To treat or not to treat: puberty suppression in childhood-onset gender dysphoria (2024)

1. Sohn, M. & Bosinski, H. A. Gender identity disorders: diagnostic and surgical aspects. J. Sex. Med. 4, 1193–1207 (2007).

   PubMed Google Scholar

2. Benjamin, H. The Transsexual Phenomenon (Julian Press, 1966).

   Google Scholar

3. Coleman, E. et al. Standards of care (SOC) for the health of transsexual, transgender, and gender nonconforming people, 7th version. Int. J. Transgenderism 13, 165–232 (2012).

   Google Scholar

4. Hidalgo, M. A. et al. The gender affirmative model: what we know and what we aim to learn. Hum. Dev. 56, 285–290 (2013).

   Google Scholar

5. American Psychiatric Association. Quick Reference to the Diagnostic Criteria From DSM-III (American Psychiatric Association, 1980).

6. American Psychiatric Association. Diagnostic Criteria From DSM-IV (American Psychiatric Association, 1994).

7. American Psychiatric Association. Diagnostic Criteria From DSM-IV-TR (American Psychiatric Association, 2000).

8. American Psychiatric Association. Desk Reference to the Diagnostic Criteria From DSM-5 (American Psychiatric Association, 2013).

9. Drescher, J. Queer diagnoses: parallels and contrasts in the history of hom*osexuality, gender variance, and the diagnostic and statistical manual. Arch. Sex. Behav. 39, 427–460 (2010).

   PubMed Google Scholar

10. Money, J. & Tucker, P. Sexual Signatures: On Being a Man or a Woman (Little Brown & Co., 1975).

    Google Scholar

11. fa*got, B. L. & Leinbach, M. D. Gender identity: some thoughts on an old concept. J. Am. Acad. Child Psychiatry 24, 684–688 (1985).

    CAS PubMed Google Scholar

12. Stoller, R. J. A contributiuon to the study of gender identity. Int. J. Psychoanal. 45, 220–226 (1964).

    CAS PubMed Google Scholar

13. Maccoby, E. E. The Two Sexes: Growing Up Apart, Coming Together (Harvard Univ. Press, 1998).

    Google Scholar

14. Szkrybalo, J. & Ruble, D. N. “God made me a girl”: sex-category constancy judgments and explanations revisited. Dev. Psychol. 35, 392–402 (1999).

    CAS PubMed Google Scholar

15. Ruble, D. N., Martin, C. L. & Berenbaum, S. A. Handbook of Child Psychology Wiley Online Library http://onlinelibrary.wiley.com/doi/10.1002/9780470147658.chpsy0314/abstract (2007).

    Google Scholar

16. Zucker, K. J. et al. Gender constancy judgments in children with gender identity disorder: evidence for a developmental lag. Arch. Sex. Behav. 28, 475–502 (1999).

    CAS PubMed Google Scholar

17. Durkin, K. Developmental Social Psychology: From Infancy to Old Age (Blackwell, 1995).

    Google Scholar

18. Martin, C. L., Ruble, D. N. & Szkrybalo, J. Cognitive theories of early gender development. Psychol. Bull. 128, 903–933 (2002).

    See Also

    Posts Make False Claim About Cause of Gender Dysphoria - FactCheck.orgFrontiers | Editorial: Gender dysphoria: Diagnostic issues, clinical aspects, and health promotion‘An explosion’: what is behind the rise in girls questioning their gender identity?Special Report: Evolving Controversies in the Treatment of Gender Dysphoric/Incongruent Minors

    PubMed Google Scholar

19. Goldner, V. Trans: gender in free fall. Psychoanal. Dialogues 21, 159–171 (2011).

    Google Scholar

20. Egan, S. K. & Perry, D. G. Gender identity: a multidimensional analysis with implications for psychosocial adjustment. Dev. Psychol. 37, 451–463 (2001).

    CAS PubMed Google Scholar

21. Zucker, K. J., Lawrence, A. A. & Kreukels, B. P. Gender dysphoria in adults. Annu. Rev. Clin. Psychol. 28, 217–247 (2016).

    Google Scholar

22. Zucker, K. J. & Lawrence, A. A. Epidemiology of gender identity disorder. Int. J. Transgenderism 11, 8–18 (2009).

    Google Scholar

23. Bonifacio, H. J. & Rosenthal, S. M. Gender variance and dysphoria in children and adolescents. Pediatr. Clin. North Am. 62, 1001–1016 (2015).

    PubMed Google Scholar

24. Cohen-Kettenis, P. T. & Klink, D. Adolescents with gender dysphoria. Best Pract. Res. Clin. Endocrinol. Metab. 29, 485–495 (2015).

