Exploring the Gender Development Histories of Children and Adolescents Presenting for Gender Affirming Medical Care

Abstract

Objective: The present study descriptively explores the childhood experiences, social transition and disclosure milestones and trajectories, reactions to disclosure, gender affirmation at school, dissatisfaction with sex characteristics, and desires for gender affirming medical care (GAMC) within a sample of transgender children and adoles- cents presenting for GAMC. Method: Participants were children and adolescents (N= 224; Age 6 –17 years) who participated in an initial assessment at a multidisciplinary gender affirming program in Dallas, Texas. Data were extracted from assessment notes and participants also completed self-report measures of current depression, anxiety, and body-related dissatisfaction. Results: Most participants reported awareness of their gender identity in childhood or early adolescence and started to take steps in social transition and disclosure during adolescence, prior to presenting for GAMC. However, these milestones were not confined to 1 developmental period, and the specific progression of milestones, degree of dissatisfaction with sex characteristics, and desires for GAMC beyond feminizing/masculinizing hormone therapy were diverse. Gender differences were found in milestones, requests to change name and pronoun at school, dissatisfaction with sex characteristics, and GAMC desires. Dissatisfaction with body shape and voice were associated with greater symptoms of depression. Somewhat surprisingly, most participants did not report any distressing reactions to disclosure (63.6%). However, most were not able to use the bathroom associated with their affirmed gender at school. Conclusions: Clinical approaches sensitive to the diversity of developmental contexts, identities, and desires for GAMC are needed.