European Child & Adolescent Psychiatry

, Volume 28, Issue 11, pp 1487–1498 | Cite as

Risk factors for psychological functioning in German adolescents with gender dysphoria: poor peer relations and general family functioning

  • Naina Levitan
  • Claus Barkmann
  • Hertha Richter-Appelt
  • Michael Schulte-Markwort
  • Inga Becker-HeblyEmail author
Original Contribution


Adolescents with gender dysphoria (GD) often face various associated social, emotional, and behavioral difficulties. In such a marginalized group, it is crucial to identify factors that may impact psychological functioning to better accommodate their needs. Therefore, the present study investigated the impact of two specific risk factors, poor peer relations and general family functioning, on the development of psychological problems in adolescents with GD, and their possible interaction effect. The Youth Self-Report, a Peer Relations Scale, and a General Family Functioning scale were assessed in a sample of n = 180 clinically referred adolescents (mean age 15.5; 146 transgender boys with a female birth-assigned sex, and 34 transgender girls with a male birth-assigned sex) with a complete GD diagnosis (fulfillment of the DSM 5 criteria A and B) at their initial admission to the Hamburg Gender Identity Service. Multiple linear regression analysis was conducted to examine the relationship between peer relations, family functioning, and psychological functioning outcomes. Adolescents with GD presented significantly higher Internalizing and Total Problem scores compared to the German reference norm. Externalizing problems were above the norm for transgender boys, but within the normal range for transgender girls. Multiple regression analysis revealed that, overall, adolescents with an advanced age, a female birth-assigned sex, poorer peer relations, and poorer family functioning showed more behavioral and emotional problems. Consequently, incorporating both the family and social environment in transgender care is of high importance to adequately tend to the needs of adolescents with GD.


Gender dysphoria Transgender Adolescents Mental health Psychological functioning Psychosocial functioning Family functioning Peer relations Social support 



We thank all the participants who contributed to this study by providing important personal data on many levels, and the clinicians for their contribution to the data collection in the care unit, especially Saskia Fahrenkrug.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards statement

All human and animal studies have been approved by the appropriate local ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Child and Adolescent Psychiatry, Psychotherapy, and PsychosomaticsUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Institute for Sex Research and Forensic PsychiatryUniversity Medical Center Hamburg-EppendorfHamburgGermany

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