    PubMed Google Scholar

25. Arcelus, J. et al. Systematic review and meta-analysis of prevalence studies in transsexualism. Eur. Psychiatry 30, 807–815 (2015).

    CAS PubMed Google Scholar

26. Aitken, M. et al. Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J. Sex. Med. 12, 756–763 (2015).

    PubMed Google Scholar

27. Achenbach, T. M., Howell, C. T., Quay, H. C. & Conners, C. K. National survey of problems and competencies among four- to sixteen-year-olds: parents' reports for normative and clinical samples. Monogr. Soc. Res. Child Dev. 56, 1–131 (1991).

    CAS PubMed Google Scholar

28. Sandberg, D. E., Meyerbahlburg, H. F. L., Ehrhardt, A. A. & Yager, T. J. The prevalence of gender atypical behavior in elementary-school-children. J. Am. Acad. Child Adolesc. Psychiatry 32, 306–314 (1993).

    CAS PubMed Google Scholar

29. Kuyper, L. & Wijsen, C. Gender identities and gender dysphoria in the Netherlands. Arch. Sex. Behav. 43, 377–385 (2014).

    PubMed Google Scholar

30. Wallien, M. S. C. & Cohen-Kettenis, P. T. Psychosexual outcome of gender-dysphoric children. J. Am. Acad. Child Adolesc. Psychiatry 47, 1413–1423 (2008).

    PubMed Google Scholar

31. Zucker, K. & Bradley, S. Gender Identity Disorder and Psychosexual Problems in Children and Adolescents (Guilford Press, 1995).

    Google Scholar

32. Steensma, T. From Gender Variance to Gender Dysphoria. Psychosexual Development of Gender Atypical Children and Adolescents (Ridderprint, 2013).

    Google Scholar

33. Menvielle, E., Perrin, E. & Tuerk, C. The beat of a different drummer: children who do not follow gender-typical expectations: children who do not follow gender-typical expectations. Contemp. Pediatr. 22, 38–46 (2005).

    Google Scholar

34. Gray, S. C., Carter, A. S. & Levitt, H. A critical review of assumptions about gender variant children in psychological research. J. Gay Lesbian Mental Health 16, 4–30 (2012).

    Google Scholar

35. Steensma, T. D., Biemond, R., de Boer, F. & Cohen-Kettenis, P. T. Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. Clin. Child Psychol. Psychiatry 16, 499–516 (2011).

    See Also

    Evaluation and Treatment of Gender-Dysphoric/Gender Incongruent Adults

    PubMed Google Scholar

36. Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J. & Cohen-Kettenis, P. T. Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. J. Am. Acad. Child Adolesc. Psychiatry 52, 582–590 (2013).

    PubMed Google Scholar

37. Drummond, K. D., Bradley, S. J., Peterson-Badali, M. & Zucker, K. J. A follow-up study of girls with gender identity disorder. Dev. Psychol. 44, 34–45 (2008).

    PubMed Google Scholar

38. Lawrence, A. A. Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults. Arch. Sex. Behav. 39, 514–545 (2010).

    PubMed Google Scholar

39. Byne, W. et al. Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Arch. Sex. Behav. 41, 759–796 (2012).

    PubMed Google Scholar

40. Costa, R. et al. Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. J. Sex. Med. 12, 2206–2214 (2015).

    CAS PubMed Google Scholar

41. de Vries, A. L. C. et al. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics 134, 696–704 (2014).

    PubMed Google Scholar

42. de Vries, A. L. C., Steensma, T. D., Doreleijers, T. A. H. & Cohen-Kettenis, P. T. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J. Sex. Med. 8, 2276–2283 (2011).

    PubMed Google Scholar

43. Zucker, K. J. Children with gender identity disorder: is there a best practice? Neuropsychiat. Enfan. 56, 358–364 (2008).

    Google Scholar

44. Green, R. The 'Sissy Boy Syndrome' and the Development of hom*osexuality (Yale Univ. Press, 1987).

    Google Scholar

45. Rekers, G. A. Growing Up Straight: What Families Should Know About hom*osexuality (Moody Press, 1982).

    Google Scholar

46. Cohen-Kettenis, P. T., Steensma, T. D. & de Vries, A. L. C. Treatment of adolescents with gender dysphoria in the Netherlands. Child Adolesc. Psychiatr. Clin. N. Am. 20, 689–700 (2011).

    PubMed Google Scholar

47. Cohen-Kettenis, P. T., Schagen, S. E., Steensma, T. D., de Vries, A. L. & Delemarre-van de Waal, H. A. Puberty suppression in a gender-dysphoric adolescent: a 22-year follow-up. Arch. Sex. Behav. 40, 843–847 (2011).

