Children are presenting in greater numbers to gender clinics around the world. Prospective longitudinal research is important to better understand outcomes and trajectories for these children. This systematic review aims to identify, describe and critically evaluate longitudinal studies in the field.
Method:
Five electronic databases were systematically searched from January 2000 to February 2020. Peer-reviewed articles assessing gender identity and psychosocial outcomes for children and young people (<18 years) with gender diverse identification were included.
Results:
Nine articles from seven longitudinal studies were identified. The majority were assessed as being of moderate quality. Four studies were undertaken in the Netherlands, two in North America and one in the UK. The majority of studies had small samples, with only two studies including more than 100 participants and attrition was moderate to high, due to participants lost to follow-up. Outcomes of interest focused predominantly on gender identity over time and emotional and behavioural functioning.
Conclusions:
Larger scale and higher quality longitudinal research on gender identity development in children is needed. Some externally funded longitudinal studies are currently in progress internationally. Findings from these studies will enhance understanding of outcomes over time in relation to gender identity development in children and young people.
AchenbachT. M. (2001). Achenbach system of empirically based assessment: School age forms and profiles, child behavior checklist for ages 6-18. Aseba.
2.
AitkenM.SteensmaT. D.BlanchardR.VanderLaanD. P.WoodH.FuentesA.SpeggC.WassermanL.AmesM.FitzsimmonsC. L.LeefJ. H.LishakV.ReimE.TakagiA.VinikJ.WrefordJ.Cohen-KettenisP. T.de VriesA. L.KreukelsB. P.ZuckerK. J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. The Journal of Sexual Medicine, 12(3), 756–763.
3.
AllenL. R.WatsonL. B.EganA. M.MoserC. N. (2019). Well-being and suicidality among transgender youth after gender-affirming hormones. Clinical Practice in Pediatric Psychology, 7(3), 302–311. https://doi.org/10.1037/cpp0000288
4.
APA. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision ed.). American Psychiatric Association.
5.
APA. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
6.
ChenD.Edwards-LeeperL.StancinT.TishelmanA. (2018). Advancing the practice of pediatric psychology with transgender youth: State of the science, ongoing controversies, and future directions. Clinical Practice in Pediatric Psychology, 6(1), 73–83. https://doi.org/10.1037/cpp0000229
7.
ChewD.AndersonJ.WilliamsK.MayT.PangK. (2018). Hormonal treatment in young people with gender dysphoria: A systematic review. Pediatrics, 141(4), e20173742.
8.
ColemanE.BocktingW.BotzerM.Cohen-KettenisP.DeCuypereG.FeldmanJ.FraserL.GreenJ.KnudsonG.MeyerW. J. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13(4), 165–232.
9.
CostaR.DunsfordM.SkagerbergE.HoltV.CarmichaelP.ColizziM. (2015). Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. The Journal of Sexual Medicine, 12(11), 2206–2214. https://doi.org/https://doi.org/10.1111/jsm.13034
10.
Critical Appraisal Skills Programme. (2018). CASP cohort study checklist [online].
11.
de GraafN. M.CarmichaelP. (2019). Reflections on emerging trends in clinical work with gender diverse children and adolescents. Clinical Child Psychology and Psychiatry, 24(2), 353–364.
12.
de GraafN. M.Cohen-KettenisP. T.CarmichaelP.de VriesA. L. C.DhondtK.LaridaenJ.PauliD.BallJ.SteensmaT. D. (2018). Psychological functioning in adolescents referred to specialist gender identity clinics across Europe: A clinical comparison study between four clinics. European Child & Adolescent Psychiatry, 27(7), 909–919.
13.
de GraafN. M.GiovanardiG.ZitzC.CarmichaelP. (2018). Sex ratio in children and adolescents referred to the gender identity development service in the UK (2009–2016). Archives of Sexual Behavior, 47(5), 1301–1304.
14.
