Table 1

Study characteristics

First authorStudy designData collectionIntervention population*Participants with gender dysphoria/ incongruence*Comparator/control group*Intervention and settingOutcome and measurementTime to follow-up(s)
Allen et al,33
Australia
Pre–post with historical controls
Qualitative interviews
Mixed methods design
Pre–post: January 2017 to January 2019
Historical controls: mid-2016
Transgender and gender diverse children and young people (aged 8–17) awaiting treatment from The Royal Children’s Hospital Gender Service (RCHGS)Quantitative study (n=142)
Median age 15 years (IQR 13.7–16.2)
Birth-assigned sex, n (%): female 105 (73.9), male 37 (26.1)
Gender identity, n (%):
Transgender male 80 (56.3)
Transgender female 29 (20.4)
Non-binary 16 (11.3)
Unsure 16 (11.3)
Prefer not to answer 1 (0.7)
Qualitative study (n=14, sub-sample of above)
Age range 13–17 years
Birth-assigned sex: female (13), male (1)
Gender identity: transgender male (12), transgender female (1), unsure (1)
Within group: pre-intervention measures
Historical controls (n=120)
Children and adolescents who attended RCHGS prior to the start of triage clinic.
Median age 14.9 years (IQR 12.4–16.7)
Birth-assigned sex, n (%): female 61 (50.8), male 59 (49.2)
First Assessment Single Session Triage (FAAST) clinic led by clinical nurse consultant. Includes information, education and support.
Setting: specialist gender clinic for children and adolescents
Depression and anxiety
Parent-rated Child Behaviour Checklist (CBCL) and self-reported Youth Self-Report (YSR)
Suicidality
Columbia Suicidality Severity Rating Scale (C-SSRS) self-report age≥12
Quality of Life
Child Health Utility 9D (CHU9D) self-report
Family Functioning
Family Assessment Device (FAD) General Functioning Subscale self-report
Support, social transition, medication and health professional use
Developed by RCHGS; medication and health professional use parent report; support and social transition self-report
Median time pre–post was 259 days (IQR 154–308)
Austin et al,34
Canada
Longitudinal pre–post
Open-ended survey questions
Pilot study
2014Young people aged 14–18 years who identify as non-heterosexual and/or non-cisgender
Transgender young people attending intervention were recruited to this study
n=8
Age range 16–18 years
Gender identity: non-binary (6), queer (5), female (2), transgender (2), male (1), two-spirit (1), gender independent (1), ‘figuring things out’ (1) (most selected at least two categories)
Comparator: pre-intervention measuresAFFIRM— affirmative CBT skills group intervention
Setting: weekend retreat at a community centre for sexual and gender minority communities
Depression: The Beck Depression Inventory (BDI) self-report
Coping: Adolescent Proactive Coping Inventory (PCI-A) self-report
Post-test and 3 months
Bluth et al,35
USA
Longitudinal pre–post
End-of-programme qualitative interviews and open-ended survey questions
Mixed methods design
Date not reportedYoung people aged 13–17 years who identify as transgender or gender expansiveQuantitative study (n=41)
Median age 14.5 years SD 1.49
Gender identity: transfemale (9), transmale (18), non-binary (12), gender fluid (3), questioning (2), agender (1)
Qualitative study (n=11, sub-sample of above) Median age 14.5 years SD (1.04)
Gender identity: transmale (8), non-binary (2), gender fluid (1)
Comparator: pre-intervention measuresMindful Self-Compassion for Teens (MSC-T) group intervention
Setting: online
All self-report
Self compassion: Self-compassion Scale Youth (SCS-Y)
Global evaluation of well-being: Student Life Satisfaction Scale (SLSS)
Anxiety: Spielberger State-Trait Anxiety Inventory (STAI) - short form
Depression: Patient Health Questionnaire-9 (PHQ-9)
Suicidality: Interpersonal Needs Questionnaire (INQ)
Resilience: Brief Resilience Scale (BRS)
Post-test and 3 months
Costa et al,36
UK
Longitudinal cohort studyDate not reportedAdolescents referred to the Gender Identity Development Service (GIDS) (age <18) who completed diagnostic procedure (all diagnosed with gender dysphoria)n=201
Mean age 15.5 years SD 1.4, range 12–17 years
Birth-assigned sex, n (%): female 125 (62.2), male 76 (37.8)
The sample was divided into groups of immediately eligible for puberty suppression (101) and delayed eligible (100)
Adolescents without observed psychological/psychiatric symptoms who took part in a cohort study of children and adolescents who attended child and adolescent mental health services (n=169)Range of psychotherapeutic interventions (individual, family and group)
Setting: National gender service for children and young people
General psychosocial functioning: Children’s Global Assessment Scale (CGAS) clinician ratedEvery 6 months for 18 months.
Time 1—after 6 months of psychological support
Time 2—after 12 months of psychological support for delayed eligible adolescents, and after 12 months of psychological support+6 months of puberty suppression for immediately eligible adolescents
Time 3—after 18 months of psychological support for delayed eligible adolescents, and after 18 months of psychological support+12 months of puberty suppression for immediately eligible adolescents
Davidson et al,37
