Gender Dysphoria In Adolescents Research Articles

Time to Gender-Affirming Hormone Therapy Among US Military–Affiliated Adolescents and Young Adults

Use of exogenous sex steroid hormones, when indicated, may improve outcomes in adolescents and young adults with gender incongruence. Little is known about factors associated with the time from diagnosis of gender dysphoria to initiation of gender-affirming hormone therapy. Identification of inequities in time to treatment may have clinical, policy, and research implications. To evaluate factors associated with time to initiation of gender-affirming hormone therapy after a diagnosis of gender dysphoria in adolescents and young adults receiving care within the US Military Health System. This retrospective cohort study used TRICARE Prime billing and pharmacy data contained in the Military Health System Data Repository. Patients aged 14 to 22 years, excluding service members and their spouses, who received a diagnosis of gender dysphoria between September 1, 2016, and December 31, 2021, were included. The data were analyzed between August 30 and October 12, 2023. Included patient characteristics were race and ethnicity, age group, first sex assigned in the medical record, and TRICARE Prime sponsor military rank and service at the time of diagnosis. Health care and contextual characteristics included the year of diagnosis and the primary system in which the patient received health care. The primary outcome was the time between initial diagnosis of gender dysphoria to the first prescription for gender-affirming hormone medication within a 2-year period. A Poisson generalized additive model was used to evaluate this primary outcome. Adjusted probability estimates were calculated per specified reference categories. Of the 3066 patients included (median [IQR] age, 17 [15-19] years; 2259 with first assigned gender marker of female [74%]), an unadjusted survival model accounting for censoring indicated that 37% (95% CI, 35%-39%) initiated therapy by 2 years. Age-adjusted curves indicated that the proportion initiating therapy by 2 years increased by age category (aged 14-16 years, 25%; aged 17-18 years, 39%; aged 19-22 years, 55%). Incidence rate ratios (IRRs) and 2-year adjusted probabilities indicated that longer times to hormone initiation were experienced by adolescents aged 14 to 16 years (IRR, 0.36; 95% CI, 0.30-0.44) and 17 to 18 years (IRR, 0.66; 95% CI, 0.54-0.79) compared with young adults aged 19 to 22 years and Black compared with White adolescents (IRR, 0.73; 95% CI, 0.54-0.99). Senior officer compared with junior enlisted insurance sponsor rank (IRR, 1.93; 95% CI, 1.04-3.55) and civilian compared with military health care setting (IRR, 1.21; 95% CI, 1.02-1.43) was associated with shorter time to hormone initiation. In this cohort study, most adolescents and young adults with a diagnosis of gender dysphoria receiving health care through the US military did not initiate exogenous sex steroid hormone therapy within 2 years of diagnosis. Inequities in time to treatment indicate the need to identify and reduce barriers to care.

Gender dysphoria in adolescence: examining the rapid-onset hypothesis.

The sharp rise in the number of predominantly natal female adolescents experiencing gender dysphoria and seeking treatment in specialized clinics has sparked acontentious and polarized debate among both the scientific community and the public sphere. Few explanations have been offered for these recent developments. One proposal that has generated considerable attention is the notion of "rapid-onset" gender dysphoria, which is assumed to apply to asubset of adolescents and young adults. First introduced by Lisa Littman in a2018 study of parental reports, it describes asubset of youth, primarily natal females, with no childhood indicators of gender dysphoria but with asudden emergence of gender dysphoria symptoms during puberty or after its completion. For them, identifying as transgender is assumed to serve as amaladaptive coping mechanism for underlying mental health issues and is linked to social influences from peer groups and through social media. The purpose of this article is to analyze this theory and its associated hypotheses against the existing evidence base and to discuss its potential implications for future research and the advancement of treatment paradigms.

