Gender Dysphoria Research Articles

Frequency and mental health consequences of microaggressions experienced in the day-to-day lives of transgender and gender diverse people

Introduction Increasingly, it is apparent that in order to understand mental health and well-being, it is necessary to examine the ebb and flow of experiences and emotions across people’s day-to-day lives. For transgender and gender diverse (TGD) people, daily life is sometimes punctured by experiences of minority stress (e.g. in the form of microaggressions). Method The current daily diary study investigated the frequency and types of microaggressions experienced by TGD people as well as their concurrent and prospective associations with mental health and well-being. Daily surveys measuring microaggressions, gender dysphoria, depressive and anxious symptoms, and self-esteem over the last 24 h were completed by TGD participants (N = 39) across 10 consecutive days (total of 351 diary entries). Results Seventy-four percent of participants experienced some form of microaggression within the 10-day study period, reporting an average of 1 microaggression approximately every other day. Microaggressions were associated with greater feelings of gender dysphoria, depressive and anxious symptoms, and lower self-esteem at the between-person level, while evidence for within-person effects was mixed (with some evidence for significant associations with gender dysphoria and self-esteem for specific microaggression domains). No evidence for prospective associations between microaggressions and mental health were found in the current study. Discussion Given the frequency of experiences of microaggressions in TGD people’s daily lives, particularly misuse of pronouns, it is critical that healthcare providers are aware of potential effects on mental health and well-being.

Health Equity and Perinatal Mental Health.

Pregnancy and the postpartum period are vulnerable times to experience psychiatric symptoms. Our goal was to describe existing inequities in perinatal mental health, especially across populations, geography, and in the role of childbirth. People of color are at an increased risk for perinatal mental health difficulties and more likely to experience neglect, poor communication, and racial discrimination. LGBTQ + individuals encounter unique challenges, implicating the role of heteronormativity, cisnormativity, and gender dysphoria through pregnancy-related processes. Rural-dwelling women are significantly less likely to seek care, be screened for, or receive treatment for perinatal mental health conditions. Trauma-informed, comprehensive mental health support must be provided to all patients during pregnancy, childbirth, and the postpartum period, especially for racially and ethnically minoritized individuals that have often been omitted from care. Future research needs to prioritize inclusion of perinatal populations not well represented in the literature, including rural-dwelling individuals.

Population-adjusted numbers, demographics and mental health among children and adolescents referred to the Norwegian National Center for Gender Incongruence over two decades.

Over the last decade, there has been a sharp increase in young people seeking medical treatment for gender dysphoria/gender incongruence (GD/GI). The aims of this study were to calculate yearly population-adjusted numbers of children and adolescents referred to the Norwegian National Center for Gender Incongruence (NCGI) at Oslo University Hospital (OUS) from 2000 to 2022; to describe the demographic characteristics and prevalence of psychiatric diagnoses, self-harm and suicide attempts among the referred from 2000 to 2020; and to investigate time trends. The study used data from the Gender Incongruence Registry for Children and Adolescents (GIRCA) in Norway. All persons under 18 years (n = 1258) referred to the NCGI between 2000 and 2020 were included: 68.4% assigned female gender at birth (AFAB) and 31.6% assigned male gender at birth (AMAB). We found a sharp increase in referrals to the NCGI favouring AFAB over AMAB. Nearly two in three (64.5%) had one or more registered psychiatric diagnoses. Self-harm was registered among 35.5%, and 12.7% had attempted suicide. Registered psychiatric diagnoses were significantly (p ≤ 0.001) more prevalent among AFAB (67.8%) than AMAB (57.4%). The number of registered diagnoses per person decreased significantly over time, with an average reduction of 0.02 diagnoses per person per year. Although there was a downward time trend in registered diagnoses per person, the total mental health burden among children and adolescents with GI emphasizes the need for a holistic approach.

Differences in Subjective Transition Outcomes Between Transgender and Gender-Diverse Individuals Who Completed Mandatory Psychiatric Assessment and Those Who Received Gender-Affirmative Medical Treatment in Croatia: A Cross-Sectional Online Survey.