    PubMed PubMed Central Google Scholar

48. Staphorsius, A. S. et al. Puberty suppression and executive functioning: an fMRI-study in adolescents with gender dysphoria. Psychoneuroendocrinology 56, 190–199 (2015).

    PubMed Google Scholar

49. Klink, D., Caris, M., Heijboer, A., van Trotsenburg, M. & Rotteveel, J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. Clin. Endocrinol. Metab. 100, E270–E275 (2015).

    CAS Google Scholar

50. Ehrensaft, D. Boys will be girls, girls will be boys: children affect parents as parents affect children in gender nonconformity. Psychoanal. Psychol. 28, 528–548 (2011).

    Google Scholar

51. Hill, D. B., Menvielle, E., Sica, K. M. & Johnson, A. An affirmative intervention for families with gender variant children: parental ratings of child mental health and gender. J. Sex. Marital Ther. 36, 6–23 (2010).

    PubMed Google Scholar

52. Pleak, R. R. Ethical Issues in Diagnosing and Treating of Gender-Dysphoric Children and Adolescents (ed. Rottnek, M.) (New York Univ. Press, 1999).

    Google Scholar

53. Meyer-Bahlburg, H. F. L. Gender assignment and reassignment in intersexuality: controversies, data, and guidelines for research. Adv. Exp. Med. Biol. 511, 199–223 (2002).

    PubMed Google Scholar

54. Edwards-Leeper, L. & Spack, N. P. Psychological evaluation and medical treatment of transgender youth in an interdisciplinary 'gender management service' (GeMS) in a major pediatric center. J. hom*osex. 59, 321–336 (2012).

    PubMed Google Scholar

55. Cohen-Kettenis, P. T. & Gooren, L. J. G. Transsexualism: a review of etiology, diagnosis and treatment. J. Psychosom. Res. 46, 315–333 (1999).

    CAS PubMed Google Scholar

56. Giordano, S. Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder? J Med. Ethics 34, 580–584 (2008).

    CAS PubMed Google Scholar

57. Colizzi, M., Costa, R., Pace, V. & Todarello, O. Hormonal treatment reduces psychobiological distress in gender identity disorder, independently of the attachment style. J. Sex. Med. 10, 3049–3058 (2013).

    PubMed Google Scholar

58. Colizzi, M., Costa, R. & Todarello, O. Transsexual patients' psychiatric comorbidity and positive effect of cross-sex hormonal treatment on mental health: results from a longitudinal study. Psychoneuroendocrinology 39, 65–73 (2014).

    CAS PubMed Google Scholar

59. Colizzi, M., Costa, R. & Todarello, O. Dissociative symptoms in individuals with gender dysphoria: is the elevated prevalence real? Psychiatry Res. 226, 173–180 (2015).

    PubMed Google Scholar

60. Delemarre-van de Waal, H. A. & Cohen-Kettenis, P. T. Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects. Eur. J. Endocrinol. 155, S131–S137 (2006).

    CAS Google Scholar

61. Smith, Y. L. S., van Goozen, S. H. M. & Cohen-Kettenis, P. T. Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: a prospective follow-up study. J. Am. Acad. Child Adolesc. Psychiatry 40, 472–481 (2001).

    CAS PubMed Google Scholar

62. Smith, Y. L. S., Van Goozen, S. H. M., Kuiper, A. J. & Cohen-Kettenis, P. T. Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals. Psychol. Med. 35, 89–99 (2005).

    PubMed Google Scholar

63. Colizzi, M. et al. Concomitant psychiatric problems and hormonal treatment induced metabolic syndrome in gender dysphoria individuals: a 2 year follow-up study. J. Psychosom. Res. 78, 399–406 (2015).

    PubMed Google Scholar

64. Hembree, W. C. et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 94, 3132–3154 (2009).

    CAS PubMed Google Scholar

65. Kreukels, B. P. C. & Cohen-Kettenis, P. T. Puberty suppression in gender identity disorder: the Amsterdam experience. Nat. Rev. Endocrinol. 7, 466–472 (2011).

    CAS PubMed Google Scholar

66. Bockting, W. in The International Encyclopedia of Human Sexuality (ed Bolin, A.) 583–625 (2015).

    Google Scholar

67. Lothstein, L. M. & Levine, S. B. Expressive psychotherapy with gender dysphoric patients. Arch. Gen. Psychiatry 38, 924–929 (1981).

    CAS PubMed Google Scholar

68. Carel, J. C. & Léger, J. Clinical practice. Precocious puberty. N. Engl. J. Med. 358, 2366–2377 (2008).

    CAS Google Scholar

Download references