Gender Identity Research Articles

Suicidal Thoughts and Behaviors Among Autistic Transgender or Gender-Nonconforming US College Students

Suicide risk is a global public health crisis, with suicide ranking as a consistent leading cause of death among adults in the US. Autistic individuals and transgender or gender-nonconforming (TGNC) individuals represent populations with notably elevated rates of suicidal thoughts and behaviors (STBs). To characterize suicidal thoughts and behaviors among TGNC and autistic individuals, using a large, nationally representative sample. This study is a secondary analysis of cross-sectional data from students at colleges and universities throughout the US who participated in the American College Health Association National College Health Assessment from 2019 to 2023. Autistic and TGNC identities were self-reported by participants. The frequency of intersectionality of autism and TGNC identities and whether those who had intersectional marginalized identities had increased likelihood of STBs were examined. STBs were self-reported by participants. A series of moderated regression analyses were performed to examine how the interaction between autism and possessing a marginalized gender identity (ie, TGNC status) was associated with STBs. The sample included 41 507 college students with a mean (SD) age of 23.35 (6.83) years. A total of 2410 participants (5.81%) identified as being TGNC. Overall, 326 TGNC participants (13.53%) also identified as autistic, whereas 625 of those who identified as cisgender (1.58%) also identified as autistic. Gender identity and autism were associated with greater odds of STBs. For suicidal ideation, gender identity had an odds ratio (OR) of 3.34 (95% CI, 2.99-3.73), and autism had an OR of 2.06 (95% CI, 1.76-2.42). For suicide attempts, gender identity had an OR of 2.74 (95% CI, 2.13-3.52), and autism had an OR of 2.39 (95% CI, 1.62-3.52). A significant interaction existed for attempts (OR, 0.51; 95% CI, 0.27-0.97); nonautistic cisgender individuals had the lowest attempt rate. This cross-sectional study addresses the dearth of information on how intersectionality in gender and autism status impacts the risk of STBs, and the results confirm the elevated risk of STBs among TGNC and autistic populations. Interventions are needed to support college students with these identities.

Exploring caregiver experiences of communicating with children about differences of sex development (DSD)

ObjectiveExplore the caregiver experience of communicating about differences of sex development (DSD) with their children. Evidence-based guidance regarding how, when, and what information is shared by caregivers is lacking and is needed to inform optimal information sharing strategies for this population. MethodsQualitative semi-structured interviews were conducted with 15 caregivers of children with DSD, recruited from 3 multidisciplinary DSD clinics. Interviews were transcribed and coded using thematic analysis. ResultsFour major themes were generated: (1) communicate openly and honestly, (2) information sharing starts at a young age and occurs over time, (3) caregivers and providers should empower children with DSD by sharing positive messages to promote self-confidence and actively engaging them in their medical care, and (4) caregivers should understand and acknowledge the connection between gender identity and DSD to create a supportive environment for children experiencing gender dysphoria. ConclusionTransparent and developmentally-appropriate information sharing by caregivers with their children is essential for educating, empowering, and supporting children with DSD. Communicating with children about DSD can be a complex process for caregivers, and healthcare providers have a key role in supporting caregiver-child communication and increasing access to education and support resources.

Why DON'T We "Say Her Name"? An Intersectional Model of the Invisibility of Police Violence Against Black Women and Girls.

Racialized police violence is a profound form of systemic oppression affecting Black Americans, yet the narratives surrounding police brutality have disproportionately centered on Black men and boys, overshadowing the victimization of Black women and girls. In 2014, the #SayHerName campaign emerged to bring attention to the often-overlooked instances of police brutality against Black women and girls, including incidents of both nonsexual and sexual violence. Despite these efforts, mainstream discourse and psychological scholarship on police violence continue to marginalize the experiences of Black women and girls. This raises a critical question: Why DON'T we "Say Her Name"? This article employs intersectional frameworks to demonstrate how the historic and systemic factors that render Black women and girls particularly vulnerable to police violence also deny their legitimacy as victims, perpetuate their invisibility, and increase their susceptibility to state-sanctioned violence. We extend models of intersectional invisibility by arguing that ideologies related to age, in addition to racial and gender identities, contribute to their marginalization. Finally, we reflect on how psychological researchers can play a pivotal role in dismantling the invisibility of Black women and girls through scientific efforts and advocacy.