The aim of this study was to evaluate different aspects of transition outcomes in groups of transgender and gender diverse (TGD) people based on their transition status. We divided the 70 TGD participants (19 individuals assigned male at birth and 51 assigned female at birth) into two groups: those who had completed their psychiatric and psychological evaluation (PPE), which is mandatory in Croatia, and those who had undergone gender-affirming medical treatment (GAMT) (both gender-affirming hormone treatment and gender-affirming surgery). The online survey included sociodemographic questions and a custom-designed nine-item scale. The items were specifically designed based on the DSM-5-TR criteria for gender dysphoria to assess subjectively perceived transition outcomes. We conducted a factor analysis of the scale followed by structural equation modeling for confirmation. Chi-squared and Mann-Whitney U tests were used to compare group differences. The following three-factor structure was confirmed: better functioning, reduced body dysphoria, and satisfaction with decision. A positive influence of better functioning on satisfaction with the decision was found. In addition, our results showed that TGD individuals who had undergone GAMT scored higher on better functioning than those who had just completed PPE. Both groups consistently scored high on satisfaction with the decision, with no statistically significant differences between them. Our findings suggest that TGD individuals view gender-affirming medical care as beneficial to their overall functioning.

Aesthetic Considerations for Neuromodulator Use in Transgender Patients.

The aesthetic dimension of transgender experiences involves various aspects linked to the visual representation and expression of one's gender identity. Nonsurgical cosmetic procedures, such as neuromodulators, have consequently become a viable treatment option for patients with gender dysphoria because of the ability to yield significant, although temporary, results with minimal associated risks and downtime. To comprehensively review literature pertaining to the aesthetic considerations for use of neuromodulators in transgender and nonbinary individuals. A literature review of PubMed/MEDLINE for studies was published through January 2024 for nonsurgical facial and body modification using neuromodulators. Searches were conducted with relevant keywords. Peer-reviewed articles and their references published within the past 10 years were given emphasis in the review. Based on the limited publications to date, the authors prepared a comprehensive review on indications for neuromodulator treatment in this population, including brow positioning, lower face contouring, lip eversion, trapezius slimming, and leg contouring. Dermatologists play a crucial role in facilitating the achievement of gender affirmation goals.

Screening adolescent transgender-related distress: Gender preoccupation and stability questionnaire demonstrates excellent criterion validity with multi-disciplinary, pediatric gender specialist assessment

Objective To assess the psychometric properties of a gender-related distress questionnaire in adolescents questioning or experiencing gender incongruence and/or gender dysphoria, aged under 18 years, with multi-disciplinary, specialist pediatric gender assessment. Design & Setting : Prospective cohort study at state-wide tertiary children’s hospital gender clinic (2017–2021). Participants N = 299, aged 11–17 years referred for support with gender identity. Main outcome measure: The Gender Preoccupation and Stability Questionnaire (GPSQ) was designed for adults to assess gender dysphoria and intervention suitability. This study examined the psychometric properties of the GPSQ in an adolescent population and screening utility against the criterion of specialist assessment of gender dysphoria in a pediatric gender service. Results GPSQ demonstrated a univariate construct ‘gender dysphoria’ (α = 0.77) via factor analysis. It moderately correlated with outdated gender measure GIDYQ-AA (r = −0.31, p < .001) and strongly predicted specialist assessment outcomes (99% positive predictive power). However, negative predictive power or false negatives were high at 27%. Conclusions GPSQ is a reliable, valid tool for Australian adolescents under 18 years of age with excellent positive predictive power with a specialist pediatric gender dysphoria assessment. Caution is needed due to a high false-negative rate. General practitioners, pediatricians, psychiatrists, mental health professionals, school nurses and youth workers may benefit from the use of a reliable screening tool for gender-related distress to inform primary care planning, referrals, mental health formulation, psycho-education and conversations with young people and their parents. This is the first study to establish a reliable and valid screening tool for gender related distress in Australian minors with utility across all genders and criterion validity against multi-disciplinary, pediatric gender clinic assessment.

Mental Health Evaluation of Younger and Older Adolescents Referred to the Center of Expertise on Gender Dysphoria in Amsterdam, The Netherlands

