Gender dysphoria and affirming care

Meet the patient

A 16-year-old is brought to your clinic by a quietly supportive mother. For two years they have been certain that their experienced gender does not match the sex on their birth certificate. They use a new name at school, which the school honours; at home the name is still contested. They sleep badly, have stopped seeing friends, and last week wrote a note they did not send. They are asking, clearly and repeatedly, about puberty blockers.[6][17]

The examiner's question is never "is this real?". It is three questions at once: is the distress clinically significant, is there comorbidity or risk to manage now, and what is the clinician's role before any medical step? This topic answers all three at consultant depth.[1][17]

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1. [1]Zucker KJ, Lawrence AA, Kreukels BP Gender Dysphoria in Adults Annu Rev Clin Psychol, 2016.PMID 26788901
2. [2]Drescher J, Cohen-Kettenis PT, Reed GM Gender incongruence of childhood in the ICD-11: controversies, proposal, and rationale Lancet Psychiatry, 2016.PMID 26946394
3. [3]Arcelus J, Bouman WP, Van Den Noortgate W, et al. Systematic review and meta-analysis of prevalence studies in transsexualism Eur Psychiatry, 2015.PMID 26021270
4. [4]Dhejne C, Van Vlerken R, Heylens G, Arcelus J Mental health and gender dysphoria: A review of the literature Int Rev Psychiatry, 2016.PMID 26835611
5. [5]Marshall E, Claes L, Bouman WP, et al. Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature Int Rev Psychiatry, 2016.PMID 26329283
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8. [8]Glidden D, Bouman WP, Jones BA, Arcelus J Gender Dysphoria and Autism Spectrum Disorder: A Systematic Review of the Literature Sex Med Rev, 2016.PMID 27872002
9. [9]van der Miesen AIR, de Vries ALC, Steensma TD, Hartman CA Autistic Symptoms in Children and Adolescents with Gender Dysphoria J Autism Dev Disord, 2018.PMID 29189919
10. [10]Steensma TD, McGuire JK, Kreukels BP, et al. Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study J Am Acad Child Adolesc Psychiatry, 2013.PMID 23702447
11. [11]Steensma TD, Biemond R, de Boer F, Cohen-Kettenis PT Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study Clin Child Psychol Psychiatry, 2011.PMID 21216800
12. [12]de Vries AL, McGuire JK, Steensma TD, et al. Young adult psychological outcome after puberty suppression and gender reassignment Pediatrics, 2014.PMID 25201798
13. [13]Chen D, Berona J, Chan YM, et al. Psychosocial Functioning in Transgender Youth after 2 Years of Hormones N Engl J Med, 2023.PMID 36652355
14. [14]Tordoff DM, Wanta JW, Collin A, et al. Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care JAMA Netw Open, 2022.PMID 35212746
15. [15]Turban JL, Beckwith N, Reisner SL, Keuroghlian AS Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults JAMA Psychiatry, 2020.PMID 31509158
16. [16]Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline Endocr Pract, 2017.PMID 29320642
17. [17]Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 Int J Transgend Health, 2022.PMID 36238954
18. [18]Safer JD, Tangpricha V Care of Transgender Persons N Engl J Med, 2019.PMID 31851801
19. [19]Dhejne C, Lichtenstein P, Boman M, et al. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden PLoS One, 2011.PMID 21364939
20. [20]Wiepjes CM, den Heijer M, Bremmer MA, et al. Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study (1972-2017) Acta Psychiatr Scand, 2020.PMID 32072611
21. [21]Murad MH, Elamin MB, Garcia MZ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes Clin Endocrinol (Oxf), 2010.PMID 19473181
22. [22]Byne W, Bradley SJ, Coleman E, et al. Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder Arch Sex Behav, 2012.PMID 22736225