Utrecht Gender Dysphoria Scale Research Articles

Analyzing body dissatisfaction and gender dysphoria in the context of minority stress among transgender adolescents

BackgroundGender dysphoria among transgender adolescents has predominantly been examined in relation to body dissatisfaction. While in adult transgender samples, body dissatisfaction is higher than in cisgender controls, this has so far rarely been investigated for adolescents. In the context of a cisnormative society, the impact of influences from the social environment on body dissatisfaction and gender dysphoria has been neglected in research. Therefore, this study aimed to (1) provide a detailed analysis of body dissatisfaction among young transgender people and (2) investigate whether body dissatisfaction and gender dysphoria are associated with experiences of minority stress such as trans hostility and poor peer relations (PPR).MethodsThe paper presents a cross-sectional study among a sample of transgender adolescents, presenting at a specialized outpatient counseling clinic (N = 99; age M = 15.36, SD = 1.85). First, body dissatisfaction (assessed by the Body-Image-Scale; BIS), was explored and compared to data from a population-based control group of cisgender peers (N = 527; age M = 14.43, SD = 0.97). Second, within a clinic-referred transgender subsample (n = 74), associations between body dissatisfaction and gender dysphoria (measured by Utrecht Gender Dysphoria Scale; UGDS), PPR (measured by the Youth-Self-Report; YSR-R), and trans hostile experiences (assessed in clinical interview) were examined by correlations, t-tests and multivariate regression.ResultsTransgender adolescents reported more body dissatisfaction than cisgender peers. The dissatisfaction with sex characteristics, non-hormonal reactive body regions and the total score for body dissatisfaction were positively related with gender dysphoria. The majority had experienced trans hostility in the present and/or past (54.1%) and PPR (63.5%). More body dissatisfaction was correlated with more PPR regarding visible body parts i.e., hair, overall appearance and muscles, whilst PPR and gender dysphoria were not associated. Transgender adolescents who experienced trans hostility showed higher gender dysphoria and PPR, but not more body dissatisfaction. In multiple regression, trans hostility predicted gender dysphoria, whilst age and PPR predicted body dissatisfaction.DiscussionExperiences of minority-stress differentially interact with body dissatisfaction and gender dysphoria among transgender adolescents. Social correlates of body dissatisfaction and gender dysphoria must be considered when working with young transgender people.

MP02-20 A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECT OF GENDER-AFFIRMING PELVIC SURGERY ON GENDER DYSPHORIA AND BODY IMAGE IN TRANSGENDER PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP02-20 A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECT OF GENDER-AFFIRMING PELVIC SURGERY ON GENDER DYSPHORIA AND BODY IMAGE IN TRANSGENDER PATIENTS Kevin Hakimi, Paige De Rosa, Kyle Okamuro, and Jennifer Anger Kevin HakimiKevin Hakimi More articles by this author , Paige De RosaPaige De Rosa More articles by this author , Kyle OkamuroKyle Okamuro More articles by this author , and Jennifer AngerJennifer Anger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transgender patients often demonstrate self-criticism and social distress related to body image dissatisfaction. Although patients seek gender affirming care to reduce gender dysphoria and improve body image, the degree to which these outcomes improve after “bottom” surgery (phalloplasty, metoidioplasty, vaginoplasty, vulvoplasty) has not been well quantified. METHODS: Utilizing meta-analysis of observational studies in epidemiology (MOOSE) criteria, we performed a search of major biomedical databases for all relevant literature published regarding body image and gender dysphoria in transgender populations following bottom surgery from 1995 to 2001. Inclusion criteria included original research articles, studies of transgender patients receiving pelvic gender affirming surgery (phalloplasty, metoidoplasty, vaginoplasty, vulvoplasty), and use of either the Utrecht Gender Dysphoria Scale (UGDS) or Body Image Scale (BIS) scoring systems. Data were compiled using a comprehensive meta-analysis software (Revman). Pooled estimates were obtained using a random effects model with the generic inverse variance method. RESULTS: Our literature search included 77 titles and 4 full articles. Four studies provided UGDS data. Our analysis of 208 patients revealed bottom-surgery resulted in significant improved in UGDS scores in patients compared to baseline with a standard mean difference of 6.74 (CI 6.24, 7.25; p<0.001). Three studies provided BIS data. Our analysis of 201 patients revealed bottom surgery resulted in significant improvements in body image satisfaction with a standard mean difference of 0.79 (CI 0.68, 0.91; p<0.001). CONCLUSIONS: Gender-affirming pelvic surgery was associated with significant improvements in body image satisfaction and a significant reduction in gender dysphoria among transgender patients. Our meta-analysis supports further use of gender-affirming surgical techniques to improve body image satisfaction in transgender populations. Source of Funding: UC San Diego School of Medicine Research Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e20 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Hakimi More articles by this author Paige De Rosa More articles by this author Kyle Okamuro More articles by this author Jennifer Anger More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of Hormone Treatment on Psychosocial Functioning in Gender-Diverse Young People.