The present study aimed to investigate whether differences exist between younger and older presenting adolescents at the Center of Expertise on Gender Dysphoria regarding psychological functioning and autistic traits. A total of 1487 consecutively assessed adolescents between 2000 and 2018 were divided in younger presenters (age ≤ 13.9 years) and older presenters (age ≥ 14 years). Of younger presenters, 227 (41.1%) were assigned male at birth and 325 (58.9%) assigned female at birth. In older presenters, 279 (29.8%) were assigned male at birth and 656 (70.2%) assigned female at birth. Behavioral and emotional problems were assessed with the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). For autism traits, the Social Responsiveness Scale (SRS) was used. Compared to younger presenters, on both the CBCL and YSR older presenters had higher Total Problem (β = 1.75, p = .005, CI 0.53–2.97, R2 = .04 and β = 4.20, p < .001, CI 2.99–5.40, R2 = .07, respectively) and Internalizing Problem (β = 4.43, p < .001, CI 3.13–5.74, R2 = .06 and β = 6.69, p < .001, CI 5.31–8.07, R2 = .12, respectively) scores. Regarding autistic traits, a higher mean SRS total score was found in older presenting assigned males at birth (β = 4.55, p = .036, CI 0.30–8.81, R2 = .34). In assigned females at birth, no statistically significant difference between older and younger presenters was found in mean SRS total score (β = 1.19, p = .063, CI − 0.07 to 2.45, R2 = .39). Differences in mental health exist between younger and older presenting adolescents and call for an individualized approach in the clinical care of transgender adolescents.

Evaluation of Sexual Function of Transgender Individuals.

The current study sought to evaluate the sexual function of transgender men and women and to identify associated factors. Trans individuals who were outpatients at our gender incongruence (GI) center for follow-up of gender-affirming hormone therapy with age ranging 27 to 50 years were invited to participate in this cross-sectional study. Clinical data were collected from the medical records. Two scales, the Female Sexual Function Index (FSFI) and the Male Sexual Function Index (MSFI), were administered to all females (n = 50) and all males (n = 58). Each participant also responded to a semi-structured questionnaire that assessed feelings regarding being transgender and satisfaction with sexual life. Relative to trans women, trans men had a higher total FSFI score, and higher scores in the FSFI domains of arousal, lubrication, orgasm, and satisfaction (all p < 0.01), and in the total MSFI score, and higher scores in the MFSI domains of arousal, erection, orgasm, and satisfaction (all p < 0.01). A separate semi-structured evaluation indicated that more than half of the trans men and almost half of the trans women were satisfied or very satisfied with their sexual life. The total scores from the FSFI and MSFI indicated a high risk of sexual dysfunction in trans men and especially, in trans women. However, the semi-structured evaluation showed that more than half of the trans men and almost half of the trans women were satisfied with their sexual life.

Towards an informed research agenda for the field of personality disorders by experts with lived and living experience and researchers

BackgroundWe describe a collection of themes for a research agenda for personality disorders that was originally formulated for the ESSPD Borderline Congress in 2022.MethodsExperts with lived and living experience (EE), researchers and clinicians met virtually, exchanged ideas and discussed research topics for the field of personality disorders. The experts - patients, relatives, significant others - named the topics they thought most relevant for further research in the field. These topics were presented at the ESPPD conference in October 2022.ResultsThe five top themes were: 1. Prevention, early detection and intervention, 2. Recovery beyond symptom improvement, 3. Involvement of relatives in treatment, 4. Gender dysphoria, and 5. Stigma.ConclusionsIn general, the topics reflect current issues and changes in societal values. Overarching aims of research on these topics are the improvement of social participation and integration in society, better dissemination of research, and better information of the general public and political stakeholders.

Association between genital gender-affirming surgery and psychiatric comorbidities in individuals with gender incongruence.

Previous studies present mixed evidence on the relationship between psychiatric comorbidities and genital gender-affirming surgery (GGAS) in individuals with gender incongruence (GI). This research aims to investigate the psychiatric comorbidity rates post-GGAS in the GI population-namely, depressive disorders, anxiety disorders, posttraumatic stress disorders, substance abuse disorder, and suicidality. Based on the TriNetX health care database, an international database with >250 million patients, a cross-sectional study was executed comparing psychiatric comorbidity rates among cases of GI with and without GGAS. Individuals were matched for demographic and health-related variables, which included history of cardiovascular disease, diabetes, and obesity. The main focus was to establish the rates and changes in psychiatric comorbidities following GGAS. Among individuals with GI, the study identified 4061 with GGAS and 100 097 without. At 1 year post-GGAS, there was a significant decrease in depression (odds ratio [OR], 0.748; 95% CI, 0.672-0.833; P < .0001), anxiety (OR, 0.730; 95% CI, 0.658-0.810; P < .0001), substance use disorder (OR, 0.730; 95% CI, 0.658-0.810; P < .0001), and suicidality (OR, 0.530; 95% CI, 0.425-0.661; P < .0001), and these reductions were maintained or improved on at 5 years, including posttraumatic stress disorder (OR, 0.831; 95% CI, 0.704-0.981; P = .028). The findings indicate that GGAS may play a crucial role in diminishing psychiatric comorbidities among individuals with GI. This is the largest known study to evaluate the effect of GGAS on psychiatric comorbidities in the GI population, offering robust evidence. The reliance on the precision of CPT and ICD-10 codes for data extraction poses a limitation due to potential coding inaccuracies. The evidence suggests a significant association between GGAS and reduced psychiatric comorbidities in individuals with GI.

