Early medical treatment of children and adolescents with gender dysphoria: an empirical ethical study
Open accessAbstract
Purpose The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions. The aim of this study was to explicate the considerations of proponents and opponents of puberty suppression in GD to move forward the ethical debate. Methods Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide. Results Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits. Conclusions As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required.
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In rats, reproductive physiology and behavior are delayed with leuprolide acetate but later restored following cessation of the puberty blockade.
“For example, recent studies in rats indicate that while reproductive physiology and behavior are delayed with the usage of leuprolide acetate, these are later restored following cessation of the puberty blockade (7, 8).”
From Puberty Blocker, Leuprolide, Reduces Sex Differences in Rough-and-Tumble Play and Anxiety-like Behavior in Juvenile Rats (2024) · cites this paper as [8]
The section on possible physical or psychological harmful effects discusses uncertainty about puberty suppression and concerns about fertility, but does not report a rat study. Searches for leuprolide acetate, rats, reproductive behavior, and recovery after stopping treatment found no passage addressing the claimed finding. The indexed passages provide no page numbers. (LLM, conf=0.76)
Experimental — accuracy not yet measuredPubertal development proceeds in a typical manner on withdrawal of puberty blockers.
“While pubertal development is paused using puberty blockers, studies indicate that pubertal development proceeds in a typical manner on withdrawal of puberty blockers.”
From Puberty Blocker, Leuprolide, Reduces Sex Differences in Rough-and-Tumble Play and Anxiety-like Behavior in Juvenile Rats (2024) · cites this paper as [8]
The section on possible physical or psychological harmful effects discusses uncertainty about bone-density catch-up and long-term outcomes, but does not describe pubertal development after blockers are withdrawn. Searches for withdrawal, resumption of puberty, and reversibility found no passage addressing whether development then proceeds typically. (LLM, conf=0.70)
Experimental — accuracy not yet measured
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Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
(1998) · Sage eBooks · Cited by 38,631 · see citing works
How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability
Guest, G., Bunce, A., & Johnson, L. (2006) · Field Methods · doi:10.1177/1525822x05279903 · Cited by 20,808 · see citing works
Qualitative research: standards, challenges, and guidelines
Malterud, K. (2001) · The Lancet · doi:10.1016/s0140-6736(01)05627-6 · Cited by 5,014 · see citing works
International Statistical Classification of Diseases and Related Health Problems
Eisfeld, J. (2014) · TSQ Transgender Studies Quarterly · doi:10.1215/23289252-2399740 · Cited by 3,570 · see citing works
Coleman, E., Bockting, W. O., Botzer, M., Cohen‐Kettenis, P. T., Cuypere, G. D., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., et al. (2012) · International Journal of Transgenderism · doi:10.1080/15532739.2011.700873 · Cited by 3,145 · see citing works
Self-citationQualitative Research: Qualitative interviews in medical research
Britten, N. (1995) · BMJ · doi:10.1136/bmj.311.6999.251 · Cited by 1,670 · see citing works
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FIFTH EDITION
Abbas, A., & Aminoroaia, M. (2013) · Cited by 1,478 · see citing works
Endocrine Treatment of Transsexual Persons:An Endocrine Society Clinical Practice Guideline