Polish adaptation of the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA-PL)

Introduction and objective: The aim of the study was to develop a tool to measure the level of gender dysphoria in adolescents and adults, as well as to assess its psychometric properties. Materials and methods: The study attempted a Polish adaptation of the questionnaire to assess dysphoria and gender identification in adolescents and adults (Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults, GIDYQ-AA). It involved 1,780 respondents aged 11 to 73 years, diverse in terms of sex assigned at birth and gender identity. The questionnaire used in the adaptation study consisted of three parts: statistical data, the Hospital Anxiety and Depression Scale (HADS) and the GIDYQ-AA questionnaire translated into Polish. Results: The analysis showed that the structure of the tool is single-factor. Items 4 and 13 of the original tool were removed from the Polish version due to poor correlation with the scale and low factor loadings of these items. The structure equivalence analysis showed that developing general standards could lead to flattening of conclusions from individual measurements. It was decided to create norms taking into account sex and age. The obtained tool has a reliability of 0.97 CR and good validity measured as the correlation coefficient between the level of dysphoria and the level of anxiety, depression and irritability. Conclusions: The adaptation and analysis gave rise to a 25-item tool with high reliability and validity. Unlike the original tool, in-depth statistical analyses allowed for the creation of detailed dysphoria norms for age and sex assigned at birth. The presented questionnaire is a valuable contribution to the system of Polish standards for diagnosing people struggling with gender nonconformity.

Co-occurring Autism Spectrum Disorder and Gender Dysphoria in Adolescents.

Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses. This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis. Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth. Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.

Cortical Structure Differences in Relation to Age, Sexual Attractions, and Gender Dysphoria in Adolescents: An Examination of Mean Diffusivity and T1 Relaxation Time.

Recent research found that the combination of masculine gender identity and gynephilia was associated with cortical T1 relaxation time, which is considered to reflect gray matter density. We hypothesized that mean diffusivity (MD), a diffusion tensor imaging metric that reflects the degree to which water movement is free versus constrained, in combination with T1 relaxation time would provide further insight regarding cortical tissue characteristics. MD and T1 relaxation time were measured in 76 cortical regions in 15 adolescents assigned female at birth who experience gender dysphoria (GD AFAB) and were not receiving hormone therapy, 17 cisgender girls, and 14 cisgender boys (ages 12-17 years). Sexual orientation was represented by the degree of androphilia-gynephilia and the strength of sexual attraction. In multivariate analyses, cortical T1 relaxation time showed a weak but statistically significant positive association with MD across the cortex, suggesting that macromolecule-rich cortical tissue also tends to show water movement that is somewhat more constrained. In further multivariate analyses, in several left frontal, parietal, and temporal regions, the combination of shorter T1 relaxation time and faster MD was associated with older age and greater gynephilia in GD AFAB individuals and cisgender boys and with stronger attractions in cisgender boys only. Thus, for these cortical regions in these groups, older age, gynephilia, and stronger attractions (cisgender boys only) were associated with macromolecule-rich tissue in which water movement was freer-a pattern that some prior research suggests is associated with greater cell density and size. Overall, this study indicates that investigating T1 relaxation time and MD together can further inform how cortical gray matter tissue characteristics relate to age and psychosexuality.

From transidentity to transidentification quick triggering of gender dysphoria in adolescents confronting the malaise of puberty

ObjectivesThis article discusses the new phenomenon of a significant increase in requests for social and even medical transition, mainly from adolescents who identify as trans and often feel uncomfortable in their bodies. In France, as in all industrialized countries, this exponential increase is linked to the use of digital social networks. This phenomenon of transidentification, which we distinguish from gender dysphoria, contrasts with the previous descriptions affecting mainly adult men (who have transitioned in adulthood). We will try to understand this important increase in requests and we will try to understand the meaning of the trans identification of these adolescents. MethodFirst, in order to understand the emergence and the context of appearance of gender dysphoria in the psychological organization of young people, we will rely on studies that have highlighted the psychopathological comorbidities of transidentification. Then, we will present an analysis of certain invariants identified in our clinical practice, based on a group of 26 adolescents, around psychological history, psychic structure, and family functioning. ResultsThese elements will allow us to discuss “transidentification,” which is more a process of identification with the signifier “trans” than a fixed identity and which seems to be a solution to pubertal malaise. We will conclude on the types of psychotherapeutic treatments that seem relevant to these adolescents. DiscussionWhat psychotherapeutic care should be given to these young people? How can we listen to the request for a sex change in a hyper-connected society where images flow in a present time disconnected from history? ConclusionTransidentification is a concept that seems to us to be heuristic to think about the significant and recent increase of adolescents who present a dysphoria that seems more linked to puberty itself than to gender.

