"Trans* is Pluralistic ": Treatment Trajectories for Gender Dysphoria in a German Child and Adolescent Psychiatry Outpatient Clinic

Introduction Increasing numbers of referrals and heterogeneous trajectories are being reported internationally for the controversially discussed diagnosis of gender incongruence (GI) / gender dysphoria (GD) in childhood and adolescence. Up to now, only a few studies exist that describe referral numbers and treatment trajectories in specialized services in Germany. Objectives The objectives of this study are to evaluate the clinical characteristics of referred trans* children and adolescents as well as the diagnostic procedure and treatment carried out at the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS). Methods Descriptive information on birth-assigned sex, age, social name changes, treatment trajectories (time of the first referral until time of evaluation), GI/GD diagnosis (according to ICD-10) and treatment status of N = 680 children and adolescents (time period: 2013-2018) were assessed retrospectively. Results Out of a total number of 680 referred children and adolescents, the majority was assigned female at birth (74 %; 1:3, M:F) and had already entered adolescence (& GE; 12 years; 87 %). A social name change had mostly occurred by the time of the first referral (66 %). In total, 85 % of the cases were diagnosed with a form of GI/GD. For 75 % of the children and adolescents, treatment trajectories were known, whereas in 25 % of the cases they could not be followed up. There were descriptive differences between the two groups (known vs. unknown treatment pathways) with respect to all characteristics. In total, 66 % of the adolescents with information about their treatment pathways had started receiving some form of gender-affirming medical intervention. Conclusion The results of the present study highlight that trans* children and adolescents presenting to a specialized GI/GD service represent a heterogeneous group with varied characteristics and treatment trajectories. Gender-affirming medical interventions were indicated in many cases, but not in all. This heterogeneity of developmental and treatment trajectories highlights the increasing importance of individualized, case-based approaches in an interdisciplinary treatment setting.