Hembree, W. C., Cohen‐Kettenis, P. T., de Waal, H. A. D., Gooren, L. J., Meyer, W. J., Spack, N. P., Tangpricha, V., & Montori, V. M. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0345 · Cited by 1,029 · see citing works
Self-citationYoung Adult Psychological Outcome After Puberty Suppression and Gender Reassignment
de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., DORELEIJERS, T. A. H., & Cohen‐Kettenis, P. T. (2014) · PEDIATRICS · doi:10.1542/peds.2013-2958 · Cited by 931 · see citing works
Self-citationExamination of US puberty-timing data from 1940 to 1994 for secular trends: panel findings
Euling, S. Y., Herman-Giddens, M. E., Lee, P. A., Selevan, S. G., Juul, A., SØrensen, T. I. A., Dunkel, L., Himes, J. H., Teilmann, G., & Swan, S. H. (2008) · PEDIATRICS · doi:10.1542/peds.2007-1813d · Cited by 662 · see citing works
Puberty Suppression in Adolescents With Gender Identity Disorder: A Prospective Follow-Up Study
de Vries, A. L. C., Steensma, T. D., DORELEIJERS, T. A. H., & Cohen‐Kettenis, P. T. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2010.01943.x · Cited by 643 · see citing works
Self-citationRecent decline in age at breast development: The Copenhagen Puberty Study
Aksglaede, L., Sørensen, K., Petersen, J. H., Skakkebæk, N. E., & Juul, A. (2009) · Pediatrics · doi:10.1542/peds.2008-2491 · Cited by 626 · see citing works
Grossman, A. H., & D’Augelli, A. R. (2006) · Journal of Homosexuality · doi:10.1300/j082v51n01_06 · Cited by 590 · see citing works
Psychosexual Outcome of Gender-Dysphoric Children
Wallien, M. S. C., & Cohen‐Kettenis, P. T. (2008) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31818956b9 · Cited by 578 · see citing works
Self-citationSteensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen‐Kettenis, P. T. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.03.016 · Cited by 478 · see citing works
Self-citationClinical management of gender dysphoria in children and adolescents: the dutch approach
de Vries, A. L. C., & Cohen-Kettenis, P. T. (2012) · Journal of Homosexuality · doi:10.1080/00918369.2012.653300 · Cited by 451 · see citing works
Self-citationA follow-up study of girls with gender identity disorder.
Drummond, K. D., Bradley, S. J., Peterson‐Badali, M., & Zucker, K. J. (2008) · Developmental Psychology · doi:10.1037/0012-1649.44.1.34 · Cited by 440 · see citing works
Adolescent decision-making: the development of competence
Mann, L., Harmoni, R., & Power, C. (1989) · Journal of Adolescence · doi:10.1016/0140-1971(89)90077-8 · Cited by 355 · see citing works
de Waal, H. A. D., & Cohen‐Kettenis, P. T. (2006) · European Journal of Endocrinology · doi:10.1530/eje.1.02231 · Cited by 347 · see citing works
Self-citationMinding the body: Situating gender identity diagnoses in the ICD-11
Drescher, J., Cohen‐Kettenis, P. T., & Winter, S. (2012) · International Review of Psychiatry · doi:10.3109/09540261.2012.741575 · Cited by 339 · see citing works
Self-citationPsychiatric comorbidity in gender dysphoric adolescents
de Vries, A. L. C., DORELEIJERS, T. A. H., Steensma, T. D., & Cohen‐Kettenis, P. T. (2011) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2011.02426.x · Cited by 265 · see citing works
Self-citationKlink, D. T., Caris, M. G., Heijboer, A. C., van Trotsenburg, M., & Rotteveel, J. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-2439 · Cited by 250 · see citing works
The Treatment of Adolescent Transsexuals: Changing Insights
Cohen‐Kettenis, P. T., de Waal, H. A. D., & Gooren, L. J. (2008) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2008.00870.x · Cited by 239 · see citing works
Self-citationMeyer‐Bahlburg, H. F. L. (2009) · Archives of Sexual Behavior · doi:10.1007/s10508-009-9532-4 · Cited by 182 · see citing works