Purpose: Few studies have assessed the effects of hormonal treatments such as gonadotropin-releasing hormone agonists (GnRHa) and gender-affirming hormones (GAH) on mental health outcomes in clinically referred gender-diverse young people from a younger age. Where this research has been conducted, findings have been mixed. This study investigated a cohort of young people before treatment, 1 year into GnRHa, and 1 year into GAH treatment to understand psychological and behavioral impacts over time. Methods: Thirty-eight young people (28 assigned female and 10 assigned male) referred to endocrinology, younger than 15 years at/beyond Tanner stage two, who received GnRHa followed by GAH treatment, were assessed in a retrospective analysis study. Young people completed the Youth Self Report (YSR), the Body Image Scale, and the Utrecht Gender Dysphoria Scale, while caregivers completed the Child Behavior Checklist (CBCL) and the Social Responsiveness Scale-2 at all time points. Results: Dissatisfaction with primary sexual characteristics (p = 0.02), gender dysphoria (p = 0.01), and social motivation (p = 0.04) improved significantly over time. Self-harm and suicidality also showed a general decrease. Caregivers reported a significant reduction in internalizing (p = 0.03) behaviors on the CBCL after GnRHa. Other subcategories of the YSR and CBCL were within normal ranges with no significant difference (p > 0.05). Conclusion: These findings demonstrate some improvements in psychological and behavioral outcomes in young people concurrently receiving psychosocial support and hormone treatment. Future research with larger and more diverse samples is warranted to further understand generalizability.

Associations of acoustic parameters and gender dysphoria in transmasculine individuals

Gender dysphoria refers to a feeling of discomfort due to a mismatch between a person’s biological sex and gender identity. Voice is a secondary sex marker, and it may contribute to feelings of unease or dissatisfaction if the voice does not match a person’s gender identity. The Utrecht Gender Dysphoria Scale—Gender Spectrum (UGDS-GS) was designed to measure a person's degree of gender dysphoria. Transmasculine individuals were assigned female at birth and identify as male or masculine non-binary, and acoustic studies focusing on transmasculine voices are notably sparse. In a study including 20 transmasculine individuals, we compared UGDS-GS results to the following acoustic parameters: vocal tract length (VTL) estimates, fundamental frequency (f0), standard deviation of f0, and cepstral peak prominence smoothed (CPPS). We found a significant positive correlation between each acoustic measure and gender dysphoria. We also found robust associations between each of these measures and a voice-related quality of life measure. These findings indicate that the sound of one’s voice may be a strong predictor of gender dysphoria.

Internalized transphobia predicts worse longitudinal trend of body uneasiness in transgender persons treated with gender affirming hormone therapy: a 1-year follow-up study.

Given the relationship between interiorized stigma and body image, it could be hypothesized that high levels of internalized transphobia (IT) might predict higher levels of body uneasiness in subjects with gender dysphoria (GD) and worse improvement of body image after gender affirming hormone therapy (GAHT). We sought to evaluate the relationship between IT and body uneasiness in subjects with GD and the role of IT in moderating the improvement of body image after GAHT. In total, 200 individuals with GD performed the baseline assessment; 99 were re-evaluated 12months after starting GAHT. At baseline participants were evaluated through a face-to-face interview and filled self-administered questionnaires to evaluate GD (Utrecht Gender Dysphoria Scale [UGDS]), IT attitudes (Attitudes Toward Transgendered Individuals [ATTI] Scale), body uneasiness (Body Uneasiness Test, part A [BUT-A]), and general psychopathology (Symptom Checklist 90-Revised [SCL 90-R]). The same questionnaires, except ATTI, were readministered at follow-ups. Outcomes were based on measures of the associations between IT and baseline characteristics of the sample, the longitudinal trends of GD, body uneasiness, and general psychopathology; and IT as a moderator of the longitudinal trend of body uneasiness. At baseline, IT correlated with lower level of education, higher GD, and more severe body uneasiness. Longitudinal analyses showed significant improvements in GD, body uneasiness, and general psychopathology during GAHT. Moderation analysis confirmed that participants with more transphobic attitudes showed less improvement after GAHT with regard to body uneasiness (bTime*ATTI = -.002, P = .040). The Johnson-Neyman technique revealed that no significant improvement in body uneasiness was found for participants with ATTI scores lower than 71.14. The presence of IT should be investigated in subjects with GD who require gender affirming treatments to provide specific interventions aimed at targeting this dimension. Strengths of this study include the mixed cross-sectional and longitudinal design and the dimensional evaluation of the investigated constructs. Limitations include the small sample size and the limited follow-up. Furthermore, the effects of gender affirming surgery were not evaluated. The association of IT with both baseline body uneasinessand the longitudinal course of this dimension highlighted the clinical significance of body uneasiness and the importance of making continuous efforts to improve education and information to fight societal stigmas.

