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Gender-Affirming Care & Transition

Gender-Affirming Care & Transition Research
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Reidentification With Birth-Registered Sex in a Western Australian Pediatric Gender Clinic Cohort


Authors: Cavve, B. S., Bickendorf, X., Ball, J., Saunders, L. A., Thomas, C. S., Strauss, P., Chaplyn, G., Marion, L., Siafarikas, A., Ganti, U., Wiggins, A., Lin, A., & Moore, J. K.
Date of publication: 2024
Journal: JAMA Pediatrics, e240077. doi:10.1001/jamapediatrics.2024.0077

Summary: Some young people who identify as transgender and seek gender-affirming medical care subsequently reidentify with their sex registered at birth. Evidence regarding the frequency and characteristics of this experience is lacking. In this Australian study the research team sought to determine the frequency of reidentification and explore associated characteristics in a pediatric gender clinic setting. They did this by looking at all referrals to the Child and Adolescent Health Service Gender Diversity Service at Perth Children's Hospital between 2014 and 2020. The Gender Diversity Service is the sole statewide specialist service in Western Australia that provides children and adolescents up to age 18 years with multidisciplinary assessment, information, support, and gender-affirming medical care. All closed referrals for this study were audited between May 1, 2021, and August 8, 2022.

The researchers found that 5.3% of referral closures at the PCH Gender Diversity Service (2014-2020) that were closed by the end of 2020 were closed due to reidentification with birth-registered sex. When they cross-referenced with clinical records, they found that that two patients had started gender-affirming medical treatment before re-identification closure. This corresponds to 1% of all those who had received gender-affirming medical treatment.

The researchers concluded that a small proportion of patients, and a very small proportion of those who initiated medical gender-affirming treatment, reidentified with their birth-registered sex during the study period. Longitudinal follow-up studies, including qualitative self-report, are required to understand different pathways of gender identity experience. They stress that all youth should be supported, regardless of future stability or continued evolution of gender identity. It is important that people feel supported and reassured they will continue to receive high quality medical care if they do reidentify with their birth-registered sex. Clinical practice can be enhanced by regular check-ins with all patients regarding satisfaction, current needs, and wishes regarding affirmation.

You can read the study summary only here

Associations among gender-affirming hormonal interventions, social support, and transgender adolescents’ mental health


Authors: Olsavsky, A. L., Grannis, C., Bricker, J., Chelvakumar, G., Indyk, J. A., Leibowitz, S. F., Mattson, W. I., Nelson, E. E., Stanek, C. J., & Nahata, L.
Date of publication: 2023
Journal: Journal of Adolescent Health

Summary: This US study looked at the relationships between the use of gender-affirming hormonal interventions (i.e., puberty blockers, testosterone, estrogen), as well as family and friend social support, on gender diverse teenagers’ reports of their mental health. 75 young people aged between 11 to 18 years who were accessing care from a gender-affirming clinic completed surveys about their anxiety and depression symptoms, self-harm and suicidal thoughts. They also rated their level of support from their family, friends and other significant people. 52% of the participants were receiving gender-affirming hormonal interventions. The researchers found that using hormonal interventions was associated with less anxiety and depressive symptoms, family support was associated with less depressive symptoms and less self-harm, and friend support was associated with less anxiety symptoms and less suicidal thoughts. When young people were using gender-affirming hormonal interventions and having greater support from family and friends they had the better mental health outcomes of the group.

You can read a summary of the study only here

Early access to testosterone therapy in transgender and gender-diverse adults seeking masculinisation: A randomised clinical trial


Authors: Nolan, B. J., Zwickl, S., Locke, P. et al
Date of publication: 2023
Journal: JAMA Network Open, 6(9):e2331919.doi:10.1001/jamanetworkopen.2023.31919

Summary: This Australian study sought to compare the effect of testosterone therapy compared with no treatment on gender dysphoria, depression, and suicidality in transgender and gender-diverse adults seeking masculinization. Observational studies have demonstrated improvements in gender dysphoria and depression following commencement of gender-affirming hormone therapy but there is a lack of randomised controlled trial (RCT) data (often referred to as a ‘gold standard’ experiment). The research team carried out a 3-month RCT, with participants randomised to either immediate testosterone commencement (intervention group) or no treatment (‘standard care’ with a wait list of 3 months prior to commencement). They found that, compared to standard care, the intervention group had a significant reduction in gender dysphoria, depression, and suicidality following testosterone commencement, compared with no treatment. Over half of the study participants receiving testosterone experienced resolution of "thoughts of hurting themselves or that they were better off dead".

