Research Review: Gender identity in youth: treatment paradigms and controversies

Journal of Child Psychology and Psychiatry and Allied Disciplines

Volumn 59, Issue 12, 2018, Pages 1228-1243

  Turban, Jack L ^a   Ehrensaft, Diane ^b  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

anxiety; depression; Gender dysphoria; gender identity; suicidal behavior

Indexed keywords

ADOLESCENT; CHILD; FEMALE; GENDER DYSPHORIA; GENDER IDENTITY; HUMAN; MALE; PSYCHOLOGY; TRANSGENDER;

ADOLESCENT; CHILD; FEMALE; GENDER DYSPHORIA; GENDER IDENTITY; HUMANS; MALE; TRANSGENDER PERSONS;

EID: 85032287274     PISSN: 00219630     EISSN: 14697610     Source Type: Journal    
DOI: 10.1111/jcpp.12833     Document Type: Review

References (129)

1. Achenbach, T.M. (2001). Manual for the ASEBA school-age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.
2. Aitken, M., Steensma, T.D., Blanchard, R., VanderLaan, D.P., Wood, H., Fuentes, A., … & Leef, J.H. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. The Journal of Sexual Medicine, 12, 756–763.
3. Aitken, M., VanderLaan, D.P., Wasserman, L., Stojanovski, S., & Zucker, K.J. (2016). Self-harm and suicidality in children referred for gender dysphoria. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 513–520.
4. Allan, R., & Ungar, M. (2014). Resilience-building interventions with children, adolescents, and their families. In S. Prince-Embury & D. Saklofske (Eds.), Resilience interventions for youth in diverse populations. The Springer Series on Human Exceptionality (pp. 447–462). New York: Springer.
5. American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders: DSM-III. Washington, DC.
6. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5.
7. American Psychitric Association (1994). Diagnostic and statistical manual of mental disorders: DSM-IV.
8. Asscheman, H., T'Sjoen, G., Lemaire, A., Mas, M., Meriggiola, M.C., Mueller, A., … & Gooren, L.J. (2014). Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: A review. Andrologia, 46, 791–795.
9. Association, A.P. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. The American Psychologist, 70, 832.
10. Berglund, H., Lindström, P., Dhejne-Helmy, C., & Savic, I. (2008). Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids. Cerebral Cortex, 18, 1900–1908.
11. Berli, J.U., Knudson, G., Fraser, L., Tangpricha, V., Ettner, R., Ettner, F.M., … & Schechter, L. (2017). What surgeons need to know about gender confirmation surgery when providing care for transgender individuals: A review. JAMA Surgery, 152, 394–400.
12. Bockting, W.O., Miner, M.H., Swinburne Romine, R.E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943–951.
13. Burke, S.M., Cohen-Kettenis, P.T., Veltman, D.J., Klink, D.T., & Bakker, J. (2014). Hypothalamic response to the chemo-signal androstadienone in gender dysphoric children and adolescents. Front Endocrinol (Lausanne), 5, 60.
14. Byne, W. (2016). Regulations restrict practice of conversion therapy. LGBT Health, 3, 97–99.
15. Byne, W., Bradley, S.J., Coleman, E., Eyler, A.E., Green, R., Menvielle, E.J., … & Tompkins, D.A. (2012). Report of the American psychiatric association task force on treatment of gender identity disorder. Archives of Sexual Behavior, 41, 759–796.
16. Chen, M., Fuqua, J., & Eugster, E.A. (2016). Characteristics of referrals for gender dysphoria over a 13-year period. Journal of Adolescent Health, 58, 369–371.
17. Clark, T.C., Lucassen, M.F., Bullen, P., Denny, S.J., Fleming, T.M., Robinson, E.M., & Rossen, F.V. (2014). The health and well-being of transgender high school students: Results from the New Zealand adolescent health survey (Youth'12). Journal of Adolescent Health, 55, 93–99.
