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

Ariel Cohen; Veronica Gomez-Lobo; Laura Willing; David Call; Lauren F Damle; Lawrence J D'Angelo; Amber Song; John F Strang

doi:10.1016/j.jadohealth.2022.10.020

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

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

Authors

Ariel Cohen¹, Veronica Gomez-Lobo², Laura Willing³, David Call³, Lauren F Damle⁴, Lawrence J D'Angelo⁵, Amber Song⁶, John F Strang⁷

Affiliations

¹ Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland; Department of Surgery, Children's National Hospital, Washington, DC; Department of Pediatric and Adolescent Gynecology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Washington, DC. Electronic address: acohen3@childrensnational.org.
² Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland; Department of Surgery, Children's National Hospital, Washington, DC.
³ Gender Development Program, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC; Departments of Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, DC.
⁴ Department of Surgery, Children's National Hospital, Washington, DC; Department of Women and Infant Services, MedStar Washington Hospital Center, Washington, DC.
⁵ Department of Pediatrics, George Washington University School of Medicine, Washington, DC; Divisions of Adolescent and Young Adult Medicine, George Washington University School of Medicine, Washington, DC.
⁶ Gender Development Program, Children's National Hospital, Washington, DC; Division of Neuropsychology, Center for Autism Spectrum Disorders, Children's National Hospital, Washington, DC; Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC.
⁷ Gender Development Program, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC; Departments of Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, DC; Division of Neuropsychology, Center for Autism Spectrum Disorders, Children's National Hospital, Washington, DC; Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC.

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.

Publication types

Research Support, N.I.H., Intramural

MeSH terms

Adolescent
Child
Gender Identity
Humans
Infant, Newborn
Reproducibility of Results
Retrospective Studies
Transgender Persons*
Transsexualism*

Grants and funding

ZIA HD008985/ImNIH/Intramural NIH HHS/United States