Gender dysphoria in adolescents with psychotic disorders – symptom or co-occurring phenomenon?

The occurrence of gender dysphoria symptoms in adolescents presenting psychotic disorders generates great diagnostic and therapeutic difficulties. They are related not only to the question of what is the nature of the reported dissatisfaction with one’s biological sex, but also to the normative period of uncertainty and searching in the process of psychosexual development in a young person. In this context, reaching a decision on gender correction treatment requires a particularly thorough analysis, a precise differential diagnosis and, above all, stabilisation of the psychological state as well as prolonged observation and exclusion of the delusional basis of gender dysphoria. It strikes us as particularly important to provide such patients with appropriate care. Allowing for gender correction, in the absence of a confirmed causal relationship between the two disorders, seems to be an appropriate, although debatable, therapeutic approach. Refusing medical interventions in adolescents in a timely manner poses a significant risk of psychological deterioration, may exacerbate gender dysphoria and contribute to self-representation provoking persecution and stigmatisation, and thus may increase stress levels, which is an important factor in psychotic decompensation.

Psychological factors of gender dysphoria in adolescents: A systematic review

The objective of this research work was to analyze the psychological factors that are present in gender dysphoria in adolescents, due to the importance of approaching psychological clinical practice through intervention strategies. Method: A systematic review was carried out through digital searches in scientific databases such as ProQuest, Elsevier, and PubMed, by structuring a bibliometric type design, the collection of information was based on three crossings in the three databases. selected, including the primary studies and extracting the data to later be interpreted.

A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology.

It is unclear whether the research literature on adolescent gender dysphoria (GD) provides sufficient evidence to adequately inform clinical decision making. In the first of a series of three papers, this study sought to systematically review published evidence regarding: the prevalence of GD in adolescence; the proportions of natal males/females with GD in adolescence and whether this changed over time; and the pattern of age at (a) onset (b) referral and (c) assessment. Having searched PROSPERO and the Cochrane library for existing systematic reviews (and finding none), we searched Ovid Medline 1946 -October week 4 2020, Embase 1947-present (updated daily), CINAHL 1983-2020, and PsycInfo 1914-2020. The final search was carried out on the 2nd November 2020 using a core strategy including search terms for 'adolescence' and 'gender dysphoria' which was adapted according to the structure of each database. Papers were excluded if they did not clearly report on clinically-verified gender dysphoria, if they were focused on adult populations, if they did not include original data (epidemiological, clinical, or survey) on adolescents (aged at least 12 and under 18 years), or if they were not peer-reviewed journal publications. From 6202 potentially relevant articles (post de-duplication), 38 papers from 11 countries representing between 3000 and 4000 participants were included in our final sample. Most studies were observational cohort studies, usually using retrospective record review (26). A few compared to normative or population datasets; most (31) were published in the past 5 years. There was significant overlap of study samples (accounted for in our quantitative synthesis). No population studies are available, so prevalence is not possible to ascertain. There is evidence of an increase in frequency of presentation to services, and of a shift in the natal sex of referred cases: those assigned female at birth are now in the majority. No data were available on age of onset. Within the included samples the average age was 13 years at referral, 15 years at assessment. All papers were rated by two reviewers using the Crowe Critical Appraisal Tool v1·4 (CCAT). The CCAT quality ratings ranged from 45% to 96%, with a mean of 78%. Almost half the included studies emerged from two treatment centres: there was considerable sample overlap and it is unclear how representative these are of the adolescent GD community more broadly. The increase in clinical presentations of GD, particularly among natal female adolescents, warrants further investigation. Whole population studies using administrative datasets reporting on GD / gender non-conformity may be necessary, along with inter-disciplinary research evaluating the lived experience of adolescents with GD.

