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

Abstract

The background of this article is to examine whether consecutively transgender clinic-referred adolescents between 2000 and 2016 differ over time in demographic, psychological, diagnostic, and treatment characteristics. The sample under study consisted of 1072 adolescents (404 assigned males, 668 assigned females, mean age 14.6 years, and range 10.1-18.1 years). The data regarding the demographic, diagnostic, and treatment characteristics were collected from the adolescents' files. Psychological functioning was measured by the Child Behaviour Check List and the Youth Self-Report, intensity of gender dysphoria by the Utrecht Gender Dysphoria Scale. Time trend analyses were performed with 2016 as reference year. Apart from a shift in sex ratio in favour of assigned females, no time trends were observed in demographics and intensity of dysphoria. It was found, however, that the psychological functioning improved somewhat over time (CBCL β − 0.396, p < 0.001, 95% CI − 0.553 to − 0.240, YSR β − 0.278, p < 0.001, 95% CI − 0.434 to − 0.122). The percentage of referrals diagnosed with gender dysphoria (mean 84.6%, range 75-97.4%) remained the same. The percentage of diagnosed adolescents that started with affirmative medical treatment (puberty suppression and/or gender-affirming hormones) did not change over time (mean 77.7%; range 53.8-94.9%). These findings suggest that the recently observed exponential increase in referrals might reflect that seeking help for gender dysphoria has become more common rather than that adolescents are referred to gender identity services with lower intensities of gender dysphoria or more psychological difficulties.

Transgender im Jugendalter: Forschungsstand und zukünftiger Forschungsbedarf

“…B. Selbstdefinition als Transgender oder Vorliegen einer entsprechenden Diagnose) bzw. Aktuell berichtet die Klinik in Amsterdam von Zuweisungsraten von 62 % mit bei Geburt weiblichem und 38 % mit männlichem Zuweisungsgeschlecht [25]. Erklärt wurden solche Effekte in der Vergangenheit durch soziale und gesellschaftliche Bedingungen und die unterschiedliche Akzeptanz von non-konformen Geschlechtsrollenverhalten bei Mädchen und Jungen [21,28]: Für männlich geborene Jugendliche sei es -v. a. aufgrund möglicher Erfahrungen von Stigmatisierung -potenziell mit größeren negativen Folgen verbunden, eine weibliche Geschlechtsrolle aufzunehmen als umgekehrt, so Aitken u. Mitarb.…”

“…[28]) -jedoch nicht den aktuelleren Berichten wie jenen aktuellen Zahlen von Arnoldussen u. Mitarb. [25]. Da in Hamburg erst seit 2013 systematische Angaben erhoben werden, lässt sich für den kurzen Zeitraum von etwa 7 Jahren keine Veränderung hinsichtlich des Geschlechterverhältnisses abbilden.…”

Dealing with Moral Challenges in Treatment of Transgender Children and Adolescents: Evaluating the Role of Moral Case Deliberation

“…Over the years, these eligibility criteria have not changed and are also part of the Standards of Care and Endocrine guidelines (Coleman et al, 2012 ; Hembree et al, 2017 ). Also, despite an enormous increase, main characteristics (with the exception of a shift in sex ratio with an overrepresentation of assigned females) of the referrals did not change over the years (Arnoldussen et al, 2019 ). Mental health is an inseparable part of the clinical care of adolescents in the Netherlands.…”

Challenges in Timing Puberty Suppression for Gender-Nonconforming Adolescents

“…However, researchers of this timetrend study did not focus on differences between younger and older referred youth nor on the age of onset of gender nonconformity. In future, more-detailed studies like the one by Sorbara et al 1 and the timetrend study by Arnoldussen et al, 11 researchers should investigate whether older transgender adolescents might include individuals who experience later onset of GI, possibly postpuberty, and with more mental health challenges.…”

“…9,10 A study at the Amsterdam transgender clinic, one of the oldest in the world, whose researchers aimed to gain insight in the possible changes of certain key characteristics of earlier compared with recent applicants, revealed no changes in intensity of gender dysphoria, psychological functioning, and age over time between 2000 and 2016. 11 The only yet-unexplained observed change was a shift in sex ratio in favor of assigned female individuals. However, researchers of this timetrend study did not focus on differences between younger and older referred youth nor on the age of onset of gender nonconformity.…”