Karolinska Universitetssjukhuset - ANOVA Stockholm, Sweden
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50
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Landen M. [Dramatic increase in adolescent gender dysphoria requires careful consideration]. Lakartidningen 2019; 116:FSMH. [PMID: 31613373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The incidence of gender identity diagnoses in persons younger than 20 years old has increased more than 20 times in Sweden during a 10-year period. The reason for this is unknown, but new categories of patients seeking care or lower diagnostic thresholds are conceivable explanations. Even though gender-confirming health care is believed to ease gender dysphoria and improve quality of life in carefully selected cases, the long-term outcomes of this wider group of patients are unknown. In order to not harm patients, irreversible medical procedures should be used with caution and in the context of clinical trials given the limited evidence base for medical interventions in this group.
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Affiliation(s)
- Mikael Landen
- Institutionen för neurovetenskap och fysiologi, Göteborgs universitet - Sektionen för psykiatri och neurokemi Göteborg, Sweden Institutionen för neurovetenskap och fysiologi, Göteborgs universitet - Sektionen för psykiatri och neurokemi Göteborg, Sweden
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