UK
Single pre–post
Open-ended survey questions
Mixed methods design
2011Gender diverse young people aged 12–18 who were attending GIDSn=11
Mean age 16.27±1.1 years, range 15–18 years
Birth-assigned sex: female (10), male (1)
NoneFacilitated group drawing on variety of therapeutic techniques including CBT
Setting: Specialist gender clinic for young people
Subjective health and well-being: Kidscreen-52 self reportPost group (after last session)
Hollinsaid et al,38
USA
Secondary analysis of intervention group from 4 randomised controlled trials2013, 2018, 2018, 2019Clinically referred children and adolescents (age 7–15) determined to have a primary problem of anxiety, depression, conduct or traumaChildren and adolescents who endorsed a wish to be the opposite sex (n=64)
Mean age 10.7 SD 2.3
Birth-assigned sex, n (%): female 31 (48.4), male 33 (51.6)
Children and adolescents who did not endorse a wish to be the opposite sex (n=368)
Mean age 10.6 SD 2.2
Female (162), male (206)
Standard and Modular psychotherapy treatments (ESTs)
Setting: Community mental health sites for young people
Internalising and externalising symptoms: Parent-rated Child Behaviour Checklist (CBCL) and self-reported Youth Self-Report (YSR)A total of four evaluations over 18 months (at baseline, 6, 12, 18 months)
Lucassen et al,39
New Zealand
Longitudinal cohortApril 2014 onwards for 5 yearsYoung people aged 12–19 with symptoms of depression (with a New Zealand IP address)Self-identified transgender adolescents who completed registration (n=207)
Age range 12–15 (131), 16–19 (76)
Specific gender identity not reported—male, female or transgender-only options for participants
Self-identified male or female adolescents who completed registration (n=8872)
Age range 12–15 (5522), 16–19 (3350)
Female (5968), male (2904)
SPARX self-help CBT-based e-therapy
Setting: online
Depression: Patient Health Questionnaire-9 modified for Adolescents (PHQ-A) self-reportAssessed at baseline (post module 1), at mid-point (post module 4) and post-intervention (post module 7)
Russon et al,32
USA
Longitudinal pre–post analyses
Pilot study
Date not reportedAdolescents or young adults who identify as a sexual and/or gender minority and have clinical levels of suicidal ideation and moderate depressionn=10
Mean age 18.2, range 15–25 years (half of sample <18)
Majority of sample identified as transgender and gender diverse (8)
NoneAttachment-based family therapy (ABFT)
Settings: a gender service for children and young people and a community youth centre
Suicidality: Suicidal Ideation Questionnaire (SIQ-JR) self-report
Depression: Beck Depression Inventory-II (BDI-II) self-report
Assessments collected at baseline and at weeks 1, 4, 8 and 16
Silveri et al,40
USA
Longitudinal cohort studyData analysed October 2019 to March 2021Adolescents aged 13–17 seeking treatment for a psychiatric disorderSelf-identified transgender and
gender diverse adolescents (n=35)
Mean age 15.5 SD 1.5
Gender identity: transgender boys (9), transgender girls (2), gender non-conforming or gender queer (22), another gender identity (9) (seven participants endorsed more than one identity)
Self-identified cisgender adolescents receiving the intervention (n=165)
Mean age 16.4 SD 1.5
Girls (76), boys (89)
Acute 2-week residential treatment (ART) programme
Setting: Psychiatric hospital for young people
Depression: Centre for Epidemiologic Studies Depression Scale (CES-D) self-report
Anxiety: Multidimensional Anxiety Scale for Children (MASC) self-report
Emotional dysregulation: The Difficulties in Emotion Regulation Scale (DERS) self-report
All completed under supervision of hospital staff
Assessment at 48 hours after admission and 48 hours before discharge
Voluntary 1-month remote follow-up, added after the study began, so only a portion of participants had opportunity to complete follow-up assessment
Stevens et al,41
USA
Longitudinal cohortMarch 2010 to January 2015Young people aged 15–24 years who self-identify as LGBTQ+ and who are experiencing housing instability, mental health and/or substance abuse treatment needs (non-LGBTQ+ young people with these problems who are allies of the LGBTQ+ population also eligible)Transgender or gender non-conforming young people
(n=17)
Mean age 19.6 years (all participants)
Gender identity: transgender (12), gender queer (3), poly-gendered (1), intersex (1)
Young people not identifying as transgender (n=153)
Mean age 19.6 years (all participants)
Female (76), male (77)
iTEAM—Affirming system of care management programme
Setting: Community based
Mental Health status (depression/anxiety): The Substance Abuse and Mental Health Services Administration’s Client Outcome Measures for Discretionary Programmes Government Performance and Results Act (GPRA) (unclear whether self-report or professional report)
Self-acceptance: Self- Acceptance Scale self-report
Assessment at 6 months post-intake and at discharge from intervention (up to 12 months later)
  • *The terminology from included studies to describe the included participants is used for accuracy of reporting.

  • CBT, cognitive behavioural therapy; LGBTQ+, lesbian, gay, bisexual, transgender, queer or questioning.