French validation of the oMtFSFI Questionnaire for assessing the sexual function of Transgender women after vulvo-vaginoplasty

IntroductionThe Operated Male-to-Female Sexual Function Index (oMtFSFI) questionnaire is the first scoring system developed to assess sexual function after gender-affirming vulvo-vaginoplasty, and was initially developed and validated in Italian. The aim of this study was to provide linguistic validation of the questionnaire in French through several steps including use of the questionnaires across a series of patients who had undergone gender-affirming vulvo-vaginoplasty between 2020 and 2022 at two French academic centers. MethodThe French version of the oMtFSFI questionnaire was obtained through a double translation (Italian to French) and a back-translation (French to Italian), validated by a scientific committee, and cognitively assessed by a panel of expert patients. The questionnaire was then distributed to transgender male to female patients who had undergone genital gender affirming surgery at two French academic centers. ResultsThe oMtFSFI score consists of 18 questions exploring 7 domains (genital self-image, desire, arousal, lubrication, orgasm, satisfaction, sexual pain). Among the sixty-four patients who responded to the questionnaire, 16 patients (25%) reported abstaining from sexual activity involving vaginal penetration at the time of the study were excluded. The mean total score was 37, corresponding to mild to moderate sexual dysfunction and 60.4% of the patients reported normal overall sexual function. The level of sexual satisfaction was normal for 68.8% of the patients and the genital self-image was normal for 52.1%. Most of the patients (79.2%) reported at least mild dyspareunia and 10.4% had critical sexual dysfunction. Surgery improved gender dysphoria in 96.7% of patients. There was a strong correlation between the overall oMtFSFI score and the happiness Visual Analog Scale (VAS) (P<0.001) as well as with the quality of life VAS (P<0.001). ConclusionThe French version of the oMtFSFI questionnaire is the only scoring system specifically developed to assess sexual function after vulvo-vaginoplasty in transgender women linguistically validated in French. Its validation in French language makes it an interesting tool for research and clinical practice. Level of evidence3.

Experiences of body image in the gender non-binary community: A qualitative analysis

Body image concerns are prevalent within transgender communities – many transgender people engage in disordered eating to suppress or accentuate secondary sex characteristics and reduce gender dysphoria. However, this research has mostly been conducted with binary transgender people. Here, we examine how non-binary people experience and relate to their bodies. Semi-structured one-on-one interviews were conducted with 13 gender non-binary individuals living in Australia. Photo elicitation techniques were utilised, and the transcribed interview data were analysed using reflexive thematic analysis. Six themes were identified: Expansive Understandings of Body Image, Body Image can be Linked to Gender Dysphoria, Cultivating a Preferred Body can Lead to Gender Euphoria, Appreciating Diversity in Non-Binary Body Ideals, The Androgynous Body Ideal is not Universally Accepted, and Experiencing the Body as Functional rather than Aesthetic. The present findings highlight the diversity of experiences of body image for non-binary people. The non-binary concept of body image was found to be expansive, stressing various physical attributes involved in social gender recognition and physiological sources of gender dysphoria. Some participants valued gender-affirming medical intervention, others were accepting of their bodies as they are, attributing their body confidence to the process of affirming their non-binary gender.

Gender Dysphoria And Trauma Towards Main Character In I Wish You All The Best Novel By Mason Deaver

Gender Dysphoria And Trauma Towards Main Character In I Wish You All The Best Novel By Mason Deaver

Technical Pearls and Pitfalls of Facial Feminization Surgery: A Review of Techniques From a Single Institutional Practice.

