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A Cross-Sectional Multicenter Study of Multidimensional Body Image in Adolescents and Adults with Gender Dysphoria Before and After Transition-Related Medical Interventions


Persistent feelings of gender dysphoria (GD) are accompanied by distress and body dissatisfaction in most clinically referred adolescents and adults. Transition-related medical interventions (e.g., puberty suppression, hormones, or surgery) may alleviate body dissatisfaction. The aim of the present cross-sectional study was to compare multidimensional body image across clinically referred adolescents and adults undergoing different transition-related medical interventions. Two clinical samples of adolescents (n = 82) and adults (n = 120) referred to specialized departments of four different transgender health services in Germany participated in the study. In total, 202 individuals from the female-to-male (FtM individuals) and male-to-female (MtF individuals) spectrum aged 14–74 years were included at different stages of their transition. Four scales assessing multidimensional aspects of body image (measured by the Body Image Assessment Questionnaire, FBeK) were compared across three groups: sample, gender, and medical interventions (while controlling for age and treatment duration). The results indicated less favorable body image scores compared with the norm in both adolescents and adults with GD. Individuals who had undergone transition-related medical interventions presented a significantly better body image on two of the four scales. Differences according to gender and age were also present. These findings suggest that medical interventions, especially gender-affirming hormones and surgery, are generally beneficial to the body image in individuals with GD. However, not all of the less favorable outcomes in multidimensional body image were positively influenced by the treatment conditions and may thus benefit from additional integrative counseling before and during transition.

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We thank all the participants who contributed to this study by providing important personal data on many levels. We thank all the clinicians for their contribution to the data collection in the transgender care units and especially for their contributions to the interdisciplinary work group in Hamburg. We also thank Elmar Brähler and Bernhard Strauß for providing the FBeK norm data. Thanks to our student staff for their help with the database. The authors report no conflicts of interest.


Funding for the study was provided to the corresponding author by Hamburg macht Kinder gesund e.V. and FAZIT-Stiftung. The funding source had no involvement in the process of the study’s design, data collection, analysis, or publication.

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Correspondence to Inga Becker.

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The authors declare that they have no conflict of interest.

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All procedures in this study were performed in accordance with the ethical standards of the institutional or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Becker, I., Auer, M., Barkmann, C. et al. A Cross-Sectional Multicenter Study of Multidimensional Body Image in Adolescents and Adults with Gender Dysphoria Before and After Transition-Related Medical Interventions. Arch Sex Behav 47, 2335–2347 (2018).

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  • Gender dysphoria
  • Transgender
  • Multidimensional body image
  • DSM-5