Transgender Children and Young People: How the Evidence Can Point the Way Forward

Overview

Journal BJPsych Bull

Publisher Cambridge University Press

Specialty Psychiatry

Date 2022 Feb 18

PMID 35177147

Authors

Philip Graham

Affiliations

Soon will be listed here.

Abstract

The development of gender identity in children from around the age of 3 years is described. Wishes for transgender identity are distinguished from gender-atypical behaviour. Reasons for the recent rise in transgender referrals in the early teen years are discussed. The now widely used protocol developed by the Amsterdam group for assessing transgender children and young people and, where appropriate, offering them puberty blockers, cross-sex hormones and sex reassignment surgery is described. Evidence for the effectiveness of this approach is considered. The competence of young people to give consent to these procedures is discussed. Finally, proposals are made for topics urgently requiring further research.

References

de Vries A, McGuire J, Steensma T, Wagenaar E, Doreleijers T, Cohen-Kettenis P . Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014; 134(4):696-704. DOI: 10.1542/peds.2013-2958. View

Mercer C, Tanton C, Prah P, Erens B, Sonnenberg P, Clifton S . Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet. 2013; 382(9907):1781-94. PMC: 3899021. DOI: 10.1016/S0140-6736(13)62035-8. View

de Vries A . Challenges in Timing Puberty Suppression for Gender-Nonconforming Adolescents. Pediatrics. 2020; 146(4). DOI: 10.1542/peds.2020-010611. View

Mills K, Goddings A, Herting M, Meuwese R, Blakemore S, Crone E . Structural brain development between childhood and adulthood: Convergence across four longitudinal samples. Neuroimage. 2016; 141:273-281. PMC: 5035135. DOI: 10.1016/j.neuroimage.2016.07.044. View

Costa R, Dunsford M, Skagerberg E, Holt V, Carmichael P, Colizzi M . Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria. J Sex Med. 2015; 12(11):2206-14. DOI: 10.1111/jsm.13034. View

Wiepjes C, Nota N, de Blok C, Klaver M, de Vries A, Wensing-Kruger S . The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets. J Sex Med. 2018; 15(4):582-590. DOI: 10.1016/j.jsxm.2018.01.016. View

Offer D . Debunking the myths of adolescence: findings from recent research. J Am Acad Child Adolesc Psychiatry. 1992; 31(6):1003-14. DOI: 10.1097/00004583-199211000-00001. View

Cohen-Kettenis P, Schagen S, Steensma T, de Vries A, Delemarre-van de Waal H . Puberty suppression in a gender-dysphoric adolescent: a 22-year follow-up. Arch Sex Behav. 2011; 40(4):843-7. PMC: 3114100. DOI: 10.1007/s10508-011-9758-9. View

Ruppin U, Pfafflin F . Long-Term Follow-Up of Adults with Gender Identity Disorder. Arch Sex Behav. 2015; 44(5):1321-9. DOI: 10.1007/s10508-014-0453-5. View

10.

Evans M . Freedom to think: the need for thorough assessment and treatment of gender dysphoric children. BJPsych Bull. 2020; 45(5):285-290. PMC: 8596151. DOI: 10.1192/bjb.2020.72. View

11.

Colizzi M, Costa R, Scaramuzzi F, Palumbo C, Tyropani M, Pace V . Concomitant psychiatric problems and hormonal treatment induced metabolic syndrome in gender dysphoria individuals: a 2 year follow-up study. J Psychosom Res. 2015; 78(4):399-406. DOI: 10.1016/j.jpsychores.2015.02.001. View

12.

Wallien M, Cohen-Kettenis P . Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry. 2008; 47(12):1413-23. DOI: 10.1097/CHI.0b013e31818956b9. View

13.

de Vries A, Steensma T, Doreleijers T, Cohen-Kettenis P . Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med. 2010; 8(8):2276-83. DOI: 10.1111/j.1743-6109.2010.01943.x. View

14.

de Graaf N, Giovanardi G, Zitz C, Carmichael P . Sex Ratio in Children and Adolescents Referred to the Gender Identity Development Service in the UK (2009-2016). Arch Sex Behav. 2018; 47(5):1301-1304. DOI: 10.1007/s10508-018-1204-9. View

15.

Golombok S, Rust J, Zervoulis K, Golding J, Hines M . Continuity in sex-typed behavior from preschool to adolescence: a longitudinal population study of boys and girls aged 3-13 years. Arch Sex Behav. 2011; 41(3):591-7. DOI: 10.1007/s10508-011-9784-7. View

16.

Weithorn L, Campbell S . The competency of children and adolescents to make informed treatment decisions. Child Dev. 1982; 53(6):1589-98. View

17.

Kaltiala-Heino R, Sumia M, Tyolajarvi M, Lindberg N . Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child Adolesc Psychiatry Ment Health. 2015; 9:9. PMC: 4396787. DOI: 10.1186/s13034-015-0042-y. View

18.

Carmichael P, Butler G, Masic U, Cole T, De Stavola B, Davidson S . Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLoS One. 2021; 16(2):e0243894. PMC: 7853497. DOI: 10.1371/journal.pone.0243894. View

19.

Olson K, Durwood L, DeMeules M, McLaughlin K . Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics. 2016; 137(3):e20153223. PMC: 4771131. DOI: 10.1542/peds.2015-3223. View

20.

de Vries A, Cohen-Kettenis P . Clinical management of gender dysphoria in children and adolescents: the Dutch approach. J Homosex. 2012; 59(3):301-20. DOI: 10.1080/00918369.2012.653300. View