Gender dysphoria in adolescents with Ehlers-Danlos syndrome.

Ehlers-Danlos Syndrome represents a family of heritable connective tissue disorders that include joint hypermobility, tissue fragility, and skin hyperextensibility. Ehlers-Danlos Syndrome presents with clinical sequela across multiple body systems that require multidisciplinary care. Little is known about adolescents with Ehlers-Danlos Syndrome who are transgender and gender diverse. To date, there have been no reports of transgender and gender diverse youth in pediatric patients with Ehlers-Danlos Syndrome. The objective of this study was to characterize transgender and gender diverse adolescents with Ehlers-Danlos Syndrome seen in a pediatric multidisciplinary specialty clinic. A retrospective chart review was performed and it was found that 28 patients were seen in the Ehlers-Danlos Syndrome multidisciplinary clinic were reported being transgender and gender diverse. Chart review included analysis of all documents in the electronic medical record, including demographic data, gender identity, chosen pronouns, specialty care previously received for Ehlers-Danlos Syndrome, symptoms and conditions related to it, and medications. Of the 166 total adolescents seen in the pediatric multidisciplinary Ehlers-Danlos Syndrome clinic during the study period, 17% reported gender dysphoria. The average age at Ehlers-Danlos Syndrome diagnosis was 13.5 years (range 8-17 years). Most (61%) reported their gender identity as transgender, followed by nonbinary (14%). Most had preferred male (he/him) pronouns (47%), followed by nonbinary (they/them) pronouns (39%). The vast majority reported fatigue (75%), musculoskeletal issues (96%), psychiatric issues (86%), cardiac issues (71%), gastrointestinal issues (68%), and neurologic issues (79%). Here we report the first cohort of transgender and gender diverse adolescents in the Ehlers-Danlos syndrome population and show an association between the two. This report increases awareness for providers who care for patients with Ehlers-Danlos Syndrome. As care for those with Ehlers-Danlos Syndrome is often complex and multidisciplinary, providers should adopt practices of gender-affirming medical care that contribute to improved care and outcomes.

Abstract- Poster

Introduction:Gender dysphoria (GD) is defined as a marked incongruence between their experienced or expressed gender and the one they were assigned at birth.Case summary:A 17-year-old male from low socioeconomic status presented with repeated inclinations to be dressed up and move like a female for the past 11 years and for past 3 months with sleep disturbance, low mood and loss of interest in surroundings, and occasional passive death wishes. There was no physical ambiguity regarding his male sex at birth. During early age, he preferred to play with girls and enjoyed the role, wearing their traditional clothes without getting any sexual pleasure in doing so. Due to this behavior, he was criticized continuously by his father and faced strong opposition from all his relatives when he expressed his wish to become a transgender. He was diagnosed with Gender dysphoria in adolescents and adults with mild depressive episode and treatment was initiated.Discussion:GD occurs when an individual strongly believes that he or she was born with the body of the wrong sex. People suffering from GD were prone to serious illnesses ranging from emotional distress, depression, isolation, and in worst cases, suicide. Hence, there is an urgent need to create awareness to perceive gender expression as a continuum reducing the burden of mental health problems associated with GD.Conclusion:GDD is a difficult condition to deal and treat, especially in individuals with orthodox and low socioeconomic backgrounds.

Clinical Follow-up of Two Adolescents Diagnosed with Gender Dysphoria.

