Characteristics of children and adolescents referred to specialist gender services: a systematic review

TY - JOUR

T1 - Characteristics of children and adolescents referred to specialist gender services

T2 - a systematic review

AU - Taylor, Jo

AU - Hall, Ruth

AU - Langton, Trilby

AU - Fraser, Lorna

AU - Hewitt, Catherine Elizabeth

N1 - © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2024/4/9

Y1 - 2024/4/9

N2 - BACKGROUND: Increasing numbers of children/adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services. Services and practice guidelines are responding to these changes.AIM: This systematic review examines the numbers and characteristics of children/adolescents (under 18) referred to specialist gender or endocrinology services.METHODS: Database searches were performed (April 2022), with results assessed independently by two reviewers. Peer-reviewed articles providing at least birth-registered sex or age at referral were included. Demographic, gender-related, mental health, neurodevelopmental conditions and adverse childhood experience data were extracted. A narrative approach to synthesis was used and where appropriate proportions were combined in a meta-analysis.RESULTS: 143 studies from 131 articles across 17 countries were included. There was a twofold to threefold increase in the number of referrals and a steady increase in birth-registered females being referred. There is inconsistent collection and reporting of key data across many of the studies. Approximately 60% of children/adolescents referred to services had made steps to present themselves in their preferred gender. Just under 50% of studies reported data on depression and/or anxiety and under 20% reported data on other mental health issues and neurodevelopmental conditions. Changes in the characteristics of referrals over time were generally not reported.CONCLUSIONS: Services need to capture, assess and respond to the potentially co-occurring complexities of children/adolescents being referred to specialist gender and endocrine services. Agreement on the core characteristics for collection at referral/assessment would help to ensure services are capturing data as well as developing pathways to meet the needs of these children.PROSPERO registration number CRD42021289659.

AB - BACKGROUND: Increasing numbers of children/adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services. Services and practice guidelines are responding to these changes.AIM: This systematic review examines the numbers and characteristics of children/adolescents (under 18) referred to specialist gender or endocrinology services.METHODS: Database searches were performed (April 2022), with results assessed independently by two reviewers. Peer-reviewed articles providing at least birth-registered sex or age at referral were included. Demographic, gender-related, mental health, neurodevelopmental conditions and adverse childhood experience data were extracted. A narrative approach to synthesis was used and where appropriate proportions were combined in a meta-analysis.RESULTS: 143 studies from 131 articles across 17 countries were included. There was a twofold to threefold increase in the number of referrals and a steady increase in birth-registered females being referred. There is inconsistent collection and reporting of key data across many of the studies. Approximately 60% of children/adolescents referred to services had made steps to present themselves in their preferred gender. Just under 50% of studies reported data on depression and/or anxiety and under 20% reported data on other mental health issues and neurodevelopmental conditions. Changes in the characteristics of referrals over time were generally not reported.CONCLUSIONS: Services need to capture, assess and respond to the potentially co-occurring complexities of children/adolescents being referred to specialist gender and endocrine services. Agreement on the core characteristics for collection at referral/assessment would help to ensure services are capturing data as well as developing pathways to meet the needs of these children.PROSPERO registration number CRD42021289659.

U2 - 10.1136/archdischild-2023-326681

DO - 10.1136/archdischild-2023-326681

M3 - Article

C2 - 38594046

SN - 0003-9888

JO - Archives of Disease in Childhood

JF - Archives of Disease in Childhood

ER -