Puberty suppression in gender identity disorder: the Amsterdam experience
Kreukels, B. P. C., & Cohen‐Kettenis, P. T. (2011) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2011.78 · Cited by 171 · see citing works
Self-citationPsychiatric Comorbidity Among Children With Gender Identity Disorder
Wallien, M. S. C., Swaab, H., & Cohen‐Kettenis, P. T. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181373848 · Cited by 158 · see citing works
Self-citationVasey, P. L., & Bartlett, N. H. (2007) · Perspectives in biology and medicine · doi:10.1353/pbm.2007.0056 · Cited by 156 · see citing works
Puberty Suppression in a Gender-Dysphoric Adolescent: A 22-Year Follow-Up
Cohen‐Kettenis, P. T., Schagen, S. E. E., Steensma, T. D., de Vries, A. L. C., & de Waal, H. A. D. (2011) · Archives of Sexual Behavior · doi:10.1007/s10508-011-9758-9 · Cited by 152 · see citing works
Self-citationTrends in Menarcheal Age between 1955 and 2009 in the Netherlands
Talma, H., Schönbeck, Y., van Dommelen, P., Bakker, B., van Buuren, S., & Hirasing, R. A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0060056 · Cited by 141 · see citing works
Controversies in Gender Diagnoses
Drescher, J. (2014) · LGBT Health · doi:10.1089/lgbt.2013.1500 · Cited by 141 · see citing works
Treatment of Adolescents With Gender Dysphoria in the Netherlands
Cohen‐Kettenis, P. T., Steensma, T. D., & de Vries, A. L. C. (2011) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2011.08.001 · Cited by 121 · see citing works
Self-citationGender Identity Disorders in Childhood and Adolescence
Korte, A., Goecker, D., Krude, H., Lehmkuhl, U., Grüters‐Kieslich, A., & Beier, K. M. (2008) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2008.0834 · Cited by 69 · see citing works
Transgender Youth: Invisible and Vulnerable
(2013) · Routledge eBooks · doi:10.4324/9780203057582-10 · Cited by 67 · see citing works
Atypical Gender Development–A Review
(2006) · International Journal of Transgenderism · doi:10.1300/j485v09n01_04 · Cited by 40 · see citing works
Palma, P., Romiti, M. L., Montesano, C., Santilli, V., Mora, N., Aquilani, A., Dispinseri, S., Tchidjou, H. K., Montano, M. A. E., Eriksson, L. E., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0079957 · Cited by 34 · see citing works
The Endocrinologist’s Office—Puberty Suppression: Saving Children from a Natural Disaster?
Sadjadi, S. (2013) · Journal of Medical Humanities · doi:10.1007/s10912-013-9228-6 · Cited by 28 · see citing works
Atypical gender development: a review. Gires, King's Fund, april 2004
Besser, M., Carr, S. A., Cohen‐Kettenis, P. T., Connolly, P., Sutter, P. D., Diamond, M. J., Ceglie, D. D., Higashi, Y., Kruijver, F. P. M., Martin, J. D., et al. (2006) · Data Archiving and Networked Services (DANS) · Cited by 23 · see citing works
Self-citationHormone Treatment of Children and Adolescents with Gender Dysphoria: An Ethical Analysis
Abel, B. S. (2014) · The Hastings Center Report · doi:10.1002/hast.366 · Cited by 21 · see citing works
Geschlechtsdysphorie im Jugendalter. Schwierige Behandlungsverläufe
Meyenburg, B. (2014) · Praxis der Kinderpsychologie und Kinderpsychiatrie · doi:10.13109/prkk.2014.63.6.510 · Cited by 14 · see citing works
Where Christ Did Not Go: Men, Women and Frusculicchi
Giordano, S. (2011) · Bioethics News · doi:10.1007/bf03351327 · Cited by 7 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- McHugh P. Surgical sex. First Things 2004;147:34e8.
- Korte A, Goecker D, Krude H, et al. Gender identity disorders in childhood and adolescence: Currently debates concepts and treatment strategies. Dtsch Artztebl Int 2008;105:834e41.
- Meyenburg B. Gender dysphoria in adolescents: Difficulties in treatment. Prax Kinderpsychol Kinderpsychiatr 2014;63:510e22.