Rapid physical, psychological and sexual changes in adolescents due to the developmental process differentiate the approach to adolescents with gender dysphoria (GD) from the approach to adults. In this article, two adolescents who applied for GD and followed up for a long time are presented. The first case was assigned male at birth and defined herself as female. At the age of fifteen, a gonadotropin-releasing hormone analog was started for puberty suppression, and sex hormone was started in the follow-up. The second case's assigned sex was female and defined himself as male. At the age of sixteen years and six months, puberty suppressive treatment was started, followed by sex hormones. Both cases were able to continue their psychosocial development without any problems after the psychiatric and physical treatments they could reach on time. Although GD in adolescents cannot be resolved with puberty suppression alone, it creates time to resolve the acute problems and to search for appropriate treatment approaches in the future. Puberty suppression partially relieves and prevents the exacerbation of the dysphoria experienced by the youth diagnosed as GD, and creates time to search appropriate treatment approaches in the follow-up. Through these two cases, it is aimed to introduce the gender affirmation processes of adolescents with GD, to discuss the medical interventions in adolescence and the psychosocial effects of the process on individuals. Keywords: Gender dysphoria, gender incongruence, adolescence, gender affirmation process, puberty supression, puberty blockers.

Negotiating Gender in Everyday Life: Toward a Conceptual Model of Gender Dysphoria in Adolescents

A growing number of adolescents are seeking medical care to alleviate gender dysphoria (GD). This qualitative study explored the subjective experiences of GD among help-seeking transgender and gender nonconforming (TGNC) youth in order to develop a more nuanced conceptualization of the phenomenon. Fifteen life-mode interviews were conducted with newly referred youth between the ages of 13 and 19. All participants were assigned female at birth. The data were analyzed using thematic analysis. The participants targeted five major themes that characterize GD: (1) Bodily sensations were constant reminders of GD throughout the day, (2) emotional memories from the past of being different and outside triggered GD, (3) the process of coming out was a transformative experience that changed how the participants understood themselves, (4) GD both increased and decreased in relation to others, (5) everyday life required careful negotiation to feel whole without developing new forms of GD. Based on the results, we suggest a more conceptually nuanced model of GD, one which accounts for how bodily sensations and emotional memories from the past were sources that elicited GD. The sources were mediated through the process of coming out and relating to others, and this resulted in the negotiation of GD today. The conceptual model suggested in the present study could ideally shed light on preexisting knowledge on TGNC youth struggling with GD. In addition, an improved understanding of GD could ideally help clinicians when addressing individual treatment needs.

Gender dysphoria in adolescents: can adolescents or parents give valid consent to puberty blockers?

This article considers the claim that gender diverse minors and their families should not be able to consent to hormonal treatment for gender dysphoria. The claim refers particularly to hormonal...

Dysforia płciowa, niezgodność płciowa i nonkonformizm płciowy w adolescencji – zmiany i wyzwania diagnostyczne

Specjaliści z zakresu psychiatrii, psychoterapii i seksuologii zajmujący się leczeniem i wspieraniem pacjentów nastoletnich, w swojej praktyce mogą dostrzec znaczny wzrost zgłoszeń dotyczących nieakceptowania płci przypisanej przy urodzeniu, kwestionowania jej, odrzucania lub na różne sposoby przeżywania. Chociaż praca z osobami dorosłymi znajdującymi się w spektrum transpłciowości ma historię sięgającą lat 20-tych XX wieku, dysforia płciowa u młodzieży, zwłaszcza w ostatnich latach, jest zjawiskiem, które w swojej złożoności wymyka się próbom ujednolicenia podejść i działań. Wiążące się z tą tematyką kontrowersje często skutkują pochopnymi wnioskami i mylnymi - w ocenie Autorów niniejszego artykułu założeniami - że populacja młodzieży doświadczającej dysforii lub niezgodności płciowej, jest homogeniczna. Tekst porusza następujące aspekty: omówienie zmian w zakresie diagnoz związanych z tożsamością płciową, które zaszły w ostatnich dekadach w klasyfikacjach DSM oraz ICD; zdrowie psychiczne i neuroróżnorodność pacjentów zgłaszających dysforię, dominujące obecnie modele leczenia, wraz z ich zaletami i wadami oraz wyzwania diagnostyczne i terapeutyczne w pracy z tą populacją.

Gender dysphoria in children and adolescents: an overview.