Validation of Two Measures of Gender Dysphoria/Incongruence in Transgender and Cisgender Populations in China.

This study examined gender dysphoria (GD) in transgender and cisgender populations in China and aimed to provide validity evidence for two dimensional measures of GD. A total of 293 transgender people (170 transmen, 65 transwomen, and 58 non-binary trans people; mean age, 21.3 years) and 538 cisgender people (296 ciswomen and 242 cismen; mean age, 23.5 years) completed the Utrecht Gender Dysphoria Scale (UGDS), the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA), and demographic information online. The UGDS and the GIDYQ-AA had good reliability and validity for the Chinese population. Transgender people reported higher intensity of GD than cisgender people. Cisgender women reported higher intensity of GD than cisgender men. Non-binary transgender people reported lower intensity than binary transgender people. However, transmen reported higher intensity than transwomen for the UGDS but not for the GIDYQ-AA. Transgender people with gender-affirming hormonal treatment experience reported higher intensity of GD than those without treatment. Moreover, transgender people coming out to parents reported higher intensity than those who did not. The cutoff values of the UGDS and the GIDYQ-AA in the original version show high sensitivity for transgender people and specificity for cisgender people. Our findings indicate that the UGDS and the GIDYQ-AA are validated measures of GD in China.

Utrecht Gender Dysphoria Scale - Gender Spectrum in a Chinese population: scale validation and associations with mental health, self-harm and suicidality.

Individuals with gender dysphoria display an incongruence between birth-assigned gender and gender expression. However, there is no existing Chinese measure for gender dysphoria. This study aims to validate the Utrecht Gender Dysphoria Scale - Gender Spectrum (UGDS-GS) in a Chinese population, and compare the psychometric properties of the UGDS-GS with one frequently used scale for gender dysphoria measurement, the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA). A total of 2646 Chinese participants were recruited. The following information was collected: sociodemographic variables, gender identity, sexual orientation, gender dysphoria measured by the UGDS-GS and the GIDYQ-AA, anxiety, depression and suicide assessment. Principal component analyses and confirmatory factor analysis (CFA) were conducted to test the fitness of the model. Discriminant validity was tested with one-way analysis of variance. The UGDS-GS showed good psychometric properties, with the GIDYQ-AA demonstrating slightly better psychometric properties than the UGDS-GS. UGDS-GS also showed strong internal consistency (Cronbach's α = 0.89), and good convergent validity and criterion validity. Exploratory factor analysis showed a one-factor structure (Kaiser-Meyer-Olkin test, 0.93; χ2 = 13 342.50; d.f. = 153; P < 0.001). The UGDS-GS was positively associated with anxiety symptoms, depressive symptoms, suicidal ideation, attempted suicide and self-harm. We also found the results were robust in different samples. The validated UGDS-GS can significantly stimulate and promote gender dysphoria assessment in Chinese populations, allowing for assessment in a more diverse subset of gender minorities.

