Characteristics of Adolescents Referred to a Gender Clinic: Are Youth Seen Now Different from Those in Initial Reports?

Abstract

Background/Aims: To examine characteristics, including mental health comorbidities, among adolescents presenting to a transgender clinic and to compare these data to previous reports. Methods: Retrospective chart review among youth seen at The Hospital for Sick Children between January 2014 and June 2016. Demographic data, clinical characteristics, and mental health comorbidities were assessed. Baseline and repeat blood work were also examined. Results: Charts from 203 adolescents aged 12–18 years were reviewed (156 assigned female at birth [AFAB] (77%) aged 16.3 ± 1.63 years, 47 assigned male at birth [AMAB] aged 16.1 ± 1.70 years). There was no statistically significant difference between gender groups except for Tanner stage (AFAB, mean 4.42 ± 0.8 and AMAB, mean 4.03 ± 1.1, p = 0.040). Individuals from racial/ethnic minority populations were under-represented compared to the background population. Self-report and baseline psychological questionnaires showed high levels of gender dysphoria, mood disorders, and suicidal ideation, with higher levels of anxiety detected on questionnaires among AFAB (p = 0.03). Laboratory abnormalities identified on baseline and repeat testing were minor; on cross-sex hormones, hemoglobin levels increased slightly in AFAB (p = 0.002, highest = 166 g/L) and decreased among AMAB (p = 0.02, lowest = 132 g/L). Conclusion: Our study supports an evolving demographic trend with more AFAB than AMAB youth now presenting to gender clinics. The data also corroborate studies indicating that extensive laboratory testing may not be a necessary part of caring for these youths. Why more AFAB are now presenting to clinic and racial/ethnic minorities are underrepresented is not clear, but these trends have important implications for clinical care and warrant further study.

Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals?

“…So far, one study has examined whether adolescents (N = 203) who were referred to a gender clinic in recent years were different from those in initial reports [18]. In contrast to initial studies, it was found that more birthassigned females than birth-assigned males applied.…”

Mental Health and Timing of Gender-Affirming Care

“…Gender-incongruent (GI) youth often experience gender dysphoria, the distress resulting from the discordance between birth-assigned and experienced gender. 1 These youth face higher rates of mental health problems (including mood and anxiety disorders, self-harm, suicidal ideation, and suicide attempts) [2][3][4][5][6][7][8] than gender-congruent youth. 9,10 GI youth are also more likely to be hospitalized 9 for mental health concerns compared with their gender-congruent peers.…”

“…12,13 Despite these benefits, reports of GI youth seeking GAMC demonstrate that some youth present to care later in adolescence with more pubertal development. [2][3][4][5]14 It is possible that presentation at earlier ages may be associated with fewer mental health concerns. We are aware of one study in which researchers address this question directly: Holt et al 7 reported that youth referred to a gender clinic at age $12 were more likely to have suicidal ideation and attempts, selfharm, and low mood and/or depression than those referred at younger ages.…”

Management of gender dysphoria in adolescents in primary care

“…Recent studies have suggested a change in the sex ratio of adolescents presenting to transgender clinics, with many more youth who are assigned female gender at birth seeking care than those assigned male. [50][51][52] One clinic reported that more than 85% of patients seeking to transition were assigned female gender at birth. 20 A recent Canadian national survey also found a higher proportion of people assigned female gender at birth seeking to transition.…”

“…The likely underrepresentation of minority ethnic and Indigenous youth is one area deserving of much further attention. 52 Practically speaking, the intersection of multiple identities (e.g., ethnicity, race, socioeconomic privilege, geographical location), medical and psychological comorbidities, and transgender identity will affect the resources suggested to youths and their families. Specialized youth groups and mental health organizations may have experience working with these unique populations.…”