18. Cohen-Kettenis, P.T., & Pfäfflin, F. (2003). Transgenderism and intersexuality in childhood and adolescence: Making choices, Vol. 46. London, UK: Sage.
19. Cohen-Kettenis, P.T., Owen, A., Kaijser, V.G., Bradley, S.J., & Zucker, K.J. (2003). Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis. Journal of Abnormal Child Psychology, 31, 41–53.
20. Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., & Zucker, K. (2011). Standards of care for the health of transsexual, transgender and gender non-conforming people, version 7. International Journal of Transgenderism, 13, 165–232.
21. Coolidge, F.L., Thede, L.L., & Young, S.E. (2002). The heritability of gender identity disorder in a child and adolescent twin sample. Behavior Genetics, 32, 251–257.
22. Corley, K.P., Valk, T.W., Kelch, R.P., & Marshall, J.C. (1981). Estimation of GnRH pulse amplitude during pubertal development. Pediatric Research, 15, 157–162.
23. de Vries, A.L., & Cohen-Kettenis, P.T. (2012). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality, 59, 301–320.
24. de Vries, A.L., Noens, I.L., Cohen-Kettenis, P.T., van Berckelaer-Onnes, I.A., & Doreleijers, T.A. (2010). Autism spectrum disorders in gender dysphoric children and adolescents. Journal of Autism and Developmental Disorders, 40, 930–936.
25. de Vries, A.L., Doreleijers, T.A., Steensma, T.D., & Cohen-Kettenis, P.T. (2011). Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry, 52, 1195–1202.
26. de Vries, A.L., Kreukels, B.P., Steensma, T.D., Doreleijers, T.A., & Cohen-Kettenis, P.T. (2011). Comparing adult and adolescent transsexuals: An MMPI-2 and MMPI-A study. Psychiatry Research, 186, 414–418.
27. de Vries, A.L., McGuire, J.K., Steensma, T.D., Wagenaar, E.C., Doreleijers, T.A., & Cohen-Kettenis, P.T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134, 696–704.
28. de Vries, A.L., Steensma, T.D., Cohen-Kettenis, P.T., VanderLaan, D.P., & Zucker, K.J. (2016). Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: A cross-national, cross-clinic comparative analysis. European Child and Adolescent Psychiatry, 25, 579–588.
29. Demeestere, I., Simon, P., Dedeken, L., Moffa, F., Tsépélidis, S., Brachet, C., … & Ferster, A. (2015). Live birth after autograft of ovarian tissue cryopreserved during childhood. Human reproduction. dev128.
30. Dessens, A.B., Slijper, F.M., & Drop, S.L. (2005). Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Archives of Sexual Behavior, 34, 389–397.
31. Diamond, M. (2004). Sex, gender, and identity over the years: A changing perspective. Child and Adolescent Psychiatric Clinics of North America, 13, 591–607.
32. Drescher, J., Cohen-Kettenis, P.T., & Reed, G.M. (2016). Gender incongruence of childhood in the ICD-11: Controversies, proposal, and rationale. Lancet Psychiatry, 3, 297–304.
33. Drummond, K.D., Bradley, S.J., Peterson-Badali, M., & Zucker, K.J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34–45.
34. Durwood, L., McLaughlin, K.A., & Olson, K.R. (2017). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child and Adolescent Psychiatry, 56, 116–123. e2.
35. Ehrensaft, D. (2011). Gender born, gender made. New York: The Experiment.
36. Ehrensaft, D. (2012). From gender identity disorder to gender identity creativity: True gender self child therapy. Journal of Homosexuality, 59, 337–356.
37. Ehrensaft, D. (2016). The gender creative child: Pathways for nurturing and supporting children who live outside gender boxes. New York: The Experiment.
38. Ehrensaft, D., & Hsaio, K. (2016). Fertility issues for youth: Puberty blockers hormones Decision-making through the lens of family building options. In World professional association for transgender health symposia. Amsterdam.