Standardized instruments for assessing psychiatric, behavioral, sexual problems, and quality of life in male and female adults with disorders of sex development in Indonesia

Disorders of Sex Development (DSD) are a group of congenital medical conditions defined as atypical development of chromosomal, gonadal, and anatomical sex. Psychiatric, behavioral, and gender-associated problems could arise in both male and female adult with DSD. Structured assessments for each variable are needed to properly measure psychiatric and sexual issues and overall quality of life in adults with DSD. This study aims to review structured questionnaire instruments that had been used to assess psychiatric, behavioral, sexual problems, and quality of life in adults with DSD.For psychiatric or behavioral problems, adults with DSD can be assessed with GHQ-28, Brief Symptoms Inventory, Achenbach and Rescorla’s Adult Behavior Checklist, Rosenberg Self-esteem Scale, Mini International Neuropsychiatric Interview plus, Hospital anxiety and depression scale, Body image scale, Adult ADHD self-report scale screener, Short Autism Spectrum Quotient, and coping with DSD questionnaire. For quality of life, assessment could be done with WHOQOL and Short Form-36. Gender role assessment in adults with DSD can be done using Core Gender Identity, Sexual Orientation, and Gender Role Behavior and Utrecht Gender Dysphoria Scale. Both of the apparent male and female DSD patients can be assessed using the instruments available. Recommendations are made based on its function, compliance, validity, reliability, and avaibility of an Indonesian version of the questionnaire.There are a plethora of structured questionnaire tools that have been used to measure psychiatric or behavioral problems, quality of life, and gender roles in adult with DSD, each with its own advantages and disadvantages

A review of instruments of experimental psychological diagnostics of gender dysphoria and gender incongruence in the context of transition to ICD-11

In 2024, Russia will change over to the 11th version of the International Classification of Diseases (ICD-11) where the diagnosis transsexualism will be replaced by gender incongruence. At present, clinical practice guidelines rooted in evidence-based medicine are being developed. This means that validated instruments of experimental psychological diagnostics should be used. In the present review, we identify ten instruments used in international practice. After discussing their strengths and weaknesses we can recommend four instruments for diagnosing gender dysphoria and gender incongruence: Transgender Congruence Scale, Trans Collaborations Clinical Check-In (TC3), Gender Congruence and Life Satisfaction Scale, and Utrecht Gender Dysphoria Scale Gender Spectrum (UDGS-GS). Six instruments are recommended for prescribing psychotherapy aimed to help the patients accept their gender identity and build resilience: Transgender Congruence Scale, Gender Identity Reflection and Rumination Scale, Gender Preoccupation and Stability Questionnaire, Trans Collaborations Clinical Check-In (TC3), Gender Congruence and Life Satisfaction Scale, and Transgender Identity Survey. At the same time, we do not recommend two widely used instruments Utrecht Gender Dysphoria Scale (classical version) and Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults due to their inapplicability to gender non-binary individuals and those in the process of gender transition. In the article we also discuss issues related to differential diagnostics in the context of ICD-11, as well as peculiarities of using diagnostic scales with gender non-binary individuals, intersex people and detransitioners.

Prevalence of Gender Dysphoria by Gender and Age in Japan: A Population-Based Internet Survey Using the Utrecht Gender Dysphoria Scale

BackgroundSeveral studies have attempted to estimate the prevalence of gender dysphoria (GD) from a general population sample. However, no previous studies used reliable questionnaires. AimTo estimate the prevalence of GD in Japan by gender and age using the Utrecht Gender Dysphoria Scale (UGDS). MethodsA cross-sectional observational study was conducted with 20,000 respondents between the ages of 20 and 69 who were registered with an internet research company. The study consisted of two phases. First, the participants were asked to self-identify their gender on two 5-point Likert scales. Second, the screened participants completed the UGDS. OutcomesSelf-identified gender and GD were defined as follows: ambivalent gender (equally feeling like the birth gender and another gender), incongruent gender (a stronger sense of the latter vs the former), narrow GD (incongruent gender + UGDS score ≥ 41), and broad GD (ambivalent or incongruent gender + UGDS score ≥ 41). ResultsAmong the eligible participants, the age-adjusted proportions of those classified as male (n = 7827) and female (n = 8903) at birth were 6.0% and 5.9%, respectively, for ambivalent gender, and 0.93% and 1.0%, respectively, for incongruent gender. The age-adjusted prevalence of GD was 0.27% (95% confidence interval, 0.18–0.42) and 0.35% (95% confidence interval, 0.25–0.50) for narrow GD and 0.87% (95% confidence interval, 0.69–1.1) and 1.1% (95% confidence interval, 0.86–1.3) for broad GD, respectively. No significant gender differences were found within the age groups, except for broad GD in respondents in their 50s (P = .016). However, for both genders, significant differences were found between age groups such that GD was more prevalent in younger vs older respondents, except for broad GD in respondents classified as female at birth (P = .063). Clinical ImplicationsClinicians should be aware that the prevalence of GD is not negligible and that it varies with age. GD should be assessed in detail from various perspectives in addition to self-identified gender. Strengths & LimitationsThis study used a reliable questionnaire to examine the prevalence of GD in a large population. However, the participants did not represent the general population because this was an internet survey. ConclusionThe prevalence of GD was much higher than previously estimated by clinic-based studies, and was more frequently associated with participant age vs gender.Oshima Y, Matsumoto Y, Terada S, et al. Prevalence of Gender Dysphoria by Gender and Age in Japan: A Population-based Internet Survey Using the Utrecht Gender Dysphoria Scale. J Sex Med 2022;19:1185–1195.

