Original article
Psychological Functioning in Transgender Adolescents Before and After Gender-Affirmative Care Compared With Cisgender General Population Peers

https://doi.org/10.1016/j.jadohealth.2019.12.018Get rights and content

Abstract

Purpose

Transgender adolescents are at risk for internalizing and externalizing problems, along with high suicidality rates, and poor peer relations. The present study compared transgender adolescents before and after gender-affirmative care with a sample of nonclinical age-equivalent cisgender adolescents from the general population on psychological well-being and aimed to investigate the possible effect of transgender care involving puberty suppression.

Methods

In this cross-sectional study, emotional and behavioral problems were assessed by the Youth Self-Report in a sample of 272 adolescents referred to a specialized gender identity clinic who did not yet receive any affirmative medical treatment and compared with 178 transgender adolescents receiving affirmative care consisting of puberty suppression and compared with 651 Dutch high school cisgender adolescents from the general population.

Results

Before medical treatment, clinic-referred adolescents showed more internalizing problems and reported increased self-harm/suicidality and poorer peer relations compared with their age-equivalent peers. Transgender adolescents receiving puberty suppression had fewer emotional and behavioral problems than the group that had just been referred to transgender care and had similar or fewer problems than their same-age cisgender peers on the Youth Self-Report domains.

Conclusions

Transgender adolescents show poorer psychological well-being before treatment but show similar or better psychological functioning compared with cisgender peers from the general population after the start of specialized transgender care involving puberty suppression.

Section snippets

Participants and procedure

The samples in this study consisted of consecutive referrals to the Center of Expertise on Gender Dysphoria of the VU University Medical Center (VUmc) in Amsterdam, the Netherlands, between 2012 and 2015, and a control group of cisgender adolescents recruited in 2015 in the general population. During this period, 504 adolescents were seen in our gender identity service. Fifty-three participants did not complete the assessment process and did, therefore, not participate in this study. The reason

Mean scores for internalizing, externalizing, suicidality, and peer relations

Table 2 shows the mean scores for internalizing, externalizing, suicidality, and peer relations per sample. On average, the scores of the transgender adolescents who have just been referred on internalizing, suicidality, and peer relations were higher than the scores of the transgender adolescents using puberty suppression and the cisgender comparison group, respectively. A multivariate GLM analysis with group as a fixed factor and the internalizing, externalizing, suicidality, and poor peer

Discussion

Our study revealed that adolescents referred for gender-affirmative care have increased behavioral and emotional problems, especially internalizing problems, reported increased self-harm/suicidality, and poorer peer relations compared with cisgender adolescents from the general population. This finding, including the clinical range percentage for internalizing problems, is in line with the current literature that in general, transgender adolescents are at risk for mental health problems [[3],

Acknowledgments

None.

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    Conflicts of interest: The authors declare that they have no conflict of interest.

    This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

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