Cited by
Sorted by citations
Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth
Gridley, S. J., Crouch, J. M., Evans, Y. N., Eng, W., Antoon, E., Lyapustina, M. E., Schimmel‐Bristow, A., Woodward, J. A., Dundon, K. M. W., Schaff, R., et al. (2016) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2016.03.017 · Cited by 346 · see citing works
Gender dysphoria in adolescence: current perspectives
Kaltiala‐Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018) · Adolescent Health Medicine and Therapeutics · doi:10.2147/ahmt.s135432 · Cited by 238 · see citing works
Characteristics of Referrals for Gender Dysphoria Over a 13-Year Period
Chen, M. E., Fuqua, J. S., & Eugster, E. A. (2016) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2015.11.010 · Cited by 209 · see citing works
Strauss, P., Cook, A. G., Winter, S., Watson, V., Toussaint, D. W., & Lin, A. P. (2019) · Psychological Medicine · doi:10.1017/s0033291719000643 · Cited by 184 · see citing works
A critical commentary on ‘rapid-onset gender dysphoria’
Ashley, F. (2020) · The Sociological Review · doi:10.1177/0038026120934693 · Cited by 170 · see citing works
Gender Fluidity and Nonbinary Gender Identities Among Children and Adolescents
Diamond, L. M. (2020) · Child Development Perspectives · doi:10.1111/cdep.12366 · Cited by 168 · see citing works
Rew, L., Young, C. C., Monge, M., & Bogucka, R. (2021) · Child and Adolescent Mental Health · doi:10.1111/camh.12437 · Cited by 139 · see citing works
Puberty suppression in transgender children and adolescents
Mahfouda, S., Moore, J. K., Siafarikas, A., Zepf, F. D., & Lin, A. P. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30099-2 · Cited by 113 · see citing works
Brik, T., Vrouenraets, L. J. J. J., de Vries, M. C., & Hannema, S. E. (2020) · Archives of Sexual Behavior · doi:10.1007/s10508-020-01660-8 · Cited by 112 · see citing works
Self-citationAshley, F. (2019) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104519836462 · Cited by 100 · see citing works
van der Loos, M. A. T. C., Klink, D. T., Hannema, S. E., Bruinsma, S., Steensma, T. D., Kreukels, B. P. C., Cohen‐Kettenis, P. T., de Vries, A. L. C., den Heijer, M., & Wiepjes, C. M. (2023) · The Journal of Sexual Medicine · doi:10.1093/jsxmed/qdac029 · Cited by 80 · see citing works
Self-citationAssessing Medical Decision-Making Competence in Transgender Youth
Vrouenraets, L. J. J. J., de Vries, A. L. C., de Vries, M. C., van der Miesen, A. I. R., & Hein, I. M. (2021) · PEDIATRICS · doi:10.1542/peds.2020-049643 · Cited by 77 · see citing works
Self-citationPerceptions of Sex, Gender, and Puberty Suppression: A Qualitative Analysis of Transgender Youth
Vrouenraets, L. J. J. J., Fredriks, A. M., Hannema, S. E., Cohen‐Kettenis, P. T., & de Vries, M. C. (2016) · Archives of Sexual Behavior · doi:10.1007/s10508-016-0764-9 · Cited by 72 · see citing works
Self-citationWren, B. (2019) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104518822694 · Cited by 73 · see citing works
Is puberty delaying treatment ‘experimental treatment’?
Giordano, S., & Holm, S. (2020) · International Journal of Transgender Health · doi:10.1080/26895269.2020.1747768 · Cited by 61 · see citing works
Moral Challenges in Transgender Care: A Thematic Analysis Based on a Focused Ethnography
Gerritse, K., Hartman, L. A., Antonides, M. F., Wensing-Kruger, A., de Vries, A. L. C., & Molewijk, B. C. (2018) · Archives of Sexual Behavior · doi:10.1007/s10508-018-1287-3 · Cited by 57 · see citing works
Management of gender dysphoria in adolescents in primary care
Bonifacio, H. J., Maser, C., Stadelman, K., & Palmert, M. R. (2019) · Canadian Medical Association Journal · doi:10.1503/cmaj.180672 · Cited by 55 · see citing works
Psychosocial assessment in transgender adolescents
de Lara, D. L., Rodríguez, O., Cuéllar‐Flores, I., Masa, J. L. P., Campos‐Muñoz, L., Hernández, M. C., & Amador, J. T. R. (2020) · Anales de Pediatría (English Edition) · doi:10.1016/j.anpede.2020.01.004 · Cited by 53 · see citing works
