This article provides an overview of five contemporary clinical and research issues pertaining to adolescents with a diagnosis of gender dysphoria: (1) increased referrals to specialized gender identity clinics; (2) alteration in the sex ratio; (3) suicidality; (4) “rapid-onset gender dysphoria” (ROGD) as a new developmental pathway; (5) and best practice clinical care for adolescents who may have ROGD.
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Aitken et al. (2015) also reported on the sex ratio of adolescents seen in the Toronto clinic between 1976 and 1998, where the male-to-female sex ratio was 1.51:1 (but corresponding clinical control data were not available).
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the Achenbach system of empirically based assessment school-age forms profiles. Burlington, VT: ASEBA.
Acosta, W., Qayyum, Z., Turban, J. L., & van Schalkwyk, G. I. (2019). Identify, engage, understand: Supporting transgender youth in an inpatient psychiatric hospital. Psychiatric Quarterly. https://doi.org/10.1007/s11126-019-09653-0.
Aitken, M., Steensma, T. D., Blanchard, R., VanderLaan, D. P., Wood, H., Fuentes, A., … Zucker, K. J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. Journal of Sexual Medicine, 12, 756–763.
Alastanos, J. N., & Mullen, S. (2017). Psychiatric admission in adolescent transgender patients: A case series. Mental Health Clinician, 7, 172–175.
Allen, L. R., Watson, L. B., Egan, A. M., & Moser, C. N. (2019). Suicidality and well-being among transgender youth after gender-affirming medical interventions. Clinical Practice in Pediatric Psychology. https://doi.org/10.1037/cpp0000288.
Ashley, F. (2019). Shifts in assigned sex ratios at gender identity clinics likely reflect changes in referral patterns [Letter to the Editor]. Journal of Sexual Medicine, 16, 948–949.
Ashley, F., & Baril, A. (2018). Why ‘rapid-onset gender dysphoria’ is bad science. The Conversation. Retrieved from https://theconversation.com/why-rapid-onset-gender-dysphoria-is-bad-science-92742.
Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven sampling study in Ontario, Canada. BMC Public Health, 15, 525. https://doi.org/10.1186/s12889-015-1867-2.
Beard, J. (2019). Spike in demand for treatment of transgender teens. Retrieved from https://www.cbc.ca/news/canada/ottawa/trans-teens-ottawa-cheo-demand-1.5026034.
Becerra-Culqui, T. A., Liu, Y., Nash, R., Cromwell, L., Flanders, D., Getahun, D., & Goodman, M. (2018). Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics, 141(5), e20173845. https://doi.org/10.1542/peds.2017-3845.
Becker, M., Gjergji-Lama, V., Romer, G., & Möller, B. (2014). Merkmale von Kindern und Jugendlichen mit Geschlechtsdysphorie in der Hamburger Spezialsprechstunde [Characteristics of children and adolescents with gender dysphoria referred to the Hamburg Gender Identity Clinic]. Praxis der Kinderpsychologie und Kinderpsychiatrie, 63, 486–509.
Bever, L. (2016, 3 October). Transgender boy’s mom sues hospital, saying he went into spiral after staff called him a girl. The Washington Post. Retrieved from https://www.washingtonpost.com/news/to-your-health/wp/2016/10/03/mother-sues-hospital-for-discrimination-after-staff-kept--calling–her-transgender-son-a-girl/?noredirect=on&utm_term=.87447dfdeab3.
Biggs, M. (2018). Suicide by trans-identified children in England and Wales. Retrieved from https://www.transgendertrend.com/suicide-by-trans-identified-children-in-england-and-wales/.
Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. Journal of Sex and Marital Therapy, 17, 235–251.
Blanchard, R. (1993). Varieties of autogynephilia and their relationship to gender dysphoria. Archives of Sexual Behavior, 22, 241–251.
Brandelli Costa, A. (2019). Formal comment on: Parent reports of adolescents and young adults perceived to shown signs of a rapid onset of gender dysphoria. PLoS ONE. https://doi.org/10.1371/journal.pone.0212578.
