Research Review: Gender identity in youth: treatment paradigms and controversies

Turban, Jack L.; Ehrensaft, Diane

doi:10.1111/jcpp.12833

Cited by 146 publications

(134 citation statements)

References 117 publications

(145 reference statements)

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“…Despite these reluctances, the introduction of supposedly fully reversible puberty suppression since the beginning of this century, to provide transgender adolescents who enter puberty with time to explore their gender identity, has rapidly become an accepted and widely prescribed medical intervention for adolescents with GD in Northern America (USA and Canada), and in some countries in Europe and Australia/New-Zealand [10,11]. Puberty suppression was first introduced as a part of affirming treatment at the Center of Expertise on Gender Dysphoria in Amsterdam in The Netherlands, and therefore, GD treatment that includes puberty suppression is sometimes referred to as the 'Dutch Model' [12].…”

Section: Introductionmentioning

confidence: 99%

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

Arnoldussen

Steensma

Popma

et al. 2019

Eur Child Adolesc Psychiatry

103

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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.

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Section: Introductionmentioning

confidence: 99%

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

Arnoldussen

Steensma

Popma

et al. 2019

Eur Child Adolesc Psychiatry

103

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“…Turban and Ehrensaft () have provided a thoughtful review of transgender identity in children and adolescents. They have discussed a number of issues about gender identity and have emphasized the benefits of the affirmative approach in maintaining positive psychological health in transgender individuals.…”

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confidence: 99%

Evidence needed to understand gender identity: Commentary on Turban & Ehrensaft (2018)

Berenbaum

2018

Child Psychology Psychiatry

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Turban and Ehrensaft (2018) have provided a thoughtful review of transgender identity in children and adolescents, emphasizing the benefits of the affirmative approach in maintaining positive psychological health in transgender individuals. The review reveals significant gaps in our understanding of gender identity regarding its nature, development, plasticity, causes, and links with other aspects of gender, and of the long‐term benefits and costs of childhood social transitions. A full understanding of transgender identity requires studying cisgender identity too, and recognition that gender identity is continuous, develops across time and is not synonymous with gender expression or variations in gender‐typed characteristics. Considerable evidence is needed before we can be confident that we are providing optimal treatment for children who are gender variant.

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“…Transgender adolescents are individuals who experience marked incongruence between their gender assigned at birth and their gender identity [1]. Adolescents who experience dysphoria related to this incongruence may meet criteria for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis of "gender dysphoria in adolescents and adults" [2].…”

Section: Introductionmentioning

confidence: 99%

“…Transgender adolescents suffer high rates of internalizing psychopathology [6][7][8][9], thought to be secondary to minority stress and dysphoria associated with one's body developing incongruently to one's gender identity [1]. Up to 80% of transgender adolescents are victims of bullying [10], and poor peer relations have been identified as one of the greatest predictors of internalizing problems [11].…”

Section: Introductionmentioning

confidence: 99%

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Identify, Engage, Understand: Supporting Transgender Youth in an Inpatient Psychiatric Hospital

et al. 2019

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Transgender adolescents may require for inpatient psychiatric care, and have unique healthcare needs and can face barriers to quality care. This study sought to address limited understanding of the inpatient experience of transgender adolescents. This study uses qualitative methods to gain insight into the experience of transgender adolescents and psychiatric care providers on an adolescent inpatient psychiatric unit in the northeast United States. Semi-structured interviews were conducted with patients (9 total, ages 13-17) and unit care providers (18 total). These interviews were recorded, transcribed, and analyzed using inductive thematic analysis. Patients and providers generally reported a supportive inpatient environment. Factors that contributed to this environment were efforts by care providers to respect patients regardless of gender identity, to use patient's preferred identifiers, and to acknowledge mistakes in identifier use. Barriers to consistently supportive interactions were also identified, including a lack of consistent identification of a patient's transgender identity in a supportive manner during the admission intake, challenges associated with the presence of birth-assigned name and gender within the care system (e.g. in the electronic medical record, identifying wristbands, attendance rosters), and a lack of formal training of care providers in transgender cultural competency. Interviews also provided insight into how providers grapple with understanding the complexities of gender identity. Findings suggest that gender-affirming approaches by providers are experienced as supportive and respectful by transgender adolescent patients, while also identifying barriers to consistently supportive interactions that can be addressed to optimize care.

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Research Review: Gender identity in youth: treatment paradigms and controversies

Abstract: The field of pediatric gender identity has evolved dramatically. Emerging data suggest that these patients' high rates of anxiety, depression, and suicidality appear to be improved with affirmative protocols, although future longitudinal data are needed.

Cited by 146 publications

References 117 publications

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

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

Evidence needed to understand gender identity: Commentary on Turban & Ehrensaft (2018)

Identify, Engage, Understand: Supporting Transgender Youth in an Inpatient Psychiatric Hospital

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