Delemarre-Van De WaalH. A.Cohen-KettenisP. T. (2006). Clinical management of gender identity disorder in adolescents: A protocol on psychological and paediatric endocrinology aspects. European Journal of Endocrinology, Supplement, 155(Suppl. 1), S131–S137. https://doi.org/10.1530/eje.1.02231
15.
DeograciasJ. J.JohnsonL. L.Meyer-BahlburgH. F.KesslerS. J.SchoberJ. M.ZuckerK. J. (2007). The gender identity/gender dysphoria questionnaire for adolescents and adults. Journal of Sex Research, 44(4), 370–379.
16.
DèttoreD.RistoriJ.AntonelliP.BandiniE.FisherA.VillaniS.deVriesA.L.C.Cohen-KettenisP. T. (2015). Gender dysphoria in adolescents: The need for a shared assessment protocol and proposal of the AGIR protocol. Journal of Psychopathology, 21, 152–158.
17.
deVriesA. L. C.McGuireJ. K.SteensmaT. D.WagenaarE. C. F.DoreleijersT. A. H.Cohen-KettenisP. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696–704. https://doi.org/10.1542/peds.2013-2958
18.
deVriesA. L. C.SteensmaT. D.DoreleijersT. A. H.Cohen-KettenisP. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine, 8(8), 2276–2283. https://doi.org/10.1111/j.1743-6109.2010.01943.x
19.
DoornC. D.KuiperA. J.VerschoorA. M.Cohen-KettenisP. T. (1996). Het verloop van de geslachtsaanpassing: Een 5-jarige prospectieve studie [The course of sex reassignment: A 5-year prospective study]. Rapport voor de Nederlandse Ziekenfondsraad [Report for the Dutch National Health Council].
20.
DrummondK. D.BradleyS. J.Peterson-BadaliM.VanderLaanD. P.ZuckerK. J. (2018). Behavior problems and psychiatric diagnoses in girls with gender identity disorder: A follow-up study. Journal of Sex & Marital Therapy, 44(2), 172–187. https://doi.org/10.1080/0092623X.2017.1340382
21.
DrummondK. D.BradleyS. J.Peterson-BadaliM.ZuckerK. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44(1), 34–45. https://doi.org/10.1037/0012-1649.44.1.34
22.
FussJ.AuerM. K.BrikenP. (2015). Gender dysphoria in children and adolescents: A review of recent research. Current Opinion in Psychiatry, 28(6), 430–434. https://doi.org/10.1097/YCO.0000000000000203
23.
GalupoM. P.Pulice-FarrowL. (2020). Subjective ratings of gender dysphoria scales by transgender individuals. Archives of Sexual Behavior, 49(2), 479–488.
24.
GiovanardiG. (2017). Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents. Porto Biomedical Journal, 2(5), 153–156. https://doi.org/10.1016/j.pbj.2017.06.001
25.
HembreeW. C.Cohen-KettenisP. T.GoorenL.HannemaS. E.MeyerW. J.MuradM. H.RosenthalS. M.SaferJ. D.TangprichaV.T’SjoenG. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869–3903.
26.
KaltialaR.BergmanH.CarmichaelP.de GraafN. M.Egebjerg RischelK.FrisénL.SchorkopfM.SuomalainenL.WaehreA. (2020). Time trends in referrals to child and adolescent gender identity services: A study in four Nordic countries and in the UK. Nordic Journal of Psychiatry, 74(1), 40–44.
27.
LeibowitzS.de VriesA. L. (2016). Gender dysphoria in adolescence. International Review of Psychiatry, 28(1), 21–35.
28.
LindgrenT. W.PaulyI. B. (1975). A body image scale for evaluating transsexuals. Archives of Sexual Behavior, 4(6), 639–656.
29.
LOGIC Study. (2020). Longitudinal Outcomes of Gender Identity in Children. https://logicstudy.uk/
30.
OlsonK. R.GülgözS. (2018). Early findings from the transyouth project: Gender development in transgender children. Child Development Perspectives, 12(2), 93–97.