39. Erich, S., Tittsworth, J., Dykes, J., & Cabuses, C. (2008). Family relationships and their correlations with transsexual well–being. Journal of GLBT Family Studies, 4, 419–432.
40. Fast, I. (1999). Aspects of core gender identity. Psychoanalytic Dialogues, 9, 633–661.
41. Finlayson, C., Johnson, E.K., Chen, D., Dabrowski, E., Gosiengfiao, Y., Campo-Engelstein, L., … & Moravek, M.B. (2016). Proceedings of the working group session on fertility preservation for individuals with gender and sex diversity. Transgender Health, 1, 99–107.
42. Flores, A.R., Gates, G.J., & Brown, T.N. (2016). How many adults identify as transgender in the United States. Los Angeles: Williams Institute.
43. Freud, S. (1962). Three contributions to the theory of sex. New York: E.P. Dutton.
44. Fridell, S.R., Zucker, K.J., Bradley, S.J., & Maing, D.M. (1996). Physical attractiveness of girls with gender identity disorder. Archives of Sexual Behavior, 25, 17–31.
45. Grant, J.M., Mottet, L., Tanis, J., Harrison, J., Herman, J., & Keisling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force.
46. Green, R. (1987). The ‘sissy boy syndrome’ and the development of homosexuality. New Haven, CT: Yale University Press.
47. Greytak, E.A., Kosciw, J.G., & Diaz, E.M. (2009). Harsh realities: The experiences of transgender youth in our nation's schools. New York: Gay, Lesbian and Straight Education Network (GLSEN).
48. Grinberg, E. (2015) Why transgender teen Jazz Jennings is everywhere, in CNN Online.
49. Grossman, A.H., D'augelli, A.R., & Frank, J.A. (2011). Frank, Aspects of psychological resilience among transgender youth. Journal of LGBT Youth, 8, 103–115.
50. Guillamon, A., Junque, C., & Gomez-Gil, E. (2016). A review of the status of brain structure research in transsexualism. Archives of Sexual Behavior, 45, 1615–1648.
51. Haas, A.P., Rodgers, P.L., & Herman, J. (2014). Suicide attempts among transgender and gender non-conforming adults: Findings of the national transgender discrimination survey. Los Angeles: American Foundation for Suicide Prevention and the Williams Institute.
52. Hembree, W.C., Cohen-Kettenis, P., Delemarre-van de Waal, H.A., Gooren, l.J., Meyer, W.J., III, Spack, N.P., … & Montori, V.M. (2009). Endocrine treatment of transsexual persons: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 94, 3132–3154.
53. Hembree, W.C., Cohen-Kettenis, P.T., Gooren, L., Hannema, S.E., Meyer, W.J., Murad, M.H., … & T'Sjoen, G.G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102, 1–35.
54. Hidalgo, M.A., Ehrensaft, D., Tishelman, A.C., Clark, L.F., Garofalo, R., Rosenthal, S.M., … & Olson, J. (2013). The gender affirmative model: What we know and what we aim to learn. Human Development, 56, 285–290.
55. Hikabe, O., Hamazaki, N., Nagamatsu, G., Obata, Y., Hirao, Y., Hamada, N., … & Hayashi, K. (2016). Reconstitution in vitro of the entire cycle of the mouse female germ line. Nature, 539, 299–303.
56. Hines, M. (2006). Prenatal testosterone and gender-related behaviour. European Journal of Endocrinology, 155(Suppl 1), S115–S121.
57. Hines, M. (2009). Gonadal hormones and sexual differentiation of human brain and behavior. In D.W. Pfaff, A.P. Arnold, A.M. Etgen, S.E. Fahrbach & R.T. Rubin (Eds.), Hormones, brain and behavior (2nd edn, pp. 463–487). San Diego, CA: Academic Press.
58. Holt, V., Skagerberg, E., & Dunsford, M. (2016). Young people with features of gender dysphoria: demographics and associated difficulties. Clinical Child Psychology and Psychiatry, 21, 108–118.
59. Horváth, A.D. (2009). An Amazon Warrior, a chaste maiden or a social man? early ethnographic accounts of the Balkan man-woman. Aspasia, 3, 1–30.
