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

Marijn Arnoldussen,Arne Popma,Annelou L C De Vries,Anna I R Van Der Miesen,Thomas D Steensma,Jos W R Twisk

doi:10.1007/s00787-019-01394-6

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.

Highlights

Gender dysphoria (GD) is defined as a marked incongruence between a person’s gender identity and the gender assigned at birth accompanied by psychological distress [1]
Our results showed that recent referrals were as often diagnosed with GD as early referrals and started just as often with medical treatment including puberty suppression and/or gender affirming hormone treatment
Our study assured that adolescents referred to a long existing specialized transgender service did not show critical changes in key demographic, psychological, diagnostic, and treatment characteristics over 16 years with the exception of a shift in sex ratio

Summary

Introduction

Gender dysphoria (GD) is defined as a marked incongruence between a person’s gender identity and the gender assigned at birth accompanied by psychological distress [1]. Not all people who experience feelings of GD might be diagnosed with DSM-5’s ‘Gender Dysphoria’, because it is likely that they do not all seek assessment and gender affirmative treatment For this reason and given the lack of systematic epidemiological studies, it is difficult to establish the prevalence of GD. E.g., the Williams institute, a public policy research institute on sexual orientation and gender identity, reports a surveybased prevalence of 0.7% of US adolescents who identify a transgender [4]. Another recent high school sample study that was held amongst 135.760 adolescents under the age of 21 years showed that 0.6% identified as the opposite gender and 3.3% identified as non-binary [5]

Objectives

Methods

Results

Discussion

Conclusion