Butler, C., Joiner, R., Bradley, R., Bowles, M., Bowes, M., Bowes, A., & Roberts, V. (2019). Self-harm prevalence and ideation in a community sample of cis, trans and other youth. International Journal of Transgenderism. https://doi.org/10.1080/15532739.2019.1614130.
Chiniara, L. N., Bonifacio, H. J., & Palmert, M. R. (2018). Characteristics of adolescents referred to a gender clinic: Are youth seen now different from those in initial reports? Hormone Research in Paediatrics, 89, 434–441.
Cicchetti, D., & Rogosch, F. A. (1996). Equifinality and multifinality in developmental psychopathology [Editorial]. Development and Psychopathology, 8, 597–600.
Cohen-Kettenis, P. T., Delemarre-van de Waal, H. A., & Gooren, L. J. G. (2008). The treatment of adolescent transsexuals: Changing insights. Journal of Sexual Medicine, 5, 1892–1897.
Cohen-Kettenis, P. T., Steensma, T. D., & de Vries, A. L. C. (2011). Treatment of adolescents with gender dysphoria in the Netherlands. Child and Adolescent Psychiatric Clinics of North America, 20, 689–700.
Connolly, M. D., Zervos, M. J., Barone, C. J., Johnson, C. C., & Joseph, C. L. M. (2016). The mental health of transgender youth: Advances in understanding. Journal of Adolescent Health, 59, 489–495.
Costa, R., Dunsford, M., Skagerberg, E., Holt, V., Carmichael, P., & Colizzi, M. (2015). Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. Journal of Sexual Medicine, 12, 2206–2214.
de Graaf, N. M., Cohen-Kettenis, P. T., Carmichael, P., de Vries, A. L. C., Dhondt, K., Laridaen, J., & Steensma, T. D. (2018a). Psychological functioning in adolescents referred to specialist gender identity clinics across Europe: A clinical comparison study between four clinics. European Child and Adolescent Psychiatry, 27, 909–919.
de Graaf, N. M., Giovanardi, G., Zitz, C., & Carmichael, P. (2018b). Sex ratio in children and adolescents referred to the Gender Identity Development Services in the UK (2009–2016) [Letter to the Editor]. Archives of Sexual Behavior, 47, 1301–1304.
de Graaf, N. M., Steensma, T. D., Carmichael, P., Cohen-Kettenis, P. T., de Vries, A. L. C., Kreukels, B. P. C., … Zucker, K. J. (2019). Suicidality in adolescents diagnosed with gender dysphoria: A cross-national, cross-clinic comparative analysis. Paper presented at the meeting of the European Association for Transgender Health, Rome, Italy.
de Vries, A. L. C., Doreleijers, T. A., Steensma, T. D., & Cohen-Kettenis, P. T. (2011). Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry, 52, 1195–1202.
de Vries, A. L. C., Klink, D., & Cohen-Kettenis, P. T. (2016). What the primary care pediatrician needs to know about gender incongruence and gender dysphoria in children and adolescents. Pediatric Clinics of North America, 63, 1121–1135.
de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134, 696–704.
de Vries, A. L. C., Noens, I. L. J., Cohen-Kettenis, P. T., van Berckelaer-Onnes, I. A., & Doreleijers, T. A. H. (2010). Autism spectrum disorders in gender dysphoric children and adolescents. Journal of Autism and Developmental Disorders, 40, 930–936.
de Vries, A. L. C., Steensma, T. D., Cohen-Kettenis, P. T., VanderLaan, D. P., & Zucker, K. J. (2016). Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: A cross-national, cross-clinic comparative analysis. European Child and Adolescent Psychiatry, 25, 579–588.
Di Ceglie, D., Freedman, D., McPherson, S., & Richardson, P. (2002). Children and adolescents referred to a specialist gender identity development service: Clinical features and demographic characteristics. International Journal of Transgenderism, 6(1). Retrieved from http://www.symposion.com/ijt/ijtvo06no01_01.htm.