Gender Affirming Medical Treatment Desire and Treatment Motives in Binary and Non-Binary Transgender Individuals

BackgroundIt is currently unknown whether there are differences in desire for gender affirming medical treatment (GAMT) between binary and non-binary transgender individuals, although the latter seek treatment less prevalently. AimTo investigate differences between binary and non-binary individuals on received GAMT, desire for GAMT, and motives for (not) wanting GAMT, and to explore the association between having an unfulfilled treatment desire and general and sexual well-being. MethodsWe conducted an online questionnaire in a community sample of 125 transgender men, 72 transgender women, and 62 non-binary transgender individuals (age: M = 30.4, SD = 11.31, range 18-69). Outcome measuresUndergone GAMT, GAMT desire, motives for (not) wanting (further) GAMT, Utrecht Gender Dysphoria Scale, Satisfaction With Life Scale, Hospital Anxiety and Depression Scale, Global Measure of Sexual Satisfaction, transgender-specific body image worries, and sexual self-concept discrepancies. ResultsBinary transgender participants reported having undergone more GAMT procedures than non-binary transgender participants (P < .001 for both gender affirming hormone treatment (GAHT) and gender affirming surgery (GAS)). While binary participants reported a stronger desire for GAHT compared to non-binary participants (X2(1, N = 93) = 32.63, P < .001), the groups did not differ in their desire for GAS (X2(1, N = 247) = 0.68, P = .411). Binary and non-binary participants reported similar reasons for wanting treatment, mostly related to body and/or gender incongruence and gender affirmation. In terms of not wanting treatment, the non-binary group reported their gender identity as the most important reason, while the binary group mostly mentioned possible medical complications. The majority of both groups had an unfulfilled treatment desire (69% of binary participants and 64.5% of non-binary participants), which was related to lower levels of general life satisfaction (P < .001) and sexual satisfaction (P = .005), more anxiety (P = .006) and transgender-specific body image worries (P < .001), and larger sexual self-concept discrepancies (P < .001 for actual and/or ideal, P < .001 for actual and/or ought). Clinical implicationsSystemic barriers to GAMT (especially GAS) should be removed not only for binary but also for non-binary identifying transgender individuals to decrease the discrepancy between treatment desire and actually seeking treatment. Strengths & limitationsThis study was the first to systematically investigate differences in treatment desire motives between binary and non-binary transgender individuals, while also showing the possible negative consequences of an unfulfilled treatment desire. Given the online character of the study, results may not generalize to the broader transgender community. ConclusionSimilarly to binary transgender individuals, many non-binary transgender individuals have a desire for GAMT, and not being able to receive GAMT has a negative effect on their mental and sexual health. Further efforts should be made to make GAMT accessible for all transgender individuals, regardless of gender identity.Kennis M, Duecker F, T'Sjoen G, et al. Gender Affirming Medical Treatment Desire and Treatment Motives in Binary and Non-Binary Transgender Individuals. J Sex Med 2022;19:1173–1184.

