Gender dysphoria in adolescence could be expected to be associated with delayed sexual development because of the distress related to the sexual characteristics of the body. However, identity challenges may also increase early and risk-taking sexual behaviours among adolescents with gender dysphoria. We studied sexual experiences among 101 adolescents, attending an adolescent gender identity service, desiring gender reassignment. Their experiences were compared to the sexual experiences of the same-aged population, evaluated in a large adolescent survey. A majority of adolescents with gender dysphoria had been in love or had a crush on somebody. Birth assigned females had experiences of romantic relationships twice as commonly as birth assigned males. Otherwise, there was no statistically significant difference in the adolescents’ sexual experiences. About half of the subjects had experiences of kissing, and about 40% had intimate (genital) sexual experiences with a partner. Compared to the general adolescent population, adolescents with gender dysphoria were less experienced. Autism spectrum disorder was associated with more delayed sexual development.
AitkenM.SteensmaT. D.BlanchardR.VanderLaanD. P.WoodH.FuentesA.. . . ZuckerK. J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. Journal of Sexual Medicine, 12, 756–763. doi:10.1111/jsm.12817
2.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
3.
BrennanJ.KuhnsL. M.JohnsonA. K.BelzerM.WilsonE. C.GarofaloR., & Adolescent Medicine Trials Network for HIV/AIDS Interventions. (2012). Syndemic theory and HIV-related risk among young transgender women: The role of multiple, co-occurring health problems and social marginalization. American Journal of Public Health, 102, 1751–1757.
4.
BungenerS. L.SteensmaT. D.Cohen-KettenisP. T.de VriesA. L. C. (2017). Sexual and romantic experiences of transgender youth before gender-affirmative treatment. Pediatrics, 139(3): e20162283. doi: 10.1542/peds.2016-2283.
5.
ChenL. P.MuradM. H.ParasM. L.GolbensonK. M.SattlerA. L.GoransonE. N.. . . ZirakzadehA. (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: Systematic review and meta-analysis. Mayo Clinic Proceedings, 85, 618–629.
6.
Cohen-KettenisP. T.KlinkD. (2015). Adolescents with gender dysphoria. Best Practice & Research Clinical Endocrinology & Metabolism, 29, 485–495.
7.
DalenbergW.TimmermanM.van GeertP. L. C. (2018). Dutch adolescents’ everyday expressions of sexual behavior trajectories over a 2-year period: A mixed-methods study. Archives of Sexual Behavior, 47, 1811–1823.
8.
DankM.LachmanP.ZweigJ. M.YahnerJ. (2014). Dating violence experiences of lesbian, gay, bisexual, and transgender youth. Journal of Youth and Adolescence, 43, 846–857. doi:10.1007/s10964-013-9975-8
9.
DeHaanS.KuperL. E.MageeJ. C.BigelowL.MustanskiB. S. (2013). The interplay between online and offline explorations of identity, relationships, and sex: A mixed-methods study with LGBT youth. The Journal of Sex Research, 50, 421–434. doi:10.1080/00224499.2012.661489
10.
DiamondL. (2000). Sexual identity, attractions, and behavior among young sexual-minority women over a 2-year period. Developmental Psychology, 36, 241–250.
11.
DowningJ.BellisM. A. (2009). Early pubertal onset and its relationship with sexual risk taking, substance use and anti-social behaviour: A preliminary cross-sectional study. BMC Public Health, 9, Article 446.
12.
GoldbergS. K.HalpernC. T. (2017). Sexual initiation patterns of U.S. sexual minority youth: A latent class analysis. Perspectives on Sexual & Reproductive Health, 49, 55–67. doi:10.1363/psrh.12020
13.
HoltV.SkagerbergE.DunsfordM. (2016). Young people with features of gender dysphoria: Demographics and associated difficulties. Clinical Child Psychology and Psychiatry, 21, 108–118. doi:10.1177/1359104514558431
14.
Kaltiala-HeinoR.BergmanH.TyolajarviM.FrisenL. (2018). Gender dysphoria in adolescence: Current perspectives. Adolescent Health, Medicine and Therapeutics, 9, 31–41. doi:10.2147/AHMT.S135432
15.
Kaltiala-HeinoR.KoivistoA.-M.MarttunenM.FröjdS. (2011). Pubertal timing and substance use in middle adolescence: A 2-year follow-up study. Journal of Youth and Adolescence, 40, 1288–1301.
16.
Kaltiala-HeinoR.KosunenE.RimpeläM. (2003). Pubertal timing, sexual behaviour and self-reported depression in middle adolescence. Journal of Adolescence, 26, 531–545.
17.
Kaltiala-HeinoR.LindbergN.FröjdS.HaravuoriH.MarttunenM. (2018). Adolescents with same-sex interest: Experiences of sexual harassment are more common among boys. Manuscript under review.
18.
Kaltiala-HeinoR.MarttunenM.FröjdS. (2015). Depression, conduct disorder, smoking and alcohol use as predictors of sexual activity in middle adolescence: A longitudinal study. Health Psychology and Behavioral Medicine, 3, 25–39. doi:10.1080/21642850.2014.996887
19.
Kaltiala-HeinoR.SaviojaH.FröjdS.MarttunenM. (2018). Experiences of sexual harassment are associated with the sexual behavior of 14- to 18-year-old adolescents. Child Abuse & Neglect, 77, 46–57. doi:10.1016/j.chiabu.2017.12.014
20.
Kaltiala-HeinoR.SumiaM.TyolajarviM.LindbergN. (2015). Two years of gender identity service for minors: Overrepresentation of birth assigned girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health, 9, 9. doi:10.1186/s13034-015-0042-y
21.
