Reidentification With Birth-Registered Sex in a Western Australian Pediatric Gender Clinic Cohort

Cavve, Blake S.; Bickendorf, Xander; Ball, Jack; Saunders, Liz A.; Thomas, Cati S.; Strauss, Penelope; Chaplyn, Georgia; Marion, Larissa; Siafarikas, Aris; Ganti, Uma; Wiggins, Aaron; Lin, Ashleigh; Moore, Julia K.

doi:10.1001/jamapediatrics.2024.0077

“…Currently, there is no mutually agreed upon or uniform conceptualization for discontinuation/ detransition, with some studies using either very narrow or more expansive definitions. In the last few years, many studies examining discontinuation of gender-affirming medical treatments, detransition, and gender identity fluidity have been published, and the current study extends this literature [6,[59][60][61][62]. Given its community-driven design and large heterogenous sample, the DARE study is well-positioned to explore new questions about discontinuation/detransition experiences, including associations with sex/gender, age, race/ethnicity, minority stressors, healthcare access, and other life experiences.…”

Section: Discussionsupporting

confidence: 62%

“…Transgender and gender-diverse (TGD) people may stop taking gender-related hormonal treatments for a range of reasons, and it is important to recognize that detransition is discrete from-but sometimes overlaps with-temporary or permanent discontinuation of gender-related medical care. Depending on definitions and measurement decisions, studies conducted in the US, England, Australia, and the Netherlands estimate that between 1-13.1% of TGD people experience detransition at some point in their lives [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Sampling with Sisyphus: Introducing a community-driven study designed to reach hidden sexual and gender minority populations with experiences of gender detransition (Preprint)

MacKinnon,

Khan,

Newman

et al. 2024

Preprint

0

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BACKGROUND The myth of Sisyphus teaches about adversity and resilience in the face of challenges on the path of life. Discontinuation/detransition following an initial gender transition are emerging experiences requiring of sensitive and community-driven research in North American contexts. Yet, there are significant complexities and costs that researchers must confront to collect reliable data to better understand this emerging population, including a lack of a uniform definition. OBJECTIVE This paper presents the sampling, survey design, and recruitment methods of a new study to guide future researchers studying detransition-related phenomena. We present a novel protocol for identifying and removing bots/scam/ineligible responses from survey datasets and share preliminary descriptive socio-demographic results of the sample. This analysis does not present gender-affirming healthcare outcomes on satisfaction/regret with gender transition. METHODS To attract a large and heterogenous sample, 3 different study flyers in English, French, and Spanish were created. Between 12/1/2023 to 4/30/2024, flyers were distributed to > 615 sexual and gender minority (SGM) serving organizations and gender care providers in the United States and Canada, and via social media advertisements totaling more than $7400 CAD. Though many social media promotions were rejected or removed, study advertisements reached over 7.7 million accounts. Study website visitors were directed from 35 different traffic sources, with the top five being Facebook (46%), direct link (29%), Reddit (13%), Instagram (6%), and X/Twitter (3%). A systematic protocol was developed to identify scam/nonsense/ineligible responses and conduct virtual screening with select participants. RESULTS Out of 1,377 completed survey responses and after applying the exclusion and screening protocol, 962 (70%) were determined to be eligible and included in the analytic dataset. The mean age of the sample was 25.9 years (median age = 24). A majority of participants were racially white, living in the US (73.5%), and assigned female at birth (78.8%). Most participants reported having a sexual minority identity, with over half the sample indicating plurisexual orientations, such as bisexual, pansexual, or queer identities. Twelve percent were straight/heterosexual. When asked about gender-diverse identities after stopping/reversing their gender transition, 33.6% considered themselves nonbinary, 43.8% reported being transgender, and 41% said they were detransitioned. CONCLUSIONS Despite challenges encountered during study promotion and data collection phases, a heterogenous sample of nearly 1000 eligible participants was obtained, presenting opportunities for future analyses to better understand these diverse, largely SGM experiences. This study is among the first to introduce an innovative strategy to sample a hard-to-reach, politicized, and equity-deserving group that currently lacks a consistent definition. Future analyses will prioritize characterizing and better defining discontinuation/detransition to build theoretical and care provider-orientated knowledge. CLINICALTRIAL Not applicable

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“…In Reply We appreciate the correspondence of Wright and colleagues and McDeavitt in response to our recent article . McDeavitt’s letter emphasizes the importance of multidisciplinary care, as practiced at the Child and Adolescent Health Service Gender Diversity Service (GDS) and favorably contrasts GDS procedure with the World Professional Association for Transgender Health Standards of Care 8 (SOC 8) and assumed requirements of “pediatric gender medicine clinics in North America.”…”

