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. 2023 Mar;72(3):428-436.
doi: 10.1016/j.jadohealth.2022.10.020. Epub 2022 Dec 17.

Shifts in Gender-Related Medical Requests by Transgender and Gender-Diverse Adolescents

Ariel Cohen  1 , Veronica Gomez-Lobo  2 , Laura Willing  3 , David Call  3 , Lauren F Damle  4 , Lawrence J D'Angelo  5 , Amber Song  6 , John F Strang  7
Affiliations

Shifts in Gender-Related Medical Requests by Transgender and Gender-Diverse Adolescents

Ariel Cohen et al. J Adolesc Health. 2023 Mar.

Abstract

Purpose: Gender-affirming hormones and/or surgeries seeking to change the body can have potentially lasting effects. Changes in requests for these therapies among gender-diverse youth are not well-understood. The study aim is to characterize factors associated with shifts in gender-related medical requests.

Methods: This mixed-methods study used retrospective chart review and qualitative interviews with clinicians. Of 130 youth receiving clinical gender care at Children's National Hospital, 68 met inclusion criteria. Qualitative interview analysis was performed to identify patterns and themes around shifts in gender-related medical requests over time. Statistical analysis employed chi-square and t-tests to compare characteristics in the shift versus no-shift groups and kappa statistics to calculate qualitative coding agreement.

Results: Of the 68 youth followed over time (mean age 15.11 years, 47% autistic, 22% nonbinary), 20 (29%) reported a shift in request. No significant differences were found by age, autism status, or designated sex at birth. More youth with shifts were nonbinary (p = .012). Six shift profiles were identified from qualitative interviews with excellent reliability (κ = 0.865). Four of the profiles reflect shifts in request prior to starting treatment (85% sample); two involved shifts after commencing treatment (15%). The most common profile reflected a medical request that was made, withdrawn, and re-requested (45%).

Discussion: Shifts in gender-affirming medical requests by gender-diverse youth may not be uncommon during the adolescent's gender discernment process, and may more likely occur among nonbinary youth. Many individuals who experience shifts away from medical treatment may later resume the request.

Keywords: Adolescence; Gender diverse; Gender dysphoria; Gender incongruence; Gender-affirming hormones; Gender-affirming surgery; Transgender.

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Conflict of interest statement

Declaration of interests

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

Figures

Figure 1
Figure 1
Participant inclusion and exclusion algorithm
Figure 2
Figure 2
Diagram of the six Shift Profiles Shift profile 1: Requests treatment ➔ No longer requests treatment Shift profile 2: Requests treatment ➔ No longer requests treatment ➔ Requests treatment Shift profile 3: Requests treatment ➔ No longer requests treatment ➔ Considering future treatment Shift profile 4: Requests treatment ➔ Oscillations for request ➔ Requests treatment or no longer requests treatment Shift profile 5: Requests treatment ➔ Receives treatment ➔ Gender needs met (treatment completed) Shift profile 6: Requests treatment ➔ Receives treatment ➔ Gender needs changed (treatment terminated)
See this image and copyright information in PMC

References

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