60. Hsieh, S., & Leininger, J. (2014). Resource list: Clinical care programs for gender-nonconforming children and adolescents. Pediatric Annals, 43, 238–244.
61. Janssen, A., Huang, H., & Duncan, C. (2016). Gender variance among youth with autism spectrum disorders: a retrospective chart review. Transgender Health, 1, 63–68.
62. Jones, R.M., Wheelwright, S., Farrell, K., Martin, E., Green, R., Di Ceglie, D., & Baron-Cohen, S. (2012). Brief report: Female-to-male transsexual people and autistic traits. Journal of Autism and Developmental Disorders, 42, 301–306.
63. Khatchadourian, K., Amed, S., & Metzger, D.L. (2014). Clinical management of youth with gender dysphoria in Vancouver. The Journal of Pediatrics, 164, 906–911.
64. Klink, D., Caris, M., Heijboer, A., van Trotsenburg, M., & Rotteveel, J. (2015). Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. The Journal of Clinical Endocrinology and Metabolism, 100, E270–E275.
65. Kreukels, B.P., & Guillamon, A. (2016). Neuroimaging studies in people with gender incongruence. International Review of Psychiatry, 28, 120–128.
66. Kruijver, F.P., Zhou, J.N., Pool, C.W., Hofman, M.A., Gooren, L.J., & Swaab, D.F. (2000). Male-to-female transsexuals have female neuron numbers in a limbic nucleus. The Journal of Clinical Endocrinology and Metabolism, 85, 2034–2041.
67. Lai, M.C., Lombardo, M.V., & Baron-Cohen, S. (2014). Autism. Lancet, 383, 896–910.
68. Leland, J. (2009). A spirit of belonging, inside and out, in the New York Times. New York.
69. Levine, D.A. (2013). Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics, 132, e297–e313.
70. Mamoojee, Y., Seal, L.J., & Quinton, R. (2017). Transgender hormone therapy: Understanding international variation in practice. The Lancet Diabetes and Endocrinology, 5, 243–246.
71. Marantz, S., & Coates, S. (1991). Mothers of boys with gender identity disorder: A comparison of matched controls. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 310–315.
72. Mazur, T. (2005). Gender dysphoria and gender change in androgen insensitivity or micropenis. Archives of Sexual Behavior, 34, 411–421.
73. McGuire, J.K., Anderson, C.R., Toomey, R.B., & Russell, S.T. (2010). School climate for transgender youth: A mixed method investigation of student experiences and school responses. Journal of Youth and Adolescence, 39, 1175–1188.
74. Merke, D.P., & Bornstein, S.R. (2005). Congenital adrenal hyperplasia. Lancet, 365, 2125–2136.
75. Meyer-Bahlburg, H.F. (2002). Gender identity disorder in young boys: A parent-and peer-based treatment protocol. Clinical Child Psychology and Psychiatry, 7, 360–376.
76. Money, J. (1975). Ablatio penis: Normal male infant sex-reassigned as a girl. Archives of Sexual Behavior, 4, 65–71.
77. Money, J., & Ehrhardt, A.A. (1973). Man & woman, boy & girl: Gender identity from conception to maturity. Lanham, MD: Jason Aronson.
78. Nahata, L., Tishelman, A.C., Caltabellotta, N.M., & Quinn, G.P. (2017). Low fertility preservation utilization among transgender youth. Journal of Adolescent Health, 61, 40–44.
79. Nanda, S. (1986). The Hijras of India: Cultural and individual dimensions of an institutionalized third gender role. Journal of Homosexuality, 11, 35–54.
80. Nutt, A.E. (2015). Becoming Nicole: The transformation of an American family. New York: Random House.
81. Olson, K.R. (2016). Prepubescent transgender children: What we do and do not know. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 155–156. e3.
82. Olson, K.R., Key, A.C., & Eaton, N.R. (2015). Gender cognition in transgender children. Psychological Science, 26, 467–474.
83. Olson, J., