Individual Treatment Progress Predicts Satisfaction with Transition-Related Care for Youth with Gender Dysphoria: A Prospective Clinical Cohort Study

Abstract

Background The number of adolescents presenting with gender dysphoria (GD) in healthcare services has increased significantly, yet specialized services offering transition-related care (TRC) for trans youth is lacking. Aim To investigate satisfaction with TRC, regret, and reasons for (dis)satisfaction with transition-related medical interventions (TRMIs) in trans adolescents who had presented to the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS). Methods Data were collected from a clinical cohort sample of 75 adolescents and young adults diagnosed with GD (81% assigned female at birth) aged 11 to 21 years (M = 17.4) at baseline and follow-up (on a spectrum of ongoing care, on average 2 years after initial consultation). To determine progress of the youth’s medical transitions, an individual treatment progress score (ITPS) was calculated based on number of desired vs received TRMIs. Outcomes Main outcome measures were satisfaction with TRC at the time of follow-up, ITPS, social support, reasons for regret and termination of TRC, and (dis)satisfaction with TRMIs. RESULTS Participants underwent different stages of TRMIs, such as gender-affirming hormone treatment or surgeries, and showed overall high satisfaction with TRC received at the Hamburg GIS. Regression analysis indicated that a higher ITPS (an advanced transition treatment stage) was predictive of higher satisfaction with TRC. Sex assigned at birth, age, and time since initial consultation at the clinic showed no significant effects for satisfaction with TRC, while degree of social support showed a trend. No adolescents regretted undergoing treatment at follow-up. Additional analysis of free-text answers highlighted satisfaction mostly with the physical results of TRMI. Clinical Implications Because youth were more satisfied with TRC when their individual transition (ITPS) was more progressed, treatment should start in a timely manner to avoid distress from puberty or long waiting lists. Strengths and Limitations This study is one of the first to report on treatment satisfaction among youth with GD from Europe. The ITPS allowed for a more detailed evaluation of TRMI wishes and experiences in relation to satisfaction with TRC and may close a gap in research on these treatments in adolescent populations. However, all participants were from the same clinic, and strict treatment eligibility criteria may have excluded certain trans adolescents from the study. Low identification rates with non-binary identities prevented comparisons between non-binary and binary genders. CONCLUSION The study highlights the role of TRMI and individual treatment or transition progress for youth’s overall high satisfaction with TRC received at the Hamburg GIS.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…While marked and sustained gender incongruence should be present, it is not necessary for TGD people to experience severe levels of distress regarding their gender identity to access gender- affirming treatments. In fact, access to gender-affirming treatment can act as a prophylactic measure to prevent distress (Becker et al., 2018 ; Giovanardi et al., 2021 ; Nieder et al., 2021 ; Nobili et al., 2018 ; Robles et al., 2016 ). A TGD adult can have sustained gender incongruence without significant distress and still benefit from GAMSTs.…”

“…Nieder et al. ( 2021 ) studied satisfaction with care as an outcome measure and demonstrated transgender adolescents were more satisfied the further they progressed with the treatments they initially started. Hisle-Gorman et al.…”

Transgender, Geschlechtsinkongruenz und Geschlechtsdysphorie bei Kindern und Jugendlichen

“…Dennoch wird der eingeschlagene Behandlungsweg mit geschlechtsangleichenden Eingriffen nur in den seltensten Fällen bereut. Auch die Jugendlichen in der Hamburger Längsschnittuntersuchung berichteten kein Bereuen der erfolgten Behandlungsschritte, sondern stattdessen eine steigende Zufriedenheit mit der Versorgung in der besuchten Gender-Klinik in Abhängigkeit davon, wie viele von den gewünschten Maßnahmen sie bereits erhalten hatten 19 .…”

Gender affirming hormonal treatment in Danish transgender persons: A nationwide register‐based study

“…Knowledge is limited regarding the prescription pattern of GAHT 5 . The rate of discontinuation of GAHT is considered low in transgender persons, 6 but previous studies were performed in selected study cohorts 5,7 . Prescription and use of hormonal treatment in transgender persons without contact to a CGI remains to be determined.…”