Progression of Gender Dysphoria in Children and Adolescents: A Longitudinal Study

Abstract

BACKGROUND AND OBJECTIVES:The progression of gender-expansive behavior to gender dysphoria and to gender-affirming hormonal treatment (GAHT) in children and adolescents is poorly understood. METHODS:A cohort of 958 gender-diverse (GD) children and adolescents who did not have a gender dysphoria-related diagnosis (GDRD) or GAHT at index were identified. Rates of first GDRD and first GAHT prescription were compared across demographic groups.RESULTS: Overall, 29% of participants received a GDRD and 25% were prescribed GAHT during the average follow-up of 3.5 years (maximum 9 years). Compared with youth assigned male sex at birth, those assigned female sex at birth were more likely to receive a diagnosis and initiate GAHT with hazard ratio (95% confidence interval) estimates of 1.3 (1.0-1.7), and 2.5 (1.8-3.3), respectively. A progression to diagnosis was more common among those aged $15 years at initial presentation compared with those aged 10 to 14 years and those aged 3 to 9 years (37% vs 28% vs 16%, respectively). By using the youngest group as a reference, the adjusted hazard ratios (95% confidence interval) for a GDRD were 2.0 (1.3-3.0) for age 10 to 14 years and 2.7 (1.8-3.9) for age $15 years. Racial and ethnic minorities were less likely to receive a diagnosis or be prescribed GAHT.CONCLUSIONS: This study characterized the progression of GD behavior in children and adolescents. Less than one-third of GD youth receive an eventual GDRD, and approximately one-quarter receive GAHT. Female sex at birth, older age of initial GD presentation to medical care, and non-Hispanic white race and ethnicity increased the likelihood of receiving diagnosis and treatment.

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

“…A series of studies conducted over the last several decades, including some with methodological challenges (as noted by Temple Newhook et al., 2018 ; Winters et al., 2018 ) suggest the experience of gender incongruence is not consistent for all children as they progress into adolescence. For example, a subset of youth who experienced gender incongruence or who socially transitioned prior to puberty over time can show a reduction in or even full discontinuation of gender incongruence (de Vries et al., 2010 ; Olson et al., 2022 ; Ristori & Steensma, 2016 ; Singh et al., 2021 ; Wagner et al., 2021 ). However, there has been less research focused on rates of continuity and discontinuity of gender incongruence and gender-related needs in pubertal and adolescent populations.…”

Gender Surgery in Adolescents and Young Adults: A Review of Ethical and Surgical Considerations

“…33,48,49,54 In the largest study published on the topic to date, a 2021 longitudinal cohort of 958 gender-diverse children and adolescents found that 42% of patients diagnosed with gender dysphoria in adolescence proceeded to initiate gender-affirming hormone therapy, compared with 4% of patients diagnosed before age 9. 55 Studies on rates of progression from gender-affirming hormone therapy to surgical intervention remain lacking.…”

LGBTQ+ Perspectives on Conducting Genomic Research on Sexual Orientation and Gender Identity

“…When discussing the prospect of research results that failed to uncover genetic contributions to sexual orientation and gender identities, interviewees’ primary concerns were invalidation of LGBTQ+ identities and experiences along with delegitimization of already-marginalized individuals and groups, all of which speaks to the power of the genetics narrative as the foundation of “real differences” in current society. Interviewees foresaw increased prevalence of harmful practices (e.g., so-called “conversion therapy”) and exacerbation of existing barriers to health care and other resources (e.g., gender affirming medical care) (American Medical Association and Health Professionals Advancing LGBTQ Equality 2019 ; Padula and Baker 2017 ; Wagner et al 2021 ).…”