31.
Olson-KennedyJ.ChanY.-M.GarofaloR.SpackN.ChenD.ClarkL.EhrensaftD.HidalgoM.TishelmanA.RosenthalS. (2019). Impact of early medical treatment for transgender youth: Protocol for the longitudinal, observational trans youth care study. JMIR Research Protocols, 8(7), e14434.
32.
RedwoodS.GillP. S. (2013). Under-representation of minority ethnic groups in research—call for action. British Journal of General Practice, 63(612), 342–343.
33.
RistoriJ.SteensmaT. D. (2016). Gender dysphoria in childhood. International Review of Psychiatry, 28(1), 13–20.
34.
SmithY. L. S.van GoozenS. H. M.Cohen-KettenisP. T. (2001). Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: A prospective follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 40(4), 472–481. https://doi.org/10.1097/00004583-200104000-00017
35.
SpackN. P.Edwards-LeeperL.FeldmanH. A.LeibowitzS.MandelF.DiamondD. A.VanceS. R. (2012). Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics, 129(3), 418–425. https://doi.org/10.1542/peds.2011-0907
36.
SteensmaT. D.BiemondR.de BoerF.Cohen-KettenisP. T. (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology and Psychiatry, 16(4), 499–516. https://doi.org/10.1177/1359104510378303
37.
SteensmaT. D.Cohen-KettenisP. T. (2015). More than two developmental pathways in children with gender dysphoria?Journal of the American Academy of Child & Adolescent Psychiatry, 54(2), 147–148.
38.
SteensmaT. D.Cohen-KettenisP. T. (2018). A critical commentary on “a critical commentary on follow-up studies and ‘desistence’ theories about transgender and gender non-conforming children.”International Journal of Transgenderism, 19(2), 225–230. https://doi.org/10.1080/15532739.2018.1468292
39.
SteensmaT. D.McGuireJ. K.KreukelsB. P. C.BeekmanA. J.Cohen-KettenisP. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582–590. https://doi.org/10.1016/j.jaac.2013.03.016
40.
TebbeE. A.BudgeS. L. (2016). Research with trans communities: Applying a process-oriented approach to methodological considerations and research recommendations. The Counseling Psychologist, 44(7), 996–1024.
41.
Temple NewhookJ.PyneJ.WintersK.FederS.HolmesC.ToshJ.SinnottM.-L.JamiesonA.PickettS. (2018). A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender-nonconforming children. International Journal of Transgenderism, 19(2), 212–224. https://doi.org/10.1080/15532739.2018.1456390
42.
TollitM. A.PaceC. C.TelferM.HoqM.BrysonJ.FulkoskiN.CooperC.PangK. C. (2019). What are the health outcomes of trans and gender diverse young people in Australia? Study protocol for the Trans20 longitudinal cohort study. BMJ open, 9(11), e032151.
43.
TurbanJ. L.EhrensaftD. (2018). Research review: Gender identity in youth: Treatment paradigms and controversies. Journal of Child Psychology and Psychiatry, 59(12), 1228–1243. https://doi.org/10.1111/jcpp.12833
44.
WallienM. S. C.Cohen-KettenisP. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child & Adolescent Psychiatry, 47(12), 1413–1423. https://doi.org/10.1097/CHI.0b013e31818956b9
ZuckerK. J. (2018). The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018). International Journal of Transgenderism, 19(2), 231–245. https://doi.org/10.1080/15532739.2018.1468293
47.
ZuckerK. J.BradleyS. J.SanikhaniM. (1997). Sex differences in referral rates of children with gender identity disorder: Some hypotheses. Journal of Abnormal Child Psychology, 25(3), 217–227.
48.
ZuckerK. J.BradleyS. J.SullivanC. B. L.KuksisM.Birkenfeld-AdamsA.MitchellJ. N. (1993). A gender identity interview for children. Journal of Personality Assessment, 61(3), 443–456.
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