Digitale, E. (2017). Transgender: Caring for kids making the transition. Stanford Medicine. Retrieved from https://stanmed.stanford.edu/2017spring/caring-for-transgender-kids-at-stanford-childrens-health.html.
Edwards-Leeper, L., Leibowitz, S., & Sangganjanavich, V. F. (2016). Affirmative practice with transgender and gender nonconforming youth: Expanding the model. Psychology of Sexual Orientation & Gender Diversity, 3, 165–172.
Eisenberg, M. E., Gower, A. L., McMorris, B. J., Rider, G. N., Shea, G., & Coleman, E. (2017). Risk and protective factors in the lives of transgender/gender nonconforming adolescents. Journal of Adolescent Health, 61, 521–526.
Fisher, A. D., Ristori, J., Castellini, G., Sensi, C., Cassiolo, E., Prunas, A., & Maggi, M. (2017). Psychological characteristics of Italian gender dysphoric adolescents: A case-control study. Journal of Endocrinological Investigation, 40, 953–965.
Frisén, L., Söder, O., & Rydelius, P. A. (2017). [Dramatic increase of gender dysphoria in youth]. Lakartidningen. Retrieved from http://lakartidningen.se/Klinik-och-vetenskap/Klinisk-oversikt/2017/02/Kraftig-okning-av-konsdysfori-bland-barn-och-unga/.
Gilligan, A. (2019, 29 June). Surge in girls switching gender. The Sunday Times. Retrieved from https://www.thetimes.co.uk/article/surge-in-girls-switching-gender-c69nl57vt.
Grossman, A. H., Park, J. Y., & Russell, S. T. (2016). Transgender youth and suicidal behaviors: Applying the interpersonal psychological theory of suicide. Journal of Gay & Lesbian Mental Health, 20, 329–349.
Heber, J. (2019). Correcting the scientific record on gender incongruence—and an apology. Retrieved from https://blogs.plos.org/everyone/2019/03/19/correcting-the-scientific-record-and-an-apology/.
Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., & T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender- incongruent persons: An Endocrine Society* Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 102, 3869–3903.
Hoekzema, E., Schagen, S. E., Kruekels, B. P. C., Veltman, D. J., Cohen-Kettenis, P. T., Delemarre-van de Waal, H., & Bakker, J. (2015). Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain. Psychoneuroendocrinology, 55, 59–71.
Holt, V., Skagerberg, E., & Dunsford, M. (2016). Young people with features of gender dysphoria: Demographics and associated difficulties. Clinical Child Psychology and Psychiatry, 21, 108–118.
Human Rights Campaign. (2018). 2018 LGBTQ Report. Washington, DC: Author.
Hutchinson, A., Midgen, M., & Spiliadis, A. (2019). In support of research into rapid-onset gender dysphoria [Letter to the Editor]. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-019-01517-9.
I’d Rather Have a Living Son Than a Dead Daughter. (2016). Only Human. Retrieved from https://www.wnycstudios.org/story/id-rather-have-living-son-dead-daughter.
It’s not conversion therapy to learn to love your body: A teen desister tells her story. (2017). Retrieved from https://4thwavenow.com/2017/11/07/a-teen-desister-tells-her-story/.
Janssen, A., & Leibowitz, S. (Eds.). (2018). Affirmative mental health care for transgender and gender diverse youth. New York: Springer.
Johns, M. M., Lowry, R., Andrzejewski, J., Barrios, L. C., Demissie, Z., McManus, T., & Underwood, M. J. (2019). Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. Mortality and Morbidity Weekly Reports, 68, 67–71.
Kaltiala-Heino, R., & Lundberg, N. (2019). Gender identities in adolescent population: Methodological issues and prevalence across age groups. European Psychiatry, 55, 61–66.
Kaltiala-Heino, R., Sumia, M., Työläjärvi, M., & Lindberg, N. (2015). Two years of gender identity service for minors: Overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health, 9, 9. https://doi.org/10.1186/s13034-015-0042-y.