Milrod, C., & Karasic, D. H. (2017) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2017.02.007 · Cited by 52 · see citing works
Clarke, A. C., & Spiliadis, A. (2019) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104518825288 · Cited by 48 · see citing works
Chen, D., Strang, J. F., Kolbuck, V. D., Rosenthal, S. M., Wallen, K., Waber, D. P., Steinberg, L. D., Sisk, C. L., ROSS, J. L., Paus, T., et al. (2020) · Transgender Health · doi:10.1089/trgh.2020.0006 · Cited by 47 · see citing works
Chen, D., Edwards-Leeper, L. A., Stancin, T., & Tishelman, A. C. (2018) · Clinical Practice in Pediatric Psychology · doi:10.1037/cpp0000229 · Cited by 43 · see citing works
Gender Dysphoria and Gender Incongruence: An evolving inter-disciplinary field
Bouman, W. P., de Vries, A. L., & T’Sjoen, G. (2016) · International Review of Psychiatry · doi:10.3109/09540261.2016.1125740 · Cited by 41 · see citing works
Clark, D. B. A., Virani, A., & Saewyc, E. (2019) · Ethics & Behavior · doi:10.1080/10508422.2019.1652097 · Cited by 37 · see citing works
Two dilemmas for medical ethics in the treatment of gender dysphoria in youth
Baron, T., & Dierckxsens, G. (2021) · Journal of Medical Ethics · doi:10.1136/medethics-2021-107260 · Cited by 36 · see citing works
Reflections on emerging trends in clinical work with gender diverse children and adolescents
de Graaf, N. M., & Carmichael, P. (2018) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104518812924 · Cited by 34 · see citing works
Giovanardi, G., Morales, P., Mirabella, M., Fortunato, A., Chianura, L., Speranza, A. M., & Lingiardi, V. (2019) · Journal of Endocrinological Investigation · doi:10.1007/s40618-019-01045-2 · Cited by 33 · see citing works
Karrington, B. (2021) · Transgender Health · doi:10.1089/trgh.2020.0129 · Cited by 30 · see citing works
Evaluación psicosocial en adolescentes transgénero
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Vrouenraets, L. J. J. J., Hartman, L. A., Hein, I. M., de Vries, A. L. C., de Vries, M. C., & Molewijk, A. C. (2020) · Archives of Sexual Behavior · doi:10.1007/s10508-020-01762-3 · Cited by 29 · see citing works
Self-citationVrouenraets, L. J. J. J., de Vries, A. L. C., Arnoldussen, M., Hannema, S. E., Lindauer, R., de Vries, M. C., & Hein, I. M. (2022) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-022-02076-6 · Cited by 27 · see citing works
Self-citationEthical Concerns About Emerging Treatment Paradigms for Gender Dysphoria
Levine, S. B. (2017) · Journal of Sex & Marital Therapy · doi:10.1080/0092623x.2017.1309482 · Cited by 27 · see citing works
Martinerie, L., Condat, A., Bargiacchi, A., Bremont-Weill, C., de Vries, M. C., & Hannema, S. E. (2018) · European Journal of Endocrinology · doi:10.1530/eje-18-0227 · Cited by 26 · see citing works
Self-citationGiovanardi, G. (2017) · Porto Biomedical Journal · doi:10.1016/j.pbj.2017.06.001 · Cited by 26 · see citing works
Approach to the Patient: Pharmacological Management of Trans and Gender-Diverse Adolescents
O’Connell, M. A., Nguyen, T. P., Ahler, A., Skinner, S. R., & Pang, K. C. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab634 · Cited by 24 · see citing works
Gerritse, K., Martens, C., Bremmer, M. A., Kreukels, B. P. C., de Boer, F., & Molewijk, B. C. (2022) · BMC Medical Ethics · doi:10.1186/s12910-022-00880-y · Cited by 27 · see citing works
Vrouenraets, L. J. J. J., de Vries, M. C., Hein, I. M., Arnoldussen, M., Hannema, S. E., & de Vries, A. L. C. (2021) · International Journal of Transgender Health · doi:10.1080/26895269.2021.1974324 · Cited by 23 · see citing works
Self-citationRadobuljac, M. D., Grošelj, U., Kaltiala‐Heino, R., Division, T. E. P., Radobuljac, M. D., Vermeiren, R. R. J. M., Anagnostopoulos, D. C., Çetin, F. Ç., Crommen, S., D, S. E. M., et al. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02440-8 · Cited by 22 · see citing works
Deficiencies in Scientific Evidence for Medical Management of Gender Dysphoria
Hruz, P. W. (2019) · The Linacre Quarterly · doi:10.1177/0024363919873762 · Cited by 21 · see citing works
