Adolescent development and psychosocial functioning after starting cross-sex hormones for gender dysphoria.

Purpose: To assess how adolescent development progresses and psychiatric symptoms develop among transsexual adolescents after starting cross-sex hormone treatment.Materials and methods: Retrospective chart review among 52 adolescents who came into gender identity assessment before age 18, were diagnosed with transsexualism and started hormonal gender reassignment. The subjects were followed over the so-called real-life phase of gender reassignment.Results: Those who did well in terms of psychiatric symptoms and functioning before cross-sex hormones mainly did well during real-life. Those who had psychiatric treatment needs or problems in school, peer relationships and managing everyday matters outside of home continued to have problems during real-life.Conclusion: Medical gender reassignment is not enough to improve functioning and relieve psychiatric comorbidities among adolescents with gender dysphoria. Appropriate interventions are warranted for psychiatric comorbidities and problems in adolescent development.

Gender dysphoria in adolescent population: A 5-year replication study.

The aim of this study was to explore whether there has been an increase in prevalence and changes in sex ratio in feelings of gender dysphoria (GD) in an adolescent population in Northern Europe, and to study the impact of invalid responding on this topic. We replicated an earlier survey among junior high school students in Tampere, Finland. All first and second year students, aged 16-18, in the participating schools were invited to respond to an anonymous classroom survey on gender experience during the 2012-2013 school year and in the spring and autumn terms of 2017. Gender identity/GD was measured using the GIDYQ-A. A total of 318 male and 401 female youth participated in 2012-2013, and 326 male and 701 female youth in 2017. In the earlier survey, the GIDYQ-A scores, both among males and females, were strongly skewed toward a cis-gender experience with very narrow interquartile ranges. Of males, 2.2%, and of females, 0.5% nevertheless reported possibly clinically significant GD. The 2017 GIDYQ-A distribution was similarly skewed. The proportion of those reporting potentially clinically significant GD was 3.6% among males and 2.3% among females. Validity screening proved to have a considerable impact on conclusions. GD seems to have increased in prevalence in the adolescent population.

Sexual experiences of clinically referred adolescents with features of gender dysphoria.

Gender dysphoria in adolescence could be expected to be associated with delayed sexual development because of the distress related to the sexual characteristics of the body. However, identity challenges may also increase early and risk-taking sexual behaviours among adolescents with gender dysphoria. We studied sexual experiences among 101 adolescents, attending an adolescent gender identity service, desiring gender reassignment. Their experiences were compared to the sexual experiences of the same-aged population, evaluated in a large adolescent survey. A majority of adolescents with gender dysphoria had been in love or had a crush on somebody. Birth assigned females had experiences of romantic relationships twice as commonly as birth assigned males. Otherwise, there was no statistically significant difference in the adolescents' sexual experiences. About half of the subjects had experiences of kissing, and about 40% had intimate (genital) sexual experiences with a partner. Compared to the general adolescent population, adolescents with gender dysphoria were less experienced. Autism spectrum disorder was associated with more delayed sexual development.

Gender dysphoria in adolescence: current perspectives.

Increasing numbers of adolescents are seeking treatment at gender identity services in Western countries. An increasingly accepted treatment model that includes puberty suppression with gonadotropin-releasing hormone analogs starting during the early stages of puberty, cross-sex hormonal treatment starting at ~16 years of age and possibly surgical treatments in legal adulthood, is often indicated for adolescents with childhood gender dysphoria (GD) that intensifies during puberty. However, virtually nothing is known regarding adolescent-onset GD, its progression and factors that influence the completion of the developmental tasks of adolescence among young people with GD and/or transgender identity. Consolidation of identity development is a central developmental goal of adolescence, but we still do not know enough about how gender identity and gender variance actually evolve. Treatment-seeking adolescents with GD present with considerable psychiatric comorbidity. There is little research on how GD and/or transgender identity are associated with completion of developmental tasks of adolescence.

Current and recalled childhood gender identity in community youth in comparison to referred adolescents seeking sex reassignment.

We studied current (GIDYQ-A) and recalled (RCGI) childhood gender identity among 719 upper secondary school students 401 girls, mean age 17.0 (SD = 0.88) years old and 318 boys, mean age 17.2 (SD = 0.86 years old in Finland. We also compared these dimensions of identity in community youth to same dimensions among adolescent sex reassignment (SR) applicants. Most community youth scored high on the normative, cis-gender end of gender experience (median score 4.9 for boys and 4.9 for girls) and recalled fairly gender typical childhood behaviours and experiences. The girls displayed more gender non-conformity in childhood. Among the boys 2.2% and among the girls 0.5% displayed potentially clinically significant gender dysphoria on the GIDYQ-A. The community youth differed clearly from adolescent SR applicants on current and recalled childhood gender identity (SR applicants were 47, 6 natal boys and 41 natal girls, average ages were 16.4 years old (SD = 0.93) and girls were on average 16.8 years old (SD = 1.0).

Early pubertal timing is common among adolescent girl-to-boy sex reassignment applicants.

OBJECTIVES: The aim of our study was to explore whether gender dysphoria in adolescent girls is associated with early pubertal timing. METHODS: We compared menarcheal timing among 52 adolescent girl-to-boy sex reassignment (SR) applicants with that of 644 adolescent girls who participated in an adolescent population mental health survey. RESULTS: Of the population girls, 21% presented with early (≤11 years), 61% with normative (12-13 years) and 19% with late (≥14 years) menarcheal timing; among the SR applicants, 42% presented with early, 46% with normative and 12% with late menarcheal timing (p = 0.003). The odds ratio for SR applicant girls to have early menarcheal timing was 2.7 (95% confidence interval (CI) 1.3, 5.7), controlling for age and family structure. CONCLUSION: Like emotional and behavioural disorders, gender dysphoria in adolescence is associated in girls with early pubertal timing. The finding is discussed in the light of literature related to pubertal maturation and mental health.

[Adolescents engaging in sexually offending behavior]. / Vahingoittavaan seksuaalikäyttäytymiseen syyllistyvät nuoret.

Sexually offending behavior by adolescents may be directed towards children, age-mates and adults. Neurocognitive and psychiatric disorders and the associated inability to age-related interpersonal relationships and inability to control the sexual desires activated during adolescence may lead a young person to seek inappropriate sexual satisfaction from children. Sometimes the offenses are part of antisocial development. Interventions should be focused on the distorted cognitions and attitudes maintaining the injurious sexual behavior, and on the risk of criminal behavior in general. Pharmacological therapy, mainly with SSRI drugs, has also been tested in adolescents.

Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development.

BACKGROUND: Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development. METHODS: Structured quantitative retrospective chart review and qualitative analysis of case files of all adolescent SR applicants who entered the assessment by the end of 2013. RESULTS: The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common. CONCLUSION: The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.