Serum per- and polyfluoroalkyl substance (PFAS) levels and health-related biomarkers in a pilot study of skiers in New England

BackgroundPer- and polyfluoroalkyl substances (PFAS), synthetic chemicals with adverse health effects, are used extensively in consumer products. Ski waxes, applied to the base of skis, contain up to 100% PFAS by mass, but exposure and health effects are poorly characterized. ObjectivesOur objectives were to quantify serum PFAS concentrations among skiers and explore associations with reported ski wax use and biomarkers of cardiometabolic, thyroid, and immune health. MethodsWe recruited 30 active adult skiers to provide non-fasting blood samples and complete questionnaires. We quantified 18 PFAS using mass spectrometry, and measured serum lipids, thyroid hormones, and immunoglobulins. We explored associations of individual and aggregate measures of serum PFAS with wax use indicators and health biomarkers using multivariable regression models, adjusted for age and gender identity. ResultsNine PFAS (PFBS, PFHpS, PFHxS, Sm-PFOS, n-PFOS, PFDA, PFNA, PFUnDA, n-PFOA) were detected in 100% of participants, and MeFOSAA in 93%. Compared to NHANES, median serum concentrations (ng/ml) were similar, but higher in coaches (e.g., PFOAall: 1.1, PFOAcoaches: 2.7, PFOANHANES: 1.2; PFNAall: 0.5, PFNAcoaches: 1.7, PFNANHANES: 0.4). Factors reflecting wax exposure were positively associated with PFAS: e.g., >10 years as a snow sport athlete, compared to ≤10 years, was associated with 3.2 (95% CI: 0.7, 5.6) ng/ml higher aggregate PFAS, as defined by National Academies of Science, Engineering, and Medicine (NASEM). An IQR (6.3 ng/ml) increase in NASEM PFAS was associated with 32.1 (95% CI: 7.0, 57.2), 35.5 (13.5, 57.5), and 12.8 (0.6, 25.1) mg/dl higher total cholesterol, LDL-C, and sdLDL-C, respectively. DiscussionOur study provides early evidence that recreational skiers, particularly coaches, are exposed to PFAS through ski wax. Several PFAS were associated with higher serum lipids among these physically active adults. Interventions to remove PFAS from fluorinated wax could decrease direct exposure to skiers and reduce PFAS release into the environment.

Linguistic Hermeneutical Injustice

ABSTRACT Grammatical gender languages mark gender on every noun and agreement target such as adjectives and pronouns. While the norm for personal nouns provides that the term’s grammatical gender corresponds to its referent’s gender, in certain circumstances, a discrepancy arises between the term and its referent’s gender. Taking Italian as a case study, I identify four such circumstances: reference to non-binary people, women and non-binary professionals in traditionally male-dominated fields, generic or unknown individuals and mixed-gender groups. Among these, I distinguish between usage discrepancies, which depend on how speakers (mis)use language, and structural discrepancies, which depend on structural features of the language. The latter is the case for reference to non-binary people as Italian lacks a grammatical gender corresponding to non-binary gender identities. I focus on this case and argue that it conveys a problematic representation of gender, giving rise to a specific instance of hermeneutical injustice: structural discrepancies depend on a gap in collective interpretative resources (namely, the lack of an appropriate grammatical gender) and put non-binary people at an unfair disadvantage in making sense of their social experiences. As I show, the effects of structural discrepancies possess all the hallmarks of hermeneutical injustice.

Technology-Facilitated Abuse Among College Students: Prevalence and Consequences, and Examinations by Gender and Sexual Identity.