Facial feminization surgery (FFS) is an emerging practice that falls under the broader umbrella of gender-affirming surgery. Various approaches exist to feminize the face, yet few published articles describe in detail the techniques of each component procedure. Considering the diversity of interventions employed, the objective of this manuscript is to highlight FFS techniques utilized by the senior author and create a corresponding media gallery. All patients with the diagnosis of gender dysphoria that were referred to the senior author for FFS consultation between June 2017 and August 2022 were reviewed. Data were retrospectively collected from electronic medical records according to the institutional review board (IRB)-approved study protocol. Data collected and analyzed included demographics, operative documentation, and postoperative follow-up. Multimedia material was collected intraoperatively and postoperatively. A total of 231 patients underwent 262 operations with a total of 1224 FFS procedures. The average follow-up time was 7.7 ± 11 months. Out of the 262 operations, 24 (9.2%) patients experienced minor complications, including 3 (1.1%) with wound dehiscence, 13 (5.0%) with hematomas, and 14 (5.3%) with postoperative infection requiring antibiotics. Of those, 3 (1.1%) required a return to the operating room for washout or removal of malar implants. Although there is a consensus on the fundamental surgical principles to achieve adequate feminization of the facial architecture, the specific techniques to do so differ according to individual practices. As techniques diverge, so do their risk profiles and outcomes; techniques must, thus, align with patients' interventional goals. The material presented here is one of many that can support trainees and junior surgeons as they build a gender-affirming practice.

The Effects of Gender-Affirming Hormone Therapy on Quality of Life: The Importance of Research on Youth.

Gender-affirming hormone therapy (GAHT) plays a significant role in the medical care of transgender individuals, helping to align their physical characteristics with their gender identity. While numerous studies have investigated the impact of GAHT on adults, research focusing on its effects on the quality of life (QoL) of transgender youth is limited. In this opinion paper, we aim to address selected challenges associated with gender-affirming medical care, such as (1) the necessity for evidence-based youth gender-affirming medical care, (2) the urge to explore different approaches to gender-affirming medical care diversely in transgender youth research, and (3) understanding the challenges of the detransition process (which refers to stopping or reversing gender-affirming medical or surgical treatments), as well as suggest possible solutions for meaningful progress. Notably, the available evidence underlines a positive impact of GAHT on various aspects of QoL of transgender youth, such as mental health and social functioning, by alleviating gender dysphoria, improving body satisfaction, and facilitating appearance congruence (the degree to which an individual's physical appearance represents their gender identity). However, challenges related to methodological limitations, as well as ethical considerations, and several sociocultural factors highlight the need for further research to better understand the long-term effects of GAHT on the QoL of transgender youth. Ethical considerations, such as ensuring informed consent and weighing potential benefits against risks, are pivotal in guiding healthcare decisions. Additionally, navigating these ethical responsibilities amid sociocultural contexts is crucial for providing inclusive and respectful care to transgender youth. Addressing these research gaps is, therefore, crucial to developing successful healthcare programmes, raising awareness, and promoting the holistic well-being of transgender youth through comprehensive and affirming care.

Transgender healthcare: metabolic outcomes and cardiovascular risk.

Transgender identity is often associated with gender dysphoria and minority stress. Gender-affirming hormone treatment (GAHT) includes masculinising or feminising treatment and is expected to be lifelong in most cases. Sex and sex hormones have a differential effect on metabolism and CVD in cisgender people, and sex hormone replacement in hypogonadism is associated with higher vascular risk, especially in ageing individuals. Using narrative review methods, we present evidence regarding metabolic and cardiovascular outcomes during GAHT and propose recommendations for follow-up and monitoring of metabolic and cardiovascular risk markers during GAHT. Available data show no increased risk for type 2 diabetes in transgender cohorts, but masculinising GAHT increases lean body mass and feminising GAHT is associated with higher fat mass and insulin resistance. The risk of CVD is increased in transgender cohorts, especially during feminising GAHT. Masculinising GAHT is associated with a more adverse lipid profile, higher haematocrit and increased BP, while feminising GAHT is associated with pro-coagulant changes and lower HDL-cholesterol. Assigned male sex at birth, higher age at initiation of GAHT and use of cyproterone acetate are separate risk factors for adverse CVD markers. Metabolic and CVD outcomes may improve during gender-affirming care due to a reduction in minority stress, improved lifestyle and closer surveillance leading to optimised preventive medication (e.g. statins). GAHT should be individualised according to individual risk factors (i.e. drug, dose and form of administration); furthermore, doctors need to discuss lifestyle and preventive medications in order to modify metabolic and CVD risk during GAHT. Follow-up programmes must address the usual cardiovascular risk markers but should consider that biological age and sex may influence individual risk profiling including mental health, lifestyle and novel cardiovascular risk markers during GAHT.