Abstract- Poster

BACKGROUNDGender dysphoria is characterized by persistent and intense distress about assigned sex with a desire to be of opposite sex with a prevalence of 0.005-0.014% in biological males and 0.002-0.003% in biological females. According to ICD-10, 1/3rd of gender dysphoria cases have homosexual orientation. In this poster we report a case of young boy with Gender dysphoria having Homosexual orientation.CASE REPORTA 12-year-old boy visited GSL Psychiatry OPD with C/O Intense desire to be of opposite sex and a need for sexual gratification with same gender with H/O strong preference for games engaged by opposite gender with playmates of the opposite gender, simulating female attire when he is alone, and subjective feeling of arousal with boys. Two weeks prior to the visit, patient stripped and forced himself onto his maternal uncle in absence of other family members.General physical examination and Patient’s genetalia examination were normal. Basic blood investigations were normal. Utrecht gender dysphoria scale suggested gender dysphoria.CONCLUSIONBiological and environmental factors influence particular sexual orientation and Identity. Helping patients and society in understanding this, bringing awareness and providing support can reduce interpersonal conflicts, Rejection from society, symptoms of Depression and Anxiety, Substance use disorders, Poor Self-esteem and prevent Self-harm and Suicide.

The Comparison of Gender Dysphoria, Body Image Satisfaction and Quality of Life Between Treatment-Naive Transgender Males With and Without Polycystic Ovary Syndrome.

The prevalence of polycystic ovary syndrome (PCOS) among trans men has been reported as higher than among the cisgender population, which varies between 14.4% and 58%. In this cross-sectional study, we aimed to evaluate the association of oligo-anovulation and/or features of hyperandrogenism with the scores on the Utrecht Gender Dysphoria Scale (UGDS), the Body Image Scale (BIS), and the Short Form-36 Health Survey (SF-36) in treatment-naive trans men with PCOS seeking help for gender transition. The study sample consisted of trans men who were diagnosed with gender dysphoria (GD) between December 2019 and November 2020. To assess body dissatisfaction and psychological functioning, the UGDS, BIS, and SF-36 were administered to all transgender individuals as part of the routine assessment procedure. A total of 49 treatment-naive trans men were included in our study; 38.8% (n=19) of the participants were diagnosed with PCOS using the Rotterdam 2003 criteria. The scores of UGDS and BIS were significantly lower in the PCOS group compared with the non-PCOS group (p<0.001 and p=0.003, respectively). Among the eight parameters within SF-36, general health, emotional role, and vitality scores were significantly higher in the PCOS group (p=0.031, p=0.015, and p=0.006, respectively). Our study is the first study that demonstrates significantly lower GD, higher body image satisfaction and quality of life in trans men with PCOS compared with those without PCOS. Our findings are promising for larger prospective cohort studies to develop a consensus on the management of PCOS in trans men.

The Assessment of Reliability and Validity of Utrecht Gender Dysphoria Scale-Thai Version as a Screening Tool for Gender Dysphoria in Thai Transgender Women

Background: Gender dysphoria is a psychological distress caused by the incongruence between gender assigned at birth and gender characteristic. This condition is an indication for cross-sex hormone or sex-reassignment surgery. To date, there is no available tool to assess gender dysphoria in Thai language. Objective: To translate male-to-female Utrecht gender dysphoria scale (UGDS-MTF) into Thai language to create a credible UGDS-MTF-Thai version. Materials and Methods: The present study was a cross-sectional study in a community base setting. The process of the translation included forward translation, backward translation, and revision with a permission of the original author. The validity and reliability of the questionnaire was analyzed. Results: Fifty natal males were included in the study, which included 25 transwomen [TGW] and 25 men who had sex with men [MSM]. The average sum score of UGDS-MTF-Thai in TGW was significantly higher than those of MSM at 47.5 and 25.9, respectively. The overall index of item-objective congruence (IOC) was 0.87 and the overall Cronbach’s alpha was 0.97. The sensitivity and specificity of the test was 92% and 96%, when the cut point was set at 40. Conclusion: UGDS-MTF-Thai is a reliable tool to assess gender dysphoria in Thai natal males with gender variations. The scale provides good sensitivity and specificity in detecting gender dysphoria. According to the simplicity of the UGDS-MTF-Thai-scale, it is applicable for both epidemiologic study and in clinical use. Keywords: Gender dysphoria, Transgender, Transwomen, Utrecht gender dysphoria score, Gender dysphoria measurement

Psychometric properties and concurrent validity of the Transgender Congruence Scale (TCS) in the Swedish setting