The purpose of this investigation is to document the prevalence and consequences of technology-facilitated abuse (TFA) among college students and examine whether gender identity and sexual identity are associated with TFA exposure and related academic and mental health consequences. Data were analyzed from a campus climate survey distributed in Spring 2022. Data from 1,543 college students were collected for TFA experiences, academic consequences, and TFA-related depression, anxiety, and traumatic stress. Multiple linear regression analyses were conducted to test for unique contributions of sexual identity, gender identity, and number of TFA experiences to the outcomes of academic consequences, depression, anxiety, and traumatic stress. The number of TFA experiences was a significant predictor across all models. The contributions of sexual identity and gender identity differed for each outcome. The results of this study align with prior research which has found sexual identity and gender identity to affect outcomes associated with TFA. In addition, TFA was more prevalent among sexual and gender minority students, and the consequences of TFA were more severe within this population. These results suggest that programming takes a dual approach in addressing TFA through reducing TFA exposure and mitigating the impacts of TFA on mental health and other outcomes.

Gender identity and pronouns among trans and nonbinary students entering college

Surveys indicate that a growing number of young people in the United States identify as trans and especially as nonbinary. Further, there is evidence that an increasing number of young adults use nongendered or nonbinary pronouns for themselves (e.g. ‘they/them’). However, research to date has not captured the full range of ways that young adults label their gender identities, the specific pronouns they go by, and the intersections between their gender identities and pronoun choices. This study examines the gender identities and pronouns of the more than 2.4 million students who applied to college in Fall 2022 or Fall 2023 using the Common Application, the admissions platform utilized by more than 1,000 U.S. colleges and universities. We consider how students identified their gender in general and by legal sex, race, and citizenship status, and what pronouns they used by these same demographic factors. Our research finds major differences in students’ gender identities and pronoun use by legal sex and citizenship status and fewer significant differences by race. We conclude by making recommendations for college administrators, faculty, and staff on how they can better understand gender diversity and support trans and nonbinary students.

Sex, sexual orientation, and gender identity data collection across electronic health record platforms: a national cross-sectional survey.

To assess the current state of sex, sexual orientation, and gender identity (SSOGI) data collection options in US electronic health record (EHR) platforms. We utilized an anonymous survey distributed via purposive snowball sampling to assess EHR platforms across the United States. Of 90 surveys started, 41 (45.6%) were completed and used for data analysis. Respondents represented a geographically diverse sample of health care centers across the United States. EPIC was the most used EHR platform (70.7%) followed by Cerner (9.8%). Across reported platforms, a majority utilized structured fields to collect and document patient SSOGI data (n = 25, 61.0%). There was variability across platforms regarding SSOGI data elements collected. No platform collected all recommended SSOGI data elements. Significant variation exists across EHR platforms and across health care settings using the same EHR platform. National standards need to be followed for SSOGI data collection in EHR platforms.

AI anxiety and fear: A look at perspectives of information science students and professionals towards artificial intelligence

The rapid integration of artificial intelligence (AI) within society and the emergence of the fourth industrial revolution (4IR), has ignited a spectrum of emotions in society, ranging from enthusiasm to anxiety. This study investigates the depths of AI anxiety and fear among a population of information science students and professionals. Utilising a survey of over 200 current students and professionals, this study explores the connections between age, gender identity, ethnicity, geographic location, educational attainment and residence, and the levels of anxiety and fear associated with AI and the 4IR. The findings reveal nuanced relationships, with age, ethnicity, academic achievement and regional context serving as critical differentiators in 4IR and AI anxiety within this population. Students and professionals alike may benefit from seeking further education about this emerging technology.