Evaluation of the Quality and Reliability of YouTube Videos on Gender Dysphoria

Purpose: Many people search for information on YouTube on almost every medical topic. The aim of this study was to assess the quality and reliability of YouTube videos concerning Gender Dysphoria. Methods: We searched for Gender Dysphoria on YouTube on June 7, 2023 and conducted a detailed evaluation of the first 100 unique English videos by two expert observers. The videos were evaluated using modified DISCERN scale, Global Quality Scale (GQS), and Video Power Index (VPI). Results: The kappa coefficient for interobserver agreement was 0.892. For all 100 videos, the median value of the modified DISCERN score was 2.5 (1-4.8), and GQS score was 3 (1-5), and 68% of the videos rated as poor to moderate reliability and quality (modified DISCERN score ≤3, GQS ≤3). Reliable videos were uploaded by professional sources in a higher rate than unreliable videos (48% vs 12%, p

Gender-Affirming Hormone Treatment and Metabolic Syndrome Among Transgender Veterans.

Gender-affirming hormone treatment (GAHT) is a common therapy for transgender individuals to reduce gender dysphoria and improve quality of life. Clarifying the long-term effects of GAHT remains a priority in transgender health research. To explore whether sex hormones (estradiol and testosterone) are associated with the development of metabolic syndrome in transgender veterans compared with cisgender veterans. This retrospective, longitudinal cohort study used International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes for gender dysphoria from the Veterans Health Administration national database to identify transfeminine and transmasculine veterans receiving documented feminizing (estradiol) or masculinizing (testosterone) treatment from January 1, 2006, to December 31, 2019, and for whom the GAHT initiation date and metabolic syndrome component-related data were available. Transgender veterans were matched to cisgender referents. Gender-affirming hormone treatment. Metabolic syndrome z-scores were calculated based on body mass index, systolic blood pressure, and levels of high-density lipoprotein cholesterol, triglycerides, and blood glucose. Changes in mean z-scores were compared among the transgender and cisgender groups before and after the index date (corresponding to GAHT initiation) using a repeated-measures analysis of variance model. The cohort included 1290 participants: 645 transgender (494 [38.3%] transfeminine, 151 [11.7%] transmasculine) and 645 cisgender (280 [21.7%] female, 365 [28.3%] male). Mean (SD) age at the index date was 41.3 (13.2) years. Metabolic syndrome z-scores changed significantly over time and differed significantly across groups. Overall, transmasculine veterans had the greatest percentage increase in mean (SEM) z-scores after vs before the index date (298.0% [57.0%]; P < .001), followed by cisgender females (108.3% [27.5%]; P < .001), cisgender males (49.3% [27.5%]; P = .02), and transfeminine persons (3.0% [10.7%]; P = .77). In this cohort study, in both cisgender and transgender veterans, estradiol was associated with reduced metabolic syndrome risk, whereas testosterone was associated with increased risk. However, transmasculine individuals had the greatest risk and transfeminine individuals had the lowest risk of metabolic syndrome associated with these hormones. This is relevant for the management of metabolic syndrome risk factors in cisgender and transgender individuals and to potentially predict the risk of atherosclerotic cardiovascular disease, type 2 diabetes, systolic hypertension, insulin resistance, and nonalcoholic fatty liver disease.

Beyond the Gender Binary: Transgender Labor Force Status in the United States 2014–17

Following the recent acknowledgment of and debates around transgender people in the United States, there has emerged a small but growing literature on the economic implications of being transgender. However, most economic research on gender fails to account for major components of gender by only including sex and gender identity, which may entail drastic mischaracterizations of transgender labor market outcomes. This article accounts for how people express their gender and how one’s voice is perceived by others using the Behavioral Risk Factors Surveillance Systems 2014–7, which finds compelling evidence of transgender women facing labor market penalties for having a feminine gender expression and voice perceived as feminine, whereas transgender men are rewarded for having a masculine gender expression and voice perceived as masculine. HIGHLIGHTS Masculinity associates with a labor market premium. Feminine trans men and women have labor market outcomes similar to feminine ciswomen. Masculine trans men and women have labor market outcomes similar to masculine cismen. Gender incongruence associates with labor market penalties.

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.