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Being Trans Without Medical Transition: Exploring Characteristics of Trans Individuals from Germany Not Seeking Gender-Affirmative Medical Interventions

Abstract

Until recently, trans persons were expected to align their sex characteristics as much as possible with the opposite sex. Today, research and health care, as well as the diagnostic criteria from DSM-5 and ICD-11, reflect a broader understanding of trans individuals. It encompasses diverse identities and treatment requests, including trans individuals not wanting or having decided against gender-affirmative medical interventions (GAMI). The present study explored this insufficiently studied group by (1) reviewing the existing literature regarding trans individuals not seeking GAMI and by (2) exploring their demographic and trans-related characteristics in a non-clinical online convenience sample from Germany. The literature review found one large survey with a single question on trans individuals not seeking GAMI. Beyond that, only community literature addressed the topic. The analyzed sample consisted of 415 trans participants, of whom 220 were assigned female at birth (AFAB) and 195 were assigned male at birth (AMAB). Fourteen (3.4%) reported neither previous nor planned GAMI (AFAB = 9, AMAB = 5). Trans individuals not seeking GAMI were significantly older and more often reported to identify with a non-binary gender. The two interdependent, central reasons for refusing GAMI were the avoidance of transition-related suffering and the lack of necessity for treatment. The diversification of gender, as reflected in the increasing visibility of non-binary or genderqueer gender identities, seems to go hand in hand with a diversification of transition-related treatment, including the option not to seek GAMI.

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Fig. 1

Notes

  1. 1.

    We are aware that trans persons identify with a variety of terms and that this list could be greatly expanded. We use the term "trans" because it is widely accepted in the community, even by people with a non-binary gender identity. In the majority, trans persons seem to feel rather comfortable with this short-hand term.

  2. 2.

    “In the past, so much attention had been paid to the therapeutic sequence of cross-gender living, administration of cross-sex hormones, and genital (and other) surgeries that some made the erroneous assumption that a diagnosis of GID inevitably should lead to this sequence. A diagnosis of GID actually only creates a serious consideration of an array of complex options, only one of which is medical support for this triadic therapeutic sequence” (Levine et al., 1998, pp. 17–18).

  3. 3.

    The first evidence-based guideline has recently been published in order to improve transgender health care in Germany (Nieder & Strauß, 2019).

  4. 4.

    The strength of an association between two categorical variables is described as follows: < .10 = negligible association; .10–.20 = weak association; .20–.40 = moderate association; .40–.60 = relatively strong association; .60–.80 = strong association; and > .80 = very strong association (Rea & Parker, 1992).

  5. 5.

    The strength of an association between two continuous variables is described as follows: .20 = small; .50 = medium; and .80 = large.

  6. 6.

    The design of the flowchart is recommended by the PRISMA group (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; Moher, Liberati, Tetzlaff, Altman, & The Prisma Group, 2009).

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Acknowledgments

The researchers thank the participants for their time and willingness to participate in the study as well as the reviewers for their valuable comments.

Funding

Funding was provided by Research Fund of the Faculty of Medicine, University of Hamburg, Germany (Grant No. NWF-15-08).

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Correspondence to Timo O. Nieder.

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Nieder, T.O., Eyssel, J. & Köhler, A. Being Trans Without Medical Transition: Exploring Characteristics of Trans Individuals from Germany Not Seeking Gender-Affirmative Medical Interventions. Arch Sex Behav 49, 2661–2672 (2020). https://doi.org/10.1007/s10508-019-01559-z

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Keywords

  • Transgender
  • Non-binary
  • Gender dysphoria
  • Social transition