Health Use Cases of AI Chatbots: Identification and Analysis of ChatGPT Prompts in Social Media Discourses

The popularity of ChatGPT has raised questions surrounding AI’s potential for health use cases. Since the release of ChatGPT in 2022, social media users have shared their prompts and ChatGPT responses on different topics such as health. Despite editorials and opinion articles discussing the potential uses of ChatGPT, there is a lack of a systematic approach to identify and analyze the use cases of ChatGPT in health. This study establishes a framework for gathering and identifying tweets (i.e., posts on social media site “X”, formerly known as Twitter) that discuss health use cases of ChatGPT, integrating topic modeling with constructivist grounded theory (CGT) to organize these topics into common categories. Using this framework, nine topics were identified, which were further grouped into four categories: (1) Clinical Workflow, (2) Wellness, (3), Diseases, and (4) Gender Identity. The Clinical Workflow category was the most popular category, and included four topics: (1) Seeking Advice, (2) Clinical Documentation, (3) Medical Diagnosis, and (4) Medical Treatment. Among the identified topics, “Diet and Workout Plans” was the most popular topic. This research highlights the potential of social media to identify the health use cases and potential health applications of an AI-based chatbot such as ChatGPT. The identified topics and categories can be beneficial for researchers, professionals, companies, and policymakers working on health use cases of AI chatbots.

An ERP-based comparison of gender representations elicited by generic masculine role nouns and the German gender star form

There is an ongoing debate about the linguistic gender forms that should be used to elicit fair mental representations of all genders. While most languages with grammatical gender traditionally use the masculine form to refer to people in a gender-independent way, numerous empirical studies have demonstrated that this form leads to a male bias in mental representations. In German, the so-called gender star form has been proposed as an alternative to the masculine form, aimed at better representing persons with nonmale gender identities. To provide empirical data on this claim, we compared the neural processing mechanisms elicited by the gender star form with those elicited by the generically intended masculine form during reference resolution. Participants in the present ERP study read sentence pairs in which a group of people was introduced with a role noun in one of the two gender forms and then revealed to be partly comprised of men or women. Following the masculine form, anaphoric references to women (vs. men) resulted in an increased ERP amplitude in the P600 range. In contrast, following the gender star form, the P600 amplitude was increased for references to men (vs. women), albeit in a slightly different spatio-temporal range. The present data thus indicate that the gender star form and the generically intended masculine form impose partially different demands on the syntactic operations performed by the brain during reference resolution but that, in the end, neither form elicits gender-balanced mental representations of men and women in German.

Legalization of LGBT Marriage: Case Study from Vietnam

LGBT marriage is a legal union between two individuals of the same sex, including lesbian, gay, bisexual, and transgender people. This type of marriage recognizes the equal rights of all people to marry regardless of their sexual orientation or gender identity. In Vietnam, the legal status of LGBT marriage has been the subject of considerable discussion and debate. Although the country has made significant strides in improving the rights of LGBT people, there is still a lack of official legal recognition for same-sex marriage. To date, same-sex marriage has not been explicitly legalized nor fully protected under Vietnamese law. This means that although same-sex marriages are not criminalized, and people have their free will to live together and hold ceremonies, yet these marriages do not hold the same legal status and rights as compared to heterosexual marriages. Vietnam has a strong cultural background and conservative beliefs; these play a crucial role in society in respect to the views within it when it comes to LGBT individuals. Society is becoming more tolerant; however, the LGBT community members are still judged with a high rate of discrimination. Although acceptance still significantly varies between regions and different age groups, public opinion is indeed softening, especially among the young. Due to the legal recognition, LGBT marriages provided them with equal legal rights and responsibilities concerning property, inheritance, adoption, and healthcare, just like heterosexual couples. On the other hand, this also can be regarded as another critical step to social inclusion and the fight against discrimination. This research will discuss the current situation of same-sex marriage in contemporary Vietnam with the aim of completing the picture of the LGBT community. The research study will also interview 22 LGBT individuals and a survey of close to 200 participants.

A systematic review of social camouflaging in autistic adults and youth: Implications and theory.