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Evans, M. (2020) · BJPsych Bulletin · doi:10.1192/bjb.2020.72 · Cited by 21 · see citing works
Condat, A., & Cohen, D. (2022) · Neuropsychiatrie de l Enfance et de l Adolescence · doi:10.1016/j.neurenf.2022.10.003 · Cited by 18 · see citing works
Geschlechtsidentitäten im Wandel
Strittmatter, E., & Holtmann, M. H. (2020) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000724 · Cited by 18 · see citing works
de Snoo‐Trimp, J., de Vries, A. L. C., Molewijk, B. C., & Hein, I. M. (2022) · BMC Medical Ethics · doi:10.1186/s12910-022-00837-1 · Cited by 18 · see citing works
Ethical Issues Considered When Establishing a Pediatrics Gender Surgery Center
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Critiques of the Cass Review: Fact-Checking the Peer-Reviewed and Grey Literature
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Jorgensen, S. C. J., Athéa, N., & Masson, C. (2024) · Archives of Sexual Behavior · doi:10.1007/s10508-024-02850-4 · Cited by 13 · see citing works
Naezer, M., Oerlemans, A. J. M., Hablous, G., der Grinten, H. L. C., van der Vleuten, A., & Verhaak, C. M. (2021) · Journal of Gender Studies · doi:10.1080/09589236.2021.1881462 · Cited by 13 · see citing works
Lambert, A., Pratt, A., Conard, L. A. E., Dean, E. G., Page, E. M., Vaughn, L. M., & Lipstein, E. A. (2022) · Transgender Health · doi:10.1089/trgh.2021.0030 · Cited by 12 · see citing works
Horton, C. (2022) · The Journal of Early Adolescence · doi:10.1177/02724316221107076 · Cited by 12 · see citing works
Lee, D. W. G., Butler, G. E., Carmichael, P., Rashid, T. G., Yasmin, E., Morley, R., Barrett, J. R., Christopher, N. A., & Sangster, P. (2022) · European Urology Focus · doi:10.1016/j.euf.2022.11.002 · Cited by 12 · see citing works
Cohn, J. (2022) · Journal of Sex & Marital Therapy · doi:10.1080/0092623x.2022.2160396 · Cited by 12 · see citing works
Informed consent and childhood gender dysphoria: emerging complexities in diagnosis and treatment
d’Abrera, J. C., D’Angelo, R., Halasz, G., Prager, S., & Morris, P. (2020) · Australasian Psychiatry · doi:10.1177/1039856220928863 · Cited by 9 · see citing works
Reflections on the Clinician’s Role with Individuals Who Self-identify as Transgender
Levine, S. B. (2021) · Archives of Sexual Behavior · doi:10.1007/s10508-021-02142-1 · Cited by 9 · see citing works
« Rapid-Onset Gender Dysphoria »
Ashley, F. (2022) · GLAD! · doi:10.4000/glad.5756 · Cited by 9 · see citing works
Pediatric Gender Affirming Care is Not Evidence-based
McDeavitt, K., Cohn, J., & Kulatunga-Moruzi, C. (2025) · Current Sexual Health Reports · doi:10.1007/s11930-025-00404-w · Cited by 8 · see citing works
Phenomenological Interview and Gender Dysphoria: A Third Pathway for Diagnosis and Treatment
Dierckxsens, G., & Baron, T. (2023) · The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine · doi:10.1093/jmp/jhad039 · Cited by 8 · see citing works
Geschlechtsinkongruenz und Genderdysphorie bei Kindern und Jugendlichen
Pauli, D. (2017) · PSYCH up2date · doi:10.1055/s-0043-115159 · Cited by 8 · see citing works
Gerritse, K., Martens, C., Bremmer, M. A., Kreukels, B. P. C., de Boer, F., & Molewijk, B. C. (2023) · Journal of Homosexuality · doi:10.1080/00918369.2023.2201972 · Cited by 8 · see citing works
Giordano, S. (2023) · doi:10.1093/oso/9780192895400.001.0001 · Cited by 8 · see citing works
ETHICS IN CHILD AND YOUTH CARE PRACTICE WITH TRANSGENDER YOUTH
Clark, B. A. (2017) · International Journal of Child Youth and Family Studies · doi:10.18357/ijcyfs82201716754 · Cited by 7 · see citing works
Transgender Youth Experiences with Implantable GnRH Agonists for Puberty Suppression
Hobson, B. J., Lett, E., Hawkins, L. A., Swendiman, R. A., Nance, M. L., & Dowshen, N. (2021) · Transgender Health · doi:10.1089/trgh.2021.0006 · Cited by 6 · see citing works
Oliveira, G. D. F., Nguyen, A. T., Carreras-Simons, L., Niepsuj, T., Gadelhak, S. H., Johnson, A. K., Abdalla, A., Lev, E., Torres Román, S. G., Fuchs, S. N., et al. (2024) · Endocrinology · doi:10.1210/endocr/bqae046 · Cited by 5 · see citing works