Kaltialo-Heino, R., Carmichael, P., de Graaf, N., Rischel, K., Frisén, L., Suomalainen, L., & Wahre, A. (in press). Time trends in referrals to child and adolescent gender identity services: A study in four Nordic countries and the UK. Nordic Journal of Psychiatry.
Karasic, D., & Ehrensaft, D. (2015). We must put an end to gender conversion therapy for kids. WIRED. Retrieved on 7 November 2015 from http://www.wired.com/2015/07/must-put-end-gender-conversion-therapy-kids/.
Katz-Wise, S. L., Ehrensaft, D., Vetters, R., Forcier, M., & Austin, S. B. (2018). Family functioning and mental health of transgender and gender-nonconforming youth in the Trans Teen and Family Narratives Project. Journal of Sex Research, 55, 582–590.
Khatchadourian, K., Amed, S., & Metzger, D. L. (2014). Clinical management of youth with gender dysphoria in Vancouver. Journal of Pediatrics, 164, 906–911.
Kidd, S. A., Gaetz, S., & O’Grady, B. (2017). The 2015 National Canadian Homeless Youth Survey: Mental health and addiction findings. Canadian Journal of Psychiatry, 62, 493–500.
Kuper, L. E., Mathews, S., & Lau, M. (2019). Baseline mental health and psychosocial functioning of transgender adolescents seeking gender-affirming hormone therapy. Journal of Developmental and Behavioral Pediatrics. https://doi.org/10.1097/dbp.0000000000000697.
Lawrence, A. A. (2010). Sexual orientation versus age of onset as bases for typologies (subtypes) of gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 514–545.
Lawrence, A. A. (2017). Autogynephilia and the typology of male-to-female transsexualism: Concepts and controversies. European Psychologist, 22, 39–54.
Levitan, N., Barkmann, C., Richter-Appelt, H., Schulte-Markwort, M., & Becker-Hebly, I. (2019). Risk factors for psychological functioning in German adolescents with gender dysphoria: Poor peer relations and general family functioning. European Child and Adolescent Psychiatry. https://doi.org/10.1007/s00787-019-01308-6.
Littman, L. (2018). Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS ONE, 13(8), e0202330. https://doi.org/10.1371/journal.pone.0202330.
Littman, L. (2019). Correction: Parent reports of adolescents and young adults perceived to shown signs of a rapid onset of gender dysphoria. PLoS ONE. https://doi.org/10.1371/journal.pone.0214157.
Mann, G. E., Taylor, A., Wren, B., & de Graaf, N. (2019). Review of the literature on self-injurious thoughts and behaviours in gender-diverse children and young people in the United Kingdom. Clinical Child Psychology and Psychiatry, 24, 304–321.
Marchiano, L. (2017). Outbreak: On transgender teens and psychic epidemics. Psychological Perspectives: A Quarterly Journal of Jungian Thought, 60, 345–366.
McDermott, E., Hughes, E., & Rawlings, V. (2017). The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: A mixed methods study. Journal of Public Health, 40(3), e244–e251. https://doi.org/10.1093/pubmed/fdx135.
Milrod, C. (2014). How young is too young: Ethical concerns in genital surgery of the transgender MTF adolescent. Journal of Sexual Medicine, 11, 338–346.
Milrod, C., & Karasic, D. H. (2017). Age is just a number: WPATH-affiliated surgeons’ experiences and attitudes toward vaginoplasty in transgender females under 18 years of age in the United States. Journal of Sexual Medicine, 14, 624–634.
Olson, J., Schrager, S. M., Belzer, M., Simons, L. K., & Clark, L. F. (2015). Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. Journal of Adolescent Health, 57, 374–380.
Olson-Kennedy, J., Warus, J., Okonta, V., Belzer, M., & Clark, L. F. (2018). Chest reconstruction and chest dysphoria in transmasculine minors and young adults: Comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatrics, 172, 431–436.
Perez-Brumer, A., Day, J. K., Russell, S. T., & Hatzenbuehler, M. L. (2017). Prevalence and correlates of suicidal ideation among transgender youth in California: Findings from a representative, population-based sample of high school students. Journal of the American Academy of Child and Adolescent Psychiatry, 56, 739–746.
