JMIR Publications

ABSTRACT

Background:

Prepubertal transgender, non-binary and gender-diverse (TNGD) children (i.e., those asserting gender identity and/or expressing gender-role behavior outside of culturally-defined norms for their sex registered at birth) are presenting in greater numbers to pediatric gender clinics across the United States (US) and abroad. A large subset of TGND children experience gender dysphoria (GD), i.e., distress that arises from the incongruence between gender identity and sex registered at birth. A lack of consensus exists regarding care for prepubertal TNGD children due, in part, to a dearth of empirical research on longitudinal developmental trajectories of gender identity, role behavior, and gender dysphoria (when present).

Objective:

The objective of this NIH-funded study is to provide evidence to inform clinical care for prepubertal TNGD children by establishing a US, longitudinal cohort (N=245) of prepubertal TNGD children and their caregivers followed prospectively at 6-month intervals across 18 months.

Methods:

At each timepoint, clinical and behavioral data are collected virtually from child and caregiver reporters. Latent Class Analysis (LCA), among other methods, are used to identify subgroups and longitudinally characterize the gender identity and gender-role behavior of TNGD children. These models will define longitudinal patterns of gender-identity stability and characterize the relationship between TNGD classes and mental and behavioral health outcomes, including the moderating role of social gender transition (when present) on these associations.

Results:

Baseline data collection (N=245) is complete and the identification of TNGD subgroups based on gender identity and expression using LCA is anticipated in 2024. The completion of all 4 waves of data collection is anticipated in May 2024, coinciding with the start of a no-cost study extension period. We anticipate longitudinal analyses to be completed and forthcoming by fall 2024.

Conclusions:

Through a longitudinal observational design, this research involving prepubertal TNGD children and caregivers aims to provide empirical knowledge on gender development in TNGD, their mental health symptomology and functioning over time, and how family-initiated social gender transition may predict or alleviate mental health symptoms and/or diagnoses. The research findings have promise to provide guidance for clinicians and families aiming to ensure the best developmental outcome for these children as they develop into adolescents. Clinical Trial: This research is neither interventional nor a randomized-controlled trial.