Over the last decade, we have witnessed considerable progress in gender dysphoria (GD) terminology in an attempt to better describe the condition based on certain criteria. The ever-increasing social acceptance and destigmatization of children and adolescents with GD have resulted in an increased number of transgender individuals seeking endocrine care. In addition to terminology and diagnostic criteria, the tremendous progress of genetics and neuroimaging has enabled us to have a deeper understanding of the complex pathogenesis of GD. Although helpful guidelines for treatment with GnRH analogs and gender-affirming hormones have been proposed, several challenges and controversies still exist. In this article, the current knowledge about GD in adolescents is reviewed, with particular emphasis on terminology, clinical manifestations, and epidemiologic data. The neurobiological basis of the condition is presented, and both hormonal treatment and mental issues of transgender individuals are discussed. Undoubtedly, further research will optimize the diagnostic and therapeutic approach of children and adolescents with GD.

Potential association between type 1 diabetes mellitus and gender dysphoria.

Multiple factors have been proposed to explain the increasing prevalence of type 1 diabetes mellitus (T1DM), including psychological stress. The prevalence of gender dysphoria (GD) in youth is also growing. Identifying environmental triggers, such as psychological minority stress experienced by youth with GD, that may influence the pathogenesis and management of T1DM could have important clinical implications. The objective of this study was to determine the prevalence of concurrent diagnosis of T1DM and GD in adolescents evaluated at a university-based children's hospital. An electronic data extraction was conducted at the University of Wisconsin Hospital and Clinics from 1 November 2007 to 1 November 2017. Inclusion criteria included age 10 to 21 years and diagnosis of T1DM and/or GD. Prevalence rates were calculated for T1DM and GD. For adolescents with T1DM and GD, information related to diagnosis, treatment, and psychiatric history was collected. The prevalence for T1DM was 2.69 per 1000; the prevalence for GD was 0.42 per 1000. Eight adolescents had T1DM and GD. In adolescents with GD, the prevalence of T1DM was 9.4-fold higher than the prevalence of T1DM alone (24.77 vs 2.68 per 1000). Five adolescents were seen in GD clinic and their glycemic control initially improved after the first GD clinic visit. There was an increased prevalence of a concurrent diagnosis of T1DM in those with GD compared to the general population. Glycemic control improved after the first GD clinic visit in adolescents with T1DM and GD, which may be secondary to stress reduction.

Comment on “Outbreak: On Transgender Teens and Psychic Epidemics”

In “Outbreak: On Transgender Teens and Psychic Epidemics,” Lisa Marchiano discusses a purported social contagion called “rapid-onset gender dysphoria.” Her article ignores substantial current research on the outcomes of transition for transgender adolescents and young adults. It further portrays gender dysphoria in adolescence as a psychic epidemic rather than a legitimate medical condition, urging parents to encourage their transgender children to accept their assigned gender—an approach that has already been abandoned in the consensus standard of care because of the documented harm it causes.

PO-01-069 GnRH analogues: An effective pharmacological approach for the management of restrictive eating behaviors related to Gender Dysphoria in adolescents

The co-occurence of Gender Dysphoria (GD) and Anorexia Nervosa (AN) has been described in the scientific literature. While the emphasis so far has focused on the overlap in symptomatology of the two conditions, pathological eating behaviors in adolescents with GD may have a different psychopathological meaning. The main objective of the study is to conceptualize pathological eating behaviors (in particular, dieting, weight loss and intense physical activity) in adolescents with GD as a dysfunctional coping strategy used to deal with pubertal body changes. Furthermore, to describe the use of gonadotropin-releasing analogs (GnRHa) as an effective treatment option when adolescents with GD present restrictive eating behaviors. Two cases of adolescents with GD and pathological eating behaviors are presented. Both received psychological evaluations and endocrinological examinations at different times: at first admission to the GD clinic (T0) and 6 months after starting treatment with GnRHa (T1). In particular, at both times depression, anxiety, body dissatisfaction, social withdrawal, as well as suicidal risk were assessed. Regarding medical measures, Tanner stage, weigh, height, waist, body mass index (Kg/m2), Ferriman Gallwey score and hormonal levels were performed.

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.