Peterson, C. M., Matthews, A., Copps-Smith, E., & Conrad, L. A. (2017). Suicidality, self-harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria. Suicide and Life-Threatening Behavior, 47, 475–482.
Priest, M. (2019). Transgender children and the right to transition: Medical ethics when parents mean well but cause harm. American Journal of Bioethics, 19, 43–59.
Rae, C. (2017). Parents combating transgender propaganda introduce a spokesperson. The Fifth Column. Retrieved from https://thefifthcolumnnews.com/2017/10/4thwavenow-spokesperson-jontry/?fbclid=IwAR2B5MqUn9PiZ6OXjDNmkRR5_CNyMcrr4YlDfFprqQjwnbibJKh35RjXvho.
Restar, A. J. (2019). Methodological critique of Littman’s (2018) parental-respondents accounts of “rapid-onset gender dysphoria” [Commentary]. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-019-1453-2.
Rice, T., Kufert, Y., Walther, A., Feldman, E., Garcia-Delgar, B., & Coffey, B. J. (2016). Psychopharmacotherapy of severe self-injury in an adolescent with gender dysphoria and comorbidity. Journal of Child and Adolescent Psychopharmacology, 26, 646–650.
Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual Review of Clinical Psychology, 12, 465–487.
Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, 63, 503–505.
Savva, A., & Small, N. (2019, 29 June). Mum’s fury after transgender suicide teen sold hormones from online clinic. Cambridge News. Retrieved from https://www.cambridge-news.co.uk/news/cambridge-news/transgender-treatment-nhs-webberley-jayden-16504026.
Schneider, M. A., Spritzer, P. M., Soll, B. M. B., Fontanari, A. M. V., Carneiro, M., Tovar-Moll, F., & Lobato, M. I. R. (2017). Brain maturation, cognition and voice pattern in a gender dysphoria case under pubertal suppression. Frontiers in Human Neuroscience, 11. https://doi.org/10.3389/fnhum.2017.00528.
Sevlever, M., & Meyer-Bahlburg, H. F. L. (2019). Late-onset transgender identity development of adolescents in psychotherapy for mood and anxiety problems: Approach to assessment and treatment. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-018-1362-9.
Shiffman, M., VanderLaan, D. P., Wood, H., Hughes, S. K., Owen-Anderson, A., Lumley, M. M., … Zucker, K. J. (2016). Behavioral and emotional problems as a function of peer relationships in adolescents with gender dysphoria: A comparison to clinical and non-clinical controls. Psychology of Sexual Orientation & Gender Diversity, 3, 27–36.
Skagerberg, E., Parkinson, R., & Carmichael, P. (2013). Self-harming thoughts and behaviors in a group of children and adolescents with gender dysphoria. International Journal of Transgenderism, 14, 86–92.
Spivey, L. A., & Edwards-Leeper, L. (2019). Future directions in affirmative psychological interventions with transgender children and adolescents. Journal of Clinical Child and Adolescent Psychology, 48, 343–356.
Staphorsius, A. S., Kreuekels, B. P. C., Cohen-Kettenis, P. T., Veltman, D. J., Burke, S. M., Schagen, S. E., & Bakker, J. (2015). Puberty suppression and executive functioning: An fMRI-study in adolescents with gender dysphoria. Psychoneuroendocrinology, 56, 190–199.
Steensma, T. D., Zucker, K. J., Kreukels, B. P. C., VanderLaan, D. P., Wood, H., Fuentes, A., & Cohen-Kettenis, P. T. (2014). Behavioral and emotional problems on the Teacher’s Report Form: A cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents. Journal of Abnormal Child Psychology, 42, 635–647.
Sumia, M., Lindberg, N., Työläjärvi, M., & Kaltiala-Heino, R. (2017). Current and recalled childhood gender identity in community youth in comparison to referred adolescents seeking sex reassignment. Journal of Adolescent Health, 56, 34–39.