Bernier, A., & Leplège, A. (2018) · médecine/sciences · doi:10.1051/medsci/20183406021 · Cited by 5 · see citing works
“Crianças” e “Adolescentes” trans. A construção de categorias entre profissionais de saúde
de Pontes, J. C., da Silva, C. G., & Nakamura, E. (2020) · Sexualidad Salud y Sociedad (Rio de Janeiro) · doi:10.1590/1984-6487.sess.2020.35.06.a · Cited by 4 · see citing works
Regnerus, M., & Vermurlen, B. (2022) · Archives of Sexual Behavior · doi:10.1007/s10508-021-02214-2 · Cited by 4 · see citing works
Uncertainty in complex healthcare settings – The need for a comprehensive approach
Oerlemans, A. J. M., Stommel, W., Verhaak, C. M., de Vries, A. L. C., Cuijpers, F., Breukelman, M., & Hillen, M. A. (2023) · Patient Education and Counseling · doi:10.1016/j.pec.2023.107721 · Cited by 4 · see citing works
Cruzat, P. C., & Carrasco, M. A. (2020) · Persona y Bioética · doi:10.5294/pebi.2020.24.1.5 · Cited by 4 · see citing works
Cass, H. (2024) · The British Journal of Psychiatry · doi:10.1192/bjp.2024.162 · Cited by 4 · see citing works
Ethical Implications of Treatment for Gender Dysphoria in Youth
Hayes, K. (2018) · Journal of Health Ethics · doi:10.18785/ojhe.1402.03 · Cited by 3 · see citing works
Notini, L., Pang, K. C., Telfer, M. M., & McDougall, R. J. (2020) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2020.09.028 · Cited by 3 · see citing works
Furlong, Y. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.97517 · Cited by 3 · see citing works
Treating Transgender Youth: Pushing the Dialogue Forward
Vance, S. R., & Rosenthal, S. M. (2015) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2015.07.009 · Cited by 3 · see citing works
Evans, M. (2021) · BJPsych Bulletin · doi:10.1192/bjb.2020.124 · Cited by 3 · see citing works
Kinney, M. K. (2021) · IUScholarWorks (Indiana University) · doi:10.13140/rg.2.2.25728.15367 · Cited by 3 · see citing works
The Dutch approach for transgender adolescents; past, present and future perspectives
de Vries, A. M. , Steensma, T. D., Kreukels, B. P. C., van de Grift, T. C., van Mello, N. M., & Hannema, S. E. (2026) · European Journal of Developmental Psychology · doi:10.1080/17405629.2026.2615311 · Cited by 2 · see citing works
Self-citationBelfort, E. L., & Brown, B. (2023) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2023.05.006 · Cited by 2 · see citing works
Risks and Benefits of Puberty Suppression
Giordano, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780192895400.003.0008 · Cited by 2 · see citing works
Censorship of Essential Debate in Gender Medicine Research
Cohn, J. (2025) · Journal of Controversial Ideas · doi:10.63466/jci05020003 · Cited by 2 · see citing works
Gender-affirming care for transgender and gender diverse adolescents
Loopuijt, C., Uilhoorn, A., & Verhaak, C. M. (2025) · Routledge eBooks · doi:10.4324/9781003479055-14 · Cited by 1 · see citing works
Psychosocial Considerations in Pubertal Suppression Treatment
Chen, D., Birnkrant, J. M., & Hidalgo, M. A. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-56963-7.00006-5 · Cited by 1 · see citing works
The “New” Trans Child: Pioneering Families and Documentary Television
Vooris, J. A. (2021) · Palgrave Macmillan UK eBooks · doi:10.1057/978-1-137-56550-1_7 · Cited by 1 · see citing works
Šnajderová, M., Zapletalová, J., Magnová, O., Fifková, H., Weiss, P., & Neumann, D. (2022) · Česko-slovenská pediatrie · doi:10.55095/cspediatrie2022/056 · Cited by 1 · see citing works
Agonistas de la hormona liberadora de gonadotropinas (GnRH)
Bettahar, K., & Pinton, A. (2019) · EMC - Ginecología-Obstetricia · doi:10.1016/s1283-081x(19)42001-8 · Cited by 1 · see citing works
Baron, T., & Dierckxsens, G. (2021) · Journal of Medical Ethics · doi:10.1136/medethics-2021-107856 · Cited by 1 · see citing works
Moore, A. M. (2018) · Cited by 1 · see citing works
[Flat penile lesions in the sexual transmission of human papillomavirus].