The Transgender Congruence Scale (TCS) is a non-binary tool used in Sweden for gender dysphoria (GD) assessment; however, its Swedish version has not been validated. To investigate the psychometric properties of the TCS, its capacity to distinguish individuals with GD and its concurrent validity compared to other scales. Patients with GD (n = 135) and controls (n = 443) filled in a questionnaire containing sociodemographic questions, the TCS, the Utrecht Gender Dysphoria Scale (UGDS), and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA). TCS had good discriminatory validity and internal consistency. Patients with GD, stratified by birth-assigned sex, had lower TCS scores compared to controls. Confirmatory factor analysis (CFA) supported the two-factor model of the TCS. Multiple-group CFA suggested measurement invariance between birth-assigned sexes and configural invariance between patients with GD and controls. Area under the ROC curve for birth-assigned males was 0.991 and for females 0.994. A TCS mean value of three provided sensitivity 94.3% and 95.1% as well as specificity 98.6% and 98% for aM and aF, respectively. The TCS was significantly correlated to UGDS and GIDYQ-AA. The TCS may be a valuable tool in the clinical assessment of individuals with GD.

Utrecht Gender Dysphoria Scale - Gender Spectrum (UGDS-GS): Construct validity among transgender, nonbinary, and LGBQ samples

Background: Researchers combined both versions of the original Utrecht Gender Dysphoria Scale (UGDS) to create a single gender spectrum version (UGDS-GS) which measures dissatisfaction with gender identity and expression over time as well as comfort with affirmed gender identity.Aim: This study examined the construct validity of the newly revised, UGDS-GS.Method: Tests of measurement invariance were conducted in stages to assess measurement invariance of the UGDS-GS across three groups: cisgender, binary transgender, and nonbinary/genderqueer.Results: Findings indicate that the UGDS-GS functions acceptably in all three gender groups (configural and metric invariance). Also, across binary transgender and nonbinary/genderqueer groups, the measure functions very similarly with all four types of invariance. Item level findings highlight the specificity of the measure to distinguish experiences of binary transgender and nonbinary/genderqueer persons differently from cisgender LGBQ individuals.Conclusions: The UGDS-GS demonstrates a large degree of invariance across binary transgender, nonbinary/genderqueer, and cisgender LGBQ subgroups; and therefore, findings indicate this revision to be a substantial improvement. This 18-item self-report, Likert-type scale measure is a) inclusive of all gender identities and expressions (e.g., transfeminine spectrum, transmasculine spectrum, genderqueer, nonbinary, cisgender); b) appropriate for use longitudinally from adolescence to adulthood; and c) administered at any point in the social or medical transition process, if applicable, or in community-based research focused on gender dysphoria that examines cisgender and transgender persons.

Subjective Ratings of Gender Dysphoria Scales by Transgender Individuals.

The present research explored transgender individuals' subjective ratings of two clinical measures of gender dysphoria: the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) and the Utrecht Gender Dysphoria Scale (UGDS). Participants read each scale and provided a global rating regarding how well they captured their experiences of gender dysphoria. Participants included 622 transgender individuals who identified as transfeminine (n = 221), transmasculine (n = 206), and non-binary/agender (n = 195). Findings indicated clear patterns of responses across gender identity and assigned sex, but not clinical diagnosis. For the GIDYQ-AA, transfeminine and transmasculine individuals rated the scales more positively than did non-binary/agender individuals. In addition, participants who were assigned male rated the scale to be a more accurate measure of their dysphoria than did participants who were assigned female. For the UGDS, transfeminine individuals rated the scale most positively, followed by transmasculine individuals, and then non-binary/agender individuals. All pairwise comparisons were significant. Likewise, participants who were assigned male rated the scale to be a more accurate measure than did those who were assigned female. It is important to note that subjective ratings were relatively low (M = 3.40, SD = 1.09 for GIDYQ-AA; M = 3.43, SD = 1.22 for UGDS on a 5-point scale) where little more than half of the participants (52.5% GIDYQ-AA; 54% UGDS) agreed or strongly agreed that the scales captured their experience. Discussion focused on the implications for using these measures of gender dysphoria in both clinical and research settings.