Tanis, J. (2016). The power of 41%: A glimpse into the life of a statistic [Commentary]. American Journal of Orthopsychiatry, 86, 373–377.
Toomey, R. B., Syvertsen, A. K., & Shramko, M. (2018). Transgender adolescent suicide behavior. Pediatrics, 142(4), e20174218. https://doi.org/10.1542/peds.2017-4218.
van der Miesen, A. I. R., de Vries, A. L. C., Steensma, T. D., & Hartman, C. A. (2018). Autistic symptoms in children and adolescents with gender dysphoria. Journal of Autism and Developmental Disorders, 48, 1537–1548.
Veale, J. F., Watson, R. J., Peter, T., & Saewyc, E. M. (2017). Mental health disparities among Canadian transgender youth. Journal of Adolescent Health, 60, 44–49.
Wadman, M. (2018). New paper ignites storm over whether teens experience ‘rapid onset’ of transgender identity. Science, 361, 958–959.
Why Are So Many Teenage Girls Appearing in Gender Clinics? (2018). The Economist. Retrieved from https://www.economist.com/united-states/2018/09/01/why-are-so-many-teenage-girls-appearing-in-gender-clinics.
Williams, G. (2019). A grand conspiracy to tell the truth: An interview with 4th WaveNow founder and her daughter Chiara of the Pique Resilience Project. Retrieved from https://4thwavenow.com/2019/02/27/a-grand-conspiracy-to-tell-the-truth-an-interview-with-4thwavenow-founder-her-daughter-chiara-of-the-pique-resilience-project/.
Wood, H., Sasaki, S., Bradley, S. J., Singh, D., Fantus, S., Owen-Anderson, A., … Zucker, K. J. (2013). Patterns of referral to a gender identity service for children and adolescents (1976–2011): Age, sex ratio, and sexual orientation [Letter to the Editor]. Journal of Sex and Marital Therapy, 39, 1–6.
Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health, 14, 404–411.
Zucker, K. J., & Aitken, M. (2019). Sex ratio of transgender adolescents: A meta-analysis. Paper presented at the meeting of the European Association for Transgender Health, Rome, Italy.
Zucker, K. J., Bradley, S. J., Owen-Anderson, A., Kibblewhite, S. J., & Cantor, J. M. (2008). Is gender identity disorder in adolescents coming out of the closet? [Letter to the Editor]. Journal of Sex and Marital Therapy, 34, 287–290.
Zucker, K. J., Bradley, S. J., Owen-Anderson, A., Kibblewhite, S. J., Wood, H., Singh, D., & Choi, K. (2012). Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. Journal of Sex and Marital Therapy, 38, 151–189.
Zucker, K. J., Bradley, S. J., Owen-Anderson, A., Singh, D., Blanchard, R., & Bain, J. (2011). Puberty-blocking hormonal therapy for adolescents with gender identity disorder: A descriptive clinical study. Journal of Gay and Lesbian Mental Health, 15, 58–82.
Zucker, K. J., VanderLaan, D. P., & Aitken, M. (2019). The contemporary sex ratio of transgender youth that favors assigned females at birth is a robust phenomenon: A response to the Letter to the Editor Re: “Shifts in Assigned Sex Ratios at Gender Identity Clinics Likely Reflect Change in Referral Patterns” [Letter to the Editor]. Journal of Sexual Medicine, 16, 949–950.
Zucker, K. J., Wood, H., & VanderLaan, D. P. (2014). Models of psychopathology in children and adolescents with gender dysphoria. In B. P. C. Kreukels, T. D. Steensma, & A. L. C. de Vries (Eds.), Gender dysphoria and disorders of sex development: Progress in care and knowledge (pp. 171–192). New York: Springer.
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Zucker, K.J. Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues. Arch Sex Behav 48, 1983–1992 (2019). https://doi.org/10.1007/s10508-019-01518-8
- Gender dysphoria
- Gender identity
- Rapid-onset gender dysphoria
- Sex ratio