Bleeker, M. C. G., Snijders, P. J. F., Voorhorst, F. J., & Meijer, C. J. L. M. (2008) · PubMed · Cited by 1 · see citing works
Three decades of ‘Dutch Protocol’ research has not produced reliable evidence
McDeavitt, K., & Cohn, J. (2026) · European Journal of Developmental Psychology · doi:10.1080/17405629.2026.2680285 · Cited by 1 · see citing works
The Transgender Person in the 21st Century: Time for Clinicians of the World to Help!
Greydanus, D. E., & Codde, J. (2018) · Birat Journal of Health Sciences · doi:10.3126/bjhs.v3i2.20931
العوامل الخمسة الکبرى للشخصية وعلاقتها بالتشويهات المعرفية لدى عينة من مضطربي الهوية الجنسية
حکيم, ط. ب. (2020) · مجلة الخدمة النفسية · doi:10.21608/jps.2020.98776
Patel, E. (2019) · UCL Discovery (University College London)
Pfäfflin, F. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_77
Pfäfflin, F. (2015) · Springer eBooks · doi:10.1007/978-3-642-45028-0_77-1
Graham, K. M. (2017) · Springer eBooks · doi:10.1007/978-3-319-56782-2_9193-1
Graham, K. M. (2018) · Springer eBooks · doi:10.1007/978-3-319-57111-9_9193
Wren, B. (2019) · Clinical Psychology Forum · doi:10.53841/bpscpf.2019.1.324.1
Cohn, J. (2023) · Journal of Controversial Ideas · doi:10.35995/jci03010010
Shared Decision-Making in Transgender Healthcare
Gerritse, K. (2023) · doi:10.5463/thesis.211
Ethical Issues in the Provision of Cross-Sex Hormones
Giordano, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780192895400.003.0013
The Early Stages of Clinical Management
Giordano, S. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780192895400.003.0006
- Authors
- Vrouenraets, L. J. J. J., Fredriks, A. M., Hannema, S. E., Cohen-Kettenis, P. T., & de Vries, M. C.
- Affiliations
- Leiden University (NL)
- Leiden University Medical Center (NL)
- Corresponding author
- Vrouenraets, Lieke Josephina Jeanne Johanna
- Venue
- Journal of Adolescent Health
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 57
- Issue
- 4
- Pages
- 367-373
- ISSN
- 1054-139X (ISSN-L)
- OpenAlex
- W1565459500
- Cited by
- 127
- References
- 42
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 6 · 2023: 28 · 2022: 13 · 2021: 13 · 2020: 16 · 2019: 12 · 2018: 12 · 2017: 8 · 2016: 4 · 2015: 2
- FWCI
- 14.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Adolescent Health (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Funders
- European Society for Paediatric Endocrinology
- Universiteit Leiden
- ZonMw (731010002)
- Leids Universitair Medisch Centrum
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- gender dysphoria, puberty suppression, GnRH agonist, early medical intervention, transgender youth, ethical considerations, treatment guidelines, child competence, gender identity development, comorbidities
- MeSH terms
- Child Health, Adolescent Health, Gender Dysphoria, Adolescent, Child, Female, Gender Identity, Humans, Gonadotropin-Releasing Hormone, Male, Puberty, Gonadal Steroid Hormones, Sexual Maturation, Practice Guidelines as Topic, Qualitative Research
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