mentioning

confidence: 99%

Further Considerations on Gender-Affirming Care—Reply

Cavve,

Lin,

Moore

2024

JAMA Pediatr

0

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To the Editor As Cavve et al 1 note, there is a paucity of research looking at longer-term gender identity development in adolescents who have received hormonal interventions. This article, 1 therefore, is extremely important. The authors are to be commended for their (successful) attempt to follow up the treatment courses for young people receiving hormonal interventions, and for their recognition that experiences of birth sex reidentification and treatment cessation exist and should be formally studied. Another laudable point they recognize is that gender identity trajectories can change over time, and that such change, including what the authors term reidentification with birth sex, is not necessarily a negative experience. The reidentification term may be a useful one to add to a growing lexicon that includes words like detransition and desistance, which, as noted by the authors, lack uniform definition.This article describes a multidisciplinary pediatric gender team and regimen that includes a psychologist, a psychiatrist, a comprehensive mental health assessment over several appointments, thorough education, and family discussions. Furthermore, this treatment team considers gender-affirming hormones only after multidisciplinary team consensus and if the patient has had a 2-year period of "expressing a clear and stable gender identity." 1 This level of comprehensive care exceeds the standard set by the World Professional Association for Transgender Health 2 and endorsed by US medical organizations, 3,4 which require a single biopsychosocial evaluation by a mental health professional. 2 It is unclear if elements described in this article, including comprehensive and thorough assessment, multidisciplinary team involvement, and strict eligibility criteria, are commonplace among pediatric gender medicine clinics in North America. For example, a recent study by Tordoff et al 5 described "prerequisite mental health evaluations" with a negative connotation, suggesting that any requirement for mental health assessment prior to purveyance of hormones may be pathologizing. That study, in contrast to the clinic model described above, 1 described a process whereby a patient or family had 1 phone call with a social worker prior to being scheduled for an appointment with a medical professional. 5 The contrast between the model of care delivery described in the present study 1 and the one exemplified in the article by Tordoff et al 5 needs to be taken into account. Stated another way, in the present study, 24 patients reidentified with birth sex during a comprehensive, nonjudgmental, nonpathologizing, mental health assessment. If these 24 patients had been seen in a setting that put less emphasis on careful evaluation and more priority on expedient access to hormonal intervention, negative gender trajectory experiences (including regret) could very well have resulted.

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“…To the Editor As Cavve et al note, there is a paucity of research looking at longer-term gender identity development in adolescents who have received hormonal interventions. This article, therefore, is extremely important.…”

mentioning

confidence: 99%

“…To the Editor As Cavve et al note, there is a paucity of research looking at longer-term gender identity development in adolescents who have received hormonal interventions. This article, therefore, is extremely important. The authors are to be commended for their (successful) attempt to follow up the treatment courses for young people receiving hormonal interventions, and for their recognition that experiences of birth sex reidentification and treatment cessation exist and should be formally studied.…”

mentioning

confidence: 99%

Further Considerations on Gender-Affirming Care

McDeavitt

2024

JAMA Pediatr

0

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To the Editor As Cavve et al 1 note, there is a paucity of research looking at longer-term gender identity development in adolescents who have received hormonal interventions. This article, 1 therefore, is extremely important. The authors are to be commended for their (successful) attempt to follow up the treatment courses for young people receiving hormonal interventions, and for their recognition that experiences of birth sex reidentification and treatment cessation exist and should be formally studied. Another laudable point they recognize is that gender identity trajectories can change over time, and that such change, including what the authors term reidentification with birth sex, is not necessarily a negative experience. The reidentification term may be a useful one to add to a growing lexicon that includes words like detransition and desistance, which, as noted by the authors, lack uniform definition.This article describes a multidisciplinary pediatric gender team and regimen that includes a psychologist, a psychiatrist, a comprehensive mental health assessment over several appointments, thorough education, and family discussions. Furthermore, this treatment team considers gender-affirming hormones only after multidisciplinary team consensus and if the patient has had a 2-year period of "expressing a clear and stable gender identity." 1 This level of comprehensive care exceeds the standard set by the World Professional Association for Transgender Health 2 and endorsed by US medical organizations, 3,4 which require a single biopsychosocial evaluation by a mental health professional. 2 It is unclear if elements described in this article, including comprehensive and thorough assessment, multidisciplinary team involvement, and strict eligibility criteria, are commonplace among pediatric gender medicine clinics in North America. For example, a recent study by Tordoff et al 5 described "prerequisite mental health evaluations" with a negative connotation, suggesting that any requirement for mental health assessment prior to purveyance of hormones may be pathologizing. That study, in contrast to the clinic model described above, 1 described a process whereby a patient or family had 1 phone call with a social worker prior to being scheduled for an appointment with a medical professional. 5 The contrast between the model of care delivery described in the present study 1 and the one exemplified in the article by Tordoff et al 5 needs to be taken into account. Stated another way, in the present study, 24 patients reidentified with birth sex during a comprehensive, nonjudgmental, nonpathologizing, mental health assessment. If these 24 patients had been seen in a setting that put less emphasis on careful evaluation and more priority on expedient access to hormonal intervention, negative gender trajectory experiences (including regret) could very well have resulted.

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Reidentification With Birth-Registered Sex in a Western Australian Pediatric Gender Clinic Cohort

Cited by 6 publications

References 48 publications

Sampling with Sisyphus: Introducing a community-driven study designed to reach hidden sexual and gender minority populations with experiences of gender detransition (Preprint)

Sampling with Sisyphus: Introducing a community-driven study designed to reach hidden sexual and gender minority populations with experiences of gender detransition (Preprint)

Further Considerations on Gender-Affirming Care—Reply

Further Considerations on Gender-Affirming Care

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