For youths with gender dysphoria, transition-related care should start in “a timely manner,” according to the authors of a recent Journal of Sexual Medicine study.

This study of German adolescents found that most participants were satisfied with the care they received. However, satisfaction rates were higher for participants who were further along in their transition.

Gender dysphoria is described as an “incongruence” between one’s gender identity and the sex one is assigned at birth. This incongruence causes distress, and many transgender individuals decide to transition from one gender to another. This process may include hormone therapy and gender-affirming surgery.

The study included 75 adolescents (age 21 and younger) who had sought services for gender dysphoria at the Hamburg Gender Identity Service (Hamburg GIS). Most of the participants (85%) had been assigned female at birth; the rest of the group had been assigned male at birth.

The participants were assessed at two time points: at baseline, when they had their first consultation at Hamburg GIS and again at follow-up, six months to four years later. Each participant provided sociodemographic information and completed questionnaires on their satisfaction with transition-related care, their individual progress, and social support that they received. They were also asked about any regrets from treatment.

At the time of follow-up, almost three-quarters of the participants had undergone some form of transition-related medical intervention (TRMI). About 15% had undergone transition-related surgery. The rest had not yet had any treatment.

The researchers determined an individual treatment progress score (ITPS) for each participant, based on the number of TRMIs desired and received.

At the follow-up point, the participants had completed an average of 59% of their desired interventions. About 75% of the participants said they were “overall satisfied” with their care at Hamburg GIS. Satisfaction rates were higher for participants who had received more TRMIs. None of the participants regretted their transition experiences.

When asked about their treatment satisfaction, nine participants gave free-text answers. Many were satisfied that their menstrual periods had stopped, voices had changed, and breast size had decreased. However, points of dissatisfaction included the return of their periods, hot flashes, and acne.

Concerns about scarring and slow progress were also noted. “Youth desire their body to physically reflect their gender identity,” the authors wrote. “[They] may be disappointed by less than ideal treatment results.”

They made several recommendations:

• Because adolescents’ wishes and goals can change over time, getting feedback from patients and guardians throughout the transition process is beneficial.
• Patients should know what to expect from treatment and understand what side effects and complications are possible.
• Transition-related care should start as “in a timely fashion,” taking into account that pubertal changes can be particularly distressing for some patients.
• Counselors and therapists can help patients work through their feelings about transition, especially if the process is taking longer than expected.

The authors encouraged more research with a larger number of participants, especially non-binary youth. They also noted that their findings may not necessarily apply to all transgender adolescents.

Resources

• The Journal of Sexual Medicine - “Individual Treatment Progress Predicts Satisfaction With Transition-Related Care for Youth With Gender Dysphoria: A Prospective Clinical Cohort Study”
  Nieder, T.O., PhD, et al.
  (Full-text. Published: February 25, 2021)
  https://www.jsm.jsexmed.org/article/S1743-6095(20)31130-9/fulltext