A Cross-Sectional Multicenter Study of Multidimensional Body Image in Adolescents and Adults with Gender Dysphoria Before and After Transition-Related Medical Interventions

Abstract

Persistent feelings of gender dysphoria (GD) are accompanied by distress and body dissatisfaction in most clinically referred adolescents and adults. Transition-related medical interventions (e.g., puberty suppression, hormones, or surgery) may alleviate body dissatisfaction. The aim of the present cross-sectional study was to compare multidimensional body image across clinically referred adolescents and adults undergoing different transition-related medical interventions. Two clinical samples of adolescents (n = 82) and adults (n = 120) referred to specialized departments of four different transgender health services in Germany participated in the study. In total, 202 individuals from the female-to-male (FtM individuals) and male-to-female (MtF individuals) spectrum aged 14-74 years were included at different stages of their transition. Four scales assessing multidimensional aspects of body image (measured by the Body Image Assessment Questionnaire, FBeK) were compared across three groups: sample, gender, and medical interventions (while controlling for age and treatment duration). The results indicated less favorable body image scores compared with the norm in both adolescents and adults with GD. Individuals who had undergone transition-related medical interventions presented a significantly better body image on two of the four scales. Differences according to gender and age were also present. These findings suggest that medical interventions, especially gender-affirming hormones and surgery, are generally beneficial to the body image in individuals with GD. However, not all of the less favorable outcomes in multidimensional body image were positively influenced by the treatment conditions and may thus benefit from additional integrative counseling before and during transition.

Sexuelle Erfahrungen und sexuelle Orientierung von Transgender-Jugendlichen

“…Vor diesem Hintergrund bedeutet die sexuelle Identitätsentwicklung, die in der Regel ebenfalls mit dem Eintritt in die Pubertät beginnt, für Jugendliche mit einer Geschlechtsdysphorie oft eine besondere Herausforderung. Entsprechend lassen beeinträchtigte Gefühle bezüglich der eigenen Attraktivität und des Selbstbewusstseins sowie von verstärkt körperlichsexuellem Missempfinden, wie sie in einer Studie zum Körperbild von Becker et al (2018) berichtet wurden, massive Auswirkungen auf das Sexualverhalten dieser spezifischen Gruppe vermuten. Dennoch liegen zum aktuellen Zeitpunkt bis auf eine Studie von Bungener et al (2017) aus den Niederlanden keine empirischen Unter-Lebensqualität assoziiert wurden dabei drei Faktoren: wenig depressive Symptome zu haben, in einer festen Partnerschaft zu sein und eine geschlechtsangleichende hormonelle Behandlung zu erhalten.…”

“…Vor dem Hintergrund, dass die körperlichen Veränderungen der Pubertät für Transgender-Jugendliche in den meisten Fällen als unangenehm empfunden werden und den daraus folgenden Leidensdruck entsprechend verstärken können, lässt sich vermuten, dass es ihnen Schwierigkeiten bereitet, den eigenen Körper lustvoll in das soziosexuelle Leben zu integrieren (vgl. auch Becker et al 2018). Insofern ist es verständlich, dass Transgender-Jugendliche gewisse sexuelle Verhaltensweisen (v. a.…”

A Proposed Approach Treating Gender Dysphoria Through Body Image Therapy

“…Therefore, as there is no other existing treatment for GD, yet the constant body dissatisfaction is one of the main symptoms of GD (Becker, Auer, Barkmann, Fuss, Möller, Nieder et al, 2018), we are making an assumption that a body-image related therapy can be helpful for individuals who are experiencing GD. Currently, existing body image therapy are used for eating disorder treatment, so the rest of the text will discuss how to utilize this approach for transgender populations.…”

“…There exist important parallels between the physical and mental conditions associated with GD and eating disorder; for most clients, both disorders require medical assessment and monitoring, as well as psychological treatments (Cook-Cottone, 2015;Becker, Auer, Barkmann, Fuss, Möller, Nieder et al, 2018). Additionally, clients diagnosed with eating disorders and GD both require a change in their current physical status.…”

“…Therefore, some of the transgender population will have the desire to use medical treatments to help them achieve physical appearance that is in alignment with their chosen gender. Transitionrelated medical treatments, including puberty blockers, hormones, or surgeries may help to alleviate the body dissatisfaction, and therefore, may help to alleviate GD (Becker, Auer, Barkmann, Fuss, Möller, Nieder et al, 2018).…”