Social camouflaging (SC) is a set of behaviors used by autistic people to assimilate with their social environment. Using SC behaviours may put autistic people at risk for poor mental health outcomes. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the goal of this systematic review was to investigate the development of SC and inform theory in this area by outlining the predictors, phenotype, and consequences of SC. This review fills a gap in existing literature by integrating quantitative and qualitative methodologies, including all gender identities/age groups of autistic individuals, incorporating a large scope of associated factors with SC, and expanding on theory/implications. Papers were sourced using Medline, PsycInfo, and ERIC. Results indicate that self-protection and desire for social connection motivate SC. Camouflaging behaviors include compensation, masking, and assimilation. Female individuals were found to be more likely to SC. Additionally, this review yielded novel insights including contextual factors of SC, interpersonal relational and identity-related consequences of SC, and possible bidirectional associations between SC and mental health, cognition, and age of diagnosis. Autistic youth and adults have similar SC motivations, outward expression of SC behavior, and experience similar consequences post-camouflaging. Further empirical exploration is needed to investigate the directionality between predictors and consequences of SC, and possible mitigating factors such as social stigma and gender identity.

Sexual Orientation and Gender Identity Collection of Older Adults in the UCHealth Electronic Health Record: Assessing the First Three Years of Implementation

ABSTRACT Objectives This study examines sexual orientation/gender identity (SOGI) data collection in older adults from the UCHealth systems electronic health record. Methods Data of older adults aged 55 and older were analyzed between January 2019 and December 2022. Prevalence of SOGI documentation based on four new SOGI-related questions were analyzed along with social history documentation. Results Data were missing in reports (93% for sexual orientation and 96% for gender identity). Of 459,544 older adults potentially identifiable as a sexual or gender minority (SGM), 8.24% could be identified through other social history, and 91.76% could not. Data often returned a response of “undisclosed” (1.04%) or “unspecified” (98.79%), leaving .005% to represent the identifiable population of SGM minority adults. Conclusions SOGI data often was not documented through questions recommended since January 2019. It is unlikely that .005% accurately represents the SGM older patient population as national estimates are between 7%-11%. Lower reported percentages of SGM older adults may lead to less recognition of patient needs, and thus less equitable and personalized care. Clinical Implications These findings exemplify the need for evaluation strategies to be designed to improve SOGI collection with the primary goal of promoting equity and inclusion for SGM older adults.

Gender and ethnolinguistic lawfare

This article treats the concept of lawfare in relation to gender and ethnolinguistic identities, examining how legal systems are employed to perpetuate power imbalances and suppress marginalized communities. By focusing on various case studies and theoretical frameworks, the study explores the role of ideologies and how moral panic and moral injury manifest in legal responses to gender nonconforming individuals, women, and ethnolinguistic minorities. The article critiques how the law is weaponized as a tool of oppression, particularizing in areas such as language rights, gender equality, and access to justice. Through an interdisciplinary approach, the authors demonstrate how legal frameworks and institutional actions often reinforce societal norms that exclude vulnerable groups, rather than protecting them. As a framework to the special issue Gender and Ethnolinguistic Lawfare, this article offers a critical perspective on the relationship between law, identity, and power, contributing to a deeper understanding of how the rule of law perpetuates or challenges social hierarchies.