KorchmarosJ. D.YbarraM. L.MitchellK. J. (2015). Adolescent online romantic relationship initiation: Differences by sexual and gender identification. Journal of Adolescence, 40, 54–64. doi:10.1016/j.adolescence.2015.01.004
22.
KotchickB. A.ShafferA.ForehandR.MillerK. S. (2001). Adolescent sexual risk behavior: A multi-system perspective. Clinical Psychology Review, 21, 493–519.
23.
LawrenceA. A. (2010). Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 514–545. doi:10.1007/s10508-009-9594-3
24.
MadkourA. S.FarhatT.HalpernC. T.GodeauE.GabhainnS. N. (2010). Early adolescent sexual initiation as a problem behavior: A comparative study of five nations. Journal of Adolescent Health, 47, 389–398. doi:10.1016/j.jadohealth.2010.02.008
25.
MarchianoL. (2017). Outbreak: On transgender teens and psychic epidemics. Psychological Perspectives, 60, 345–346.
26.
MayerK. H.GarofaloR.MakadonH. J. (2014). Promoting the successful development of sexual and gender minority youths. American Journal of Public Health, 104, 976–981. doi:10.2105/AJPH.2014.301876
27.
MitchellK. J.YbarraM. L.KorchmarosJ. D. (2014). Sexual harassment among adolescents of different sexual orientations and gender identities. Child Abuse & Neglect, 38, 280–295. doi:10.1016/j.chiabu.2013.09.008
28.
OlsonJ.SchragerS. M.BelzerM.SimonsL. K.ClarkL. F. (2015a). Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. Journal of Adolescent Health, 57, 374–380.
29.
PoteatT.ScheimA.XavierJ.ReisnerS.BaralS. (2016). Global epidemiology of HIV infection and related syndemics affecting transgender people. Journal of Acquired Immune Deficiency Syndromes, 72(Suppl. 3), S210–S219. doi:10.1097/QAI.0000000000001087
30.
ReisnerS. L.VettersR.LeclercM.ZaslowS.WolfrumS.ShumerD.MimiagaM. J. (2015). Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. Journal of Adolescent Health, 56, 274–279. doi:10.1016/j.jadohealth.2014.10.264
31.
RistoriJ.SteensmaT.D. (2016). Gender dysphoria in childhood. International Review of Psychiatry, 28, 13–20.
32.
RomeoK. E.KelleyM. A. (2009). Incorporating human sexuality content into a positive youth development framework: Implications for community prevention. Children and Youth Services Review, 31, 1001–1009. doi:10.1016/j.childyouth.2009.04.015
33.
RyanC.HuebnerD.DiazR. M.SanchezJ. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346–352. doi:10.1542/peds.2007-3524
34.
SaewycE. M.BauerG. R.SkayC. L.BearingerL. H.ResnickM. D.ReisE.MurphyA. (2004). Measuring sexual orientation in adolescent health surveys: Evaluation of eight school-based surveys. Journal of Adolescent Health, 35(4), 345. e1–5.
35.
Savin-WilliamsR. C.CohenK. M. (2015). Developmental trajectories and milestones of lesbian, gay, and bisexual young people. International Review of Psychiatry, 27, 357–366.
36.
SaviojaH.HelminenM.FröjdS.MarttunenM.Kaltiala-HeinoR. (2015). Sexual experience and self-reported depression across adolescent years. Health Psychology and Behavioral Medicine, 3, 337–338.
37.
SaviojaH.HelminenM.FrojdS.MarttunenM.Kaltiala-HeinoR. (2017). Delinquency and sexual experiences across adolescence: Does depression play a role?The European Journal of Contraception & Reproductive Health Care, 22, 298–304. doi:10.1080/13625187.2017.1374361
38.
ShumerD. E.SpackN. P. (2015). Pediatrics: Transgender medicine – Long-term outcomes from ‘The Dutch Model’. Nature Reviews Urology, 12(1), 12–13.
39.
SumiaM.LindbergN.TyolajarviM.Kaltiala-HeinoR. (2016). Early pubertal timing is common among adolescent birth assigned girl gender reassignment applicants. The European Journal of Contraception & Reproductive Health Care, 21, 483–485.
40.
Van Der MiesenA. I.HurleyH.De VriesA. L. C. (2016). Gender dysphoria and autism spectrum disorder: A narrative review. International Review of Psychiatry, 28, 70–80. doi:10.3109/09540261.2015.1111199
41.
VealeJ.WatsonR. J.AdjeiJ.SaewycE. (2016). Prevalence of pregnancy involvement among Canadian transgender youth and its relation to mental health, sexual health, and gender identity. International Journal of Transgenderism, 17, 107–113. doi:10.1080/15532739.2016.1216345
42.
WightD.WilliamsonL.HendersonM. (2006). Parental influences on young people’s sexual behaviour: A longitudinal analysis. Journal of Adolescence, 29, 473–494.
43.
WilsonE. C.IversonE.GarofaloR.BelzerM. (2012). Parental support and condom use among transgender female youth. Journal of the Association of Nurses in AIDS Care, 23, 306–317. doi:10.1016/j.jana.2011.09.001
44.
WoodH.SasakiS.BradleyS. J.SinghD.FantusS.Owen-AndersonA.. . . ZuckerK. J. (2013). Patterns of referral to a gender identity service for children and adolescents (1976-2011): Age, sex ratio, and sexual orientation. Journal of Sex & Marital Therapy, 39(1), 1–6. doi:10.1080/0092623X.2012.675022
45.
World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: Author.