The authors have written a blog post about the study which you can access here
You can read the full study here

Gender identity 5 years after social transition


Authors: Olson, K. R., Durwood, L., Horton, R., Gallagher, N. M., & Devor, A.
Date of publication: 2022
Journal: Pediatrics

Summary: This US study investigated the rate of retransition (i.e. changing gender identification) and current gender identity amongst 317 children and young people who identified as gender diverse. The participants were on average just over 8 years of age and had socially transitioned (i.e. changed their gender expression, such as name, hairstyle, clothing etc to better match their gender identity) an average of 5 years ago. The researchers found that an average of 5 years after their initial social transition, 94% identified as a binary trans person, 2.5% had reverted to identifying as cisgender (ie feeling their gender identity matches the sex they were assigned at birth), and 3.5% had moved from identifying as a binary trans identity to identifying as non-binary. They also found it was more common (7.3%) for children to shift in their sense of gender identity over time rather than stop identifying as gender diverse altogether. The researchers concluded that retransitions are infrequent but clinicians and families should be aware that it can happen.

You can access the study summary only here

Expert consensus guidelines for parents and caregivers: navigating early childhood gender identity and expression


Authors: Katz-Wise, S. L., Gordon, A. R., Sharp, K. J., Johnson, N., & Hart, L. M.
Date of publication: 2021
Publisher: Harvard Medical School and Boston Children’s Hospital (U.S.)

Summary: These guidelines were created to help parents and other caregivers of young children better understand gender identity and expression in early childhood. The consensus-based guidelines were developed by 93 expert panellists including gender diverse adults, parents and caregivers of gender diverse children, and clinical and/or academic leaders in the field.

You can access the full guidelines here

Pubertal suppression for transgender youth and risk of suicidal ideation


Authors: Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S.
Date of publication: 2020
Journal: Pediatrics

Summary: This US study examined the association between access to hormones for suppression of puberty during the teenage years and adult mental health outcomes. The researchers asked 20,619 gender diverse adults aged 18 to 36 years whether they had accessed treatment to suppress puberty as teenagers and also asked them to report on their current mental health such as their levels of psychological distress and substance use and history of suicidal thoughts and attempts. They also ruled out other factors that may impact on mental health such as level of family support, age, race, gender identity and education level. The researchers found that those who received treatment with pubertal suppression, when compared with those who wanted it but did not receive it, had lower odds of past-year suicidal thoughts, lifetime suicidal thoughts, and past-month severe psychological distress. The researchers concluded that pubertal suppression for gender diverse teenagers who want this treatment is associated with favourable mental health outcomes.

You can read the full study here

The Amsterdam cohort of gender dysphoria study (1972–2015): trends in prevalence, treatment, and regrets


Authors: Wiepjes, C. M., Nota, N. M., de Blok, C. J. M., Klaver, M., de Vries, A. L. C., Wensing-Kruger, S. A., de Jongh, R. T., Bouman, M. B., Steensma, T. D., Cohen-Kettenis, P., Gooren, L. J. G., Kreukels, B. P. C., & den Heijer, M.
Date of publication: 2018
Journal: The journal of Sexual Medicine

Summary: This study in the Netherlands investigated current rates of gender dysphoria, how frequently gender-affirming treatments were performed, and how many people regretted having treatment by reviewing 6,793 patients’ medical files. This study was conducted in the largest Dutch gender identity clinic, which treats more than 95% of the gender diverse population in the Netherlands. The number of people seeking professional support increased dramatically over recent decades. Of note, of those adults who had gender-affirming surgery, 0.6% of transwomen and 0.3% of transmen were identified as experiencing regret. Of 812 teenagers accessing hormones for puberty suppression, 1.9% chose to discontinue this treatment and to not proceed with further gender-affirming treatment.

You can read a summary of the study only here