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

Ariel Cohen, 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, District of Columbia; Department of Pediatric and Adolescent Gynecology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Washington, District of Columbia. Electronic address: acohen3@childrensnational.org.
Veronica Gomez-Lobo, 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, District of Columbia.
Laura Willing, Gender Development Program, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia; Departments of Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, District of Columbia.
David Call, Gender Development Program, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia; Departments of Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, District of Columbia.
Lauren F. Damle, Department of Surgery, Children's National Hospital, Washington, District of Columbia; Department of Women and Infant Services, MedStar Washington Hospital Center, Washington, District of Columbia.
Lawrence J. D'Angelo, Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia; Divisions of Adolescent and Young Adult Medicine, George Washington University School of Medicine, Washington, District of Columbia.
Amber Song, Gender Development Program, Children's National Hospital, Washington, District of Columbia; Division of Neuropsychology, Center for Autism Spectrum Disorders, Children's National Hospital, Washington, District of Columbia; Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, District of Columbia.
John F. Strang, Gender Development Program, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia; Departments of Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, District of Columbia; Division of Neuropsychology, Center for Autism Spectrum Disorders, Children's National Hospital, Washington, District of Columbia; Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, District of Columbia.

Document Type

Journal Article

Publication Date

12-17-2022

Journal

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

DOI

10.1016/j.jadohealth.2022.10.020

Keywords

Adolescence; Gender diverse; Gender dysphoria; Gender incongruence; Gender-affirming hormones; Gender-affirming surgery; Transgender

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.

Department

Pediatrics

Link to Full Text

Share

COinS