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

The background of this article is to examine whether consecutively transgender clinic-referred adolescents between 2000 and 2016 differ over time in demographic, psychological, diagnostic, and treatment characteristics. The sample under study consisted of 1072 adolescents (404 assigned males, 668 assigned females, mean age 14.6 years, and range 10.1–18.1 years). The data regarding the demographic, diagnostic, and treatment characteristics were collected from the adolescents’ files. Psychological functioning was measured by the Child Behaviour Check List and the Youth Self-Report, intensity of gender dysphoria by the Utrecht Gender Dysphoria Scale. Time trend analyses were performed with 2016 as reference year. Apart from a shift in sex ratio in favour of assigned females, no time trends were observed in demographics and intensity of dysphoria. It was found, however, that the psychological functioning improved somewhat over time (CBCL β − 0.396, p < 0.001, 95% CI − 0.553 to − 0.240, YSR β − 0.278, p < 0.001, 95% CI − 0.434 to − 0.122). The percentage of referrals diagnosed with gender dysphoria (mean 84.6%, range 75–97.4%) remained the same. The percentage of diagnosed adolescents that started with affirmative medical treatment (puberty suppression and/or gender-affirming hormones) did not change over time (mean 77.7%; range 53.8–94.9%). These findings suggest that the recently observed exponential increase in referrals might reflect that seeking help for gender dysphoria has become more common rather than that adolescents are referred to gender identity services with lower intensities of gender dysphoria or more psychological difficulties.

PO-01-023 Sexual desire in transgender persons in relation with gender affirming hormone treatment. Results from ENIGI, a large multicenter prospective cohort study in transgender people

Several steps in the transitioning process may affect sexual desire, including hormone therapy and gender affirming surgery. Testosterone therapy in transgender men (TM) generally leads to increased sexual desire, masturbation, sexual fantasies and arousal. Studies in transgender women (TW) are often inconclusive. This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Upon first clinical contact, psychological questionnaires were completed. Sexual desire was prospectively assessed in 766 participants (401 TW, 364 TM) by the Sexual Desire Inventory (SDI) during a three-year follow-up period, starting at the initiation of hormone treatment (HT). Sex steroids were measured at each visit. Data were analyzed cross-sectionally and prospectively. Baseline SDI scores were comparable in TW and TM (P=0.342). In TW, SDI scores decreased from 39.0 [23.0 – 54.5] (baseline) to 33.0 [16.3 – 49.8] (12 months) (-4.77, P<0.001), returning to scores comparable to baseline after 18 months (P=0.114). After 36 months, SDI scores were higher than baseline scores (51.5 [39.5 – 61.0], P=0.003). In TM, total SDI scores increased from 40.0 [17.0 – 52.0] at baseline to 55.0 [40.5 – 67.0] (+14.61, P<0.001) after 12 months, remaining stable over the following year and returning to scores comparable to baseline scores (58.0 [23.0 – 62.0], P=0.250) after 36 months. People with a partner (P<0.001) and TW with lower levels of self-reported gender dysphoria (Utrecht Gender Dysphoria Scale) (ρ=0.336, P=0.002) reported higher SDI scores. Prospective SDI scores were not influenced by prospective changes in serum levels of sex steroids in TM and TW. Lower baseline levels of gender dysphoria (Utrecht Gender Dysphoria Scale) correlated to a higher prospective increase in SDI scores in TM after 12 months of HT (ρ=-0.355, P<0.001).

PS-07-010 Psychological survey and medical form to establish objective evaluation criteria of outcome about phalloplasty in pediatric age

The problem of objective assessment about aesthetic/functional Results and psychological implication after male external genitalia reconstructive surgery is yet known in the literature. To establish objective evaluation criteria of outcome about De Castro’s neo-phalloplasty in children, we created a psychological survey submitted to patients/parents and a form with medical parameters evaluated from the surgeon Medical form is divided in subjective and objective parameters. Subjective (surgeons’, parents’ and patients’ estimations) parameters are: overall appearance of external genitalia, look of penis - scrotum - penile scars - abdominal scars and look/position of the umbilicus; scored as extremely-poor, poor, acceptable, good, excellent or better in a ranking from 0 to 10. Objective parameters are: Tanner scale, Faisal external and internal masculinization score, sex hormones attitude, length of the ventral and dorsal aspect of penis and difference between the two, penile diameter, location of the urethral ending, urinary continence/voiding, patient’s position during micturition, presence of penile erection – masturbation - erogenous areas - sexual intercourse – insertion of penile prosthesis. The survey evaluate patients and parents psychological/sexual aspects and quality of life post-phalloplasty. Tests used: Child Behaviour Checklist, Parenting Stress Index, Children Global Assessment Scale, Body Uneasiness Test, Revised Children’s Manifest Anxiety Scale, Beck Depression Inventory, Beck Anxiety Inventory, Multi-Attitude Suicide Tendency Scale, Gender Identity/Gender Dysphoria Questionnaire, Duss Tales, Utrecht Gender Dysphoria Scale, Body Image Scale, Recalled Childhood Gender Identity Scale