Afektinės būsenos savižudybės procese: patirtys ir formavimosi prielaidos

The emergence of affective states during the process of suicide is regarded as a serious indicator of suicide risk. This study aims to describe the experience of affective states characteristic of the suicide process and to raise assumptions about how these affective states develop over a person’s lifetime. A qualitative approach was employed in this study, with the objective of retrospectively exploring individuals’ life experiences through in-depth semistructured interviews. The research sample comprises 12 participants (4 men, 1 person with a nonbinary gender identity, and 7 women) who had attempted suicide no more than one year prior to the study and were receiving treatment at the Vilnius City Mental Health Centre at the time of data collection. Data were analysed using phenomenological interpretive analysis to identify recurring experiential patterns. The analysis revealed nine main experiential themes: some life difficulties experienced during the suicide process were not perceived as related to suicidality; repeated traumatic events provided a foundation for the formation of deep feelings of deficiency; a compensatory mechanism emerged to fill these feelings of deficiency; exhaustion developed from the effort to maintain this compensatory mechanism; the main trigger directly challenged the compensatory mechanism; an affective state followed the experience of the primary trigger; during the affective state, dissociation may help isolate psychological pain; suicidal thoughts during the affective state are experienced as arising automatically; and suicide is perceived as a means to end suffering. The findings of the study indicate that individuals’ narratives reveal a pattern of the formation of affective states characteristic of the suicide process. Through reflection, individuals are able to intuitively distinguish significant, distressing life events from those irrelevant to the suicide process and reconsider their experiences. This ability is a valuable resource for both intervention and postvention efforts.

Beyond the binary female/male sex classification: The impact of (trans)gender on the identification of human remains.

In cases of unidentified deceased persons, sex determination is a routine task in forensic medicine. However, the binary biological sex categories 'female' and 'male' may be challenged if it is not clear whether the information in the missing persons databases refers to the biological sex or the (felt and lived) gender. An umbrella term for people who do not identify with their birth sex (which usually is the biological, chromosomal sex) is 'transgender'. In recent decades, the legal and social situation of transgender people has changed in many countries making it easier to live their felt gender more openly. This development highlights the issue of potential challenges in the postmortem identification of transgender individuals. Serious problems in corresponding cases may be rare-but they must be considered and addressed in forensic practice to minimize the risk of delayed or failed identification. The impact of (trans)gender on the identification of human remains was examined by a narrative literature review under special consideration of the prevalences of transgender identities in general populations and in the group of unidentified deceased; possible actions to avoid problems in the postmortem identification of transgender persons in forensic practice are being proposed. One can assume that 1 of 200 people in the United States, the European Union and comparable societies is transgender with an opposite-sex identification, and 2 to 3 of 100 people live outside the typical female/male binary, with numbers increasing. If legally possible, an increasing number of transgender individuals will change their name and gender in civil registration. Transgender individuals are likely to be overrepresented in suicides and in victims of homicides. Although there are no precise data on the prevalence of transgender individuals in the group of unidentified deceased, the remarkably high reported prevalence in the general population and the over-representation of transgender individuals in suicides and homicides suggest that the topic is relevant to forensic practice. An autopsy does not always provide evidence of transgender identity, for example in skeletal remains. Particularly in unsolved cases, the possibility that an unidentified person may have been transgender should be considered. Knowledge and awareness of forensic practitioners on this topic should be strengthened by research and training. Databases and data reporting should be optimized. Recording in antemortem databases should clearly distinguish between 'biological sex' and 'apparent sex /lived gender identity'. When collecting postmortem data, a clear distinction should be made between "chromosomal sex" and "sex based on morphological findings". CLINICAL TRIAL NUMBER: Not applicable (review article).

7275 Diverse Reasons for Discontinuing Gender Affirming Hormone Therapy

Abstract Disclosure: A. Jain: None. M.S. Irwig: None. Many Transgender and Gender Diverse (TGD) individuals take Gender Affirming Hormone Therapy (GAHT). A study that included 264 adults [67% assigned male at birth (AMAB)] in Georgia found that 2% (n=5) discontinued GAHT over a follow-up period of 64 months. Reasons identified were change in gender identity (n=2), financial barriers (n=2) and venous thrombosis (n=1). Discontinuation was temporary for 2 and permanent for 2. Here we describe the reasons why four TGD individuals discontinued GAHT. Case Descriptions: Patient 1, AMAB, came out as gay as a teenager. In his mid 30s he became unhappy which he attributed to a conflict between religion and his sexual orientation and failed relationships. He thought that changing his sex would solve his problems. He took injectable estrogen for 3-4 years. He subsequently underwent multiple gender-affirmation surgeries including facial feminization surgery, breast implants, an orchiectomy and vaginoplasty. Immediately following the breast implant surgery he had regrets and wanted them removed. He also regretted the vaginoplasty. He stopped estrogen following the bottom surgery. In his 40s he stated that he would like to detransition as he sees himself "as a fake" when looking in the mirror. Patient 2 was assigned female at birth. Puberty was associated with discomfort from having a large chest. In his late 20s he began injectable testosterone which he took for three years. He then decided to take a two year break as he was frustrated that he had not achieved the desired results and because he was still not able to pass as a man. He resumed testosterone two years ago and underwent top surgery. Patient 3, AMAB, knew from a young age that he was transgender. He took estrogen and an antiandrogen for > 5 years and underwent an orchiectomy and vaginoplasty. He was pleased with the results from the GAHT and surgeries. He presented as a woman for many years. A few years ago, however, he awoke one day with the thought that God wanted him to be a man. He decided to detransition and presented to the endocrinology clinic to start testosterone therapy. Patient 4, AMAB, began GAHT in her late 30s. She discontinued GAHT 4 years later due to lack of results (feminization, larger breasts, wider hips and a more curvy figure). She presented to the endocrinology clinic 2 years later, wanting to resume GAHT. Conclusion: In addition to the reasons identified by Gupta et al for discontinuation of GAHT, we also identified unrealistic expectations, not achieving the desired results and perceived conflict between religion and gender identity. Endocrinologists should be aware of the possibility of discontinuation of GAHT and know how to manage any potential complications such as hypogonadism that may arise. Reference: Gupta P et al. J Clin Endocrinol Metab. 2023. Presentation: 6/2/2024

8768 Initiation of Exogenous Sex Hormones in a Pediatric Gender Clinic

Abstract Disclosure: C.M. Roberts: None. M.M. Knoll: None. G. Robertson: None. A. Egan: None. C. Moser: None. Introduction: The demographics of patients seeking care for gender dysphoria have changed significantly since care was started in 1987. The criteria for prescribing sex hormones have also evolved to allow a greater range of patients to receive gender-affirming hormones. We examined factors associated with prescription of gender-affirming hormones to patients presenting for gender-affirming care our clinic. Methods: Secondary analysis of sex hormone initiation as a minor among 14-17-year-old adolescents diagnosed with gender dysphoria, seen in the pediatric gender clinic between 2/19/2018 and 7/20/2022. We extracted demographic variables, appointment dates, and sex hormone prescription data from our electronic medical record. We collected patient reports of gender identity and suicidal behavior, and parent and adolescent reports of general adolescent well-being, months of gender dysphoria and social transition, and parental support for the adolescent’s gender identity from electronic clinic surveys. Results: We identified 273 adolescent-parent dyads with complete data. Most of our sample were assigned female at birth (74.4%), transgender male (59.3%), and white (83.5%) adolescents who lived in urban (86.4%) and lower-middle-income (64.5%) areas. The average age was 15.9+/-1.1 years. A minority of adolescents reported recent suicidal ideation 60/273 (22%), and prior suicide attempts 20/273 (7%). Parents reported a shorter duration of gender dysphoria (-16.7 months (95%CI: -22.0, -11.5)) and social transition (-4.7: -6.5, -3.0), and higher levels of parental support than adolescents. Approximately half, 146/273 (53.5%), of adolescents started sex hormones. The average age at initiation was 16.5 years +/- 0.9. Age at presentation, length of gender dysphoria or social transition, and the presence of suicidal ideation or attempts were not associated with initiation of sex hormones. Assigned males (OR:1.82:95%CI 1.04, 3.19), adolescents with higher parent-reported parental support for the adolescent’s identity (1.03:1.01, 1.04), and adolescents with private insurance rather than Medicaid (Blue Cross- 5.39:2.73, 10.64) were more likely to start sex hormones as a minor. Conclusion: Published criteria for the initiation of sex hormones among adolescents with gender dysphoria, including age, persistence of dysphoria, and the presence of suicidality, did not predict the prescription of sex hormones to minors in our clinic. Parent-reported support for the adolescent’s gender identity played a small role in predicting the prescription of hormones, but male sex assigned at birth and having private health insurance played larger roles. Further exploration of these findings is needed to ensure equity in the treatment of gender dysphoria. Presentation: 6/3/2024

7756 Gonadectomy in Individuals with Differences of Sex Development - A Prospective I-DSD Registry Study

Abstract Disclosure: M.A. O'Connell: None. A.K. Lucas-Herald: None. J. Bryce: None. M. Chen: None. J.H. Davies: None. M. Shnorhavorian: None. N. Atapattu: None. I. Bachynska: None. N. Birkebaek: None. M. Cools: None. K. Demir: None. L. de Vries: None. H. Elsedfy: None. M.A. Fahmy: None. E. Globa: None. R. Grinspon: None. G. Guaragna-Filho: None. G. Guerra-Junior: None. D. Janus: None. Z. Kolesinska: None. I. Mazen: None. S.M. O'Connell: None. S.N. Seneviratne: None. M. Stancampiano: None. G. Verkauskas: None. S.F. Ahmed: None. O. i-DSD gonadectomy surveillance consortium: None. Introduction: Gonadectomy may be indicated in people with differences of sex development (DSD), but variation in practice is reported. This study aims to determine, through prospective surveillance, the frequency of gonadectomy and associated care pathways in individuals with DSD internationally. Methods: All I-DSD centres were invited to participate; the study commenced in December 2022. Participating centres receive a monthly email asking whether a gonadectomy has been performed in an individual with DSD. Where informed consent for inclusion in the I-DSD Registry has been obtained in a reported case, a secondary survey captures additional clinical information. Results: Of 208 centres invited, 74 have responded to monthly email surveys. Over the first 12 months of surveillance, gonadectomies were reported in 71 individuals from 34 centres in 19 countries (median [range]: 1[1, 5]); 40 centres reported no gonadectomy. Secondary survey data are available for 30/65 (46%) of reported cases to date. Twenty-four (80%) individuals are female; median (range) age at gonadectomy was 9.2 (2.1,20.0) years. All had specialist multidisciplinary team involvement prior to gonadectomy: endocrinology (97%), genetics (77%) and psychology (67%) were most frequently involved. Gonads were intra-abdominal in 25/30 (83%). Differences of gonadal development (13/30 [43%]) and Turner syndrome (8/30 [27%]) were the most frequent underlying DSD. Pre-gonadectomy investigations included: hormonal testing (28/30 [93%]), imaging (23/30 [77%] - US alone n=14; US + MRI n=7; MRI alone n=2), direct visualisation at laparoscopy (7/30 [23%]) and gonadal biopsy (2/30 [7%]). Bilateral gonadectomy was undertaken in 25/30 (83%). Mitigation of future malignancy risk in the context of gonadal insufficiency was the most common primary indication for gonadectomy (19/30, [63%]); additional indications were concerning changes on biopsy/imaging (3/30 [10%]), hormone production incongruent with sex assigned (4/30 [13%]) or gender identity (2/30 [7%]) and parental choice (2/30 [7%]). Histopathology confirmed neoplastic change in 7 individuals (23%). Gonadectomy was intentionally deferred in 8/30 (27%) individuals, most commonly to allow their involvement in decision making. Twelve individuals (40%) were 12yrs or older at gonadectomy; all were involved in the pre-operative decision-making process. Conclusions: This study offers important contemporary insights into the practice of gonadectomy in individuals with DSD internationally. Multidisciplinary care provision prior to gonadectomy is standard; however, management pathways vary, likely reflecting diversity of clinical presentations and lack of consensus regarding optimal approach. The I-DSD platform shows clear utility for performing prospective surveillance of rare procedures; such studies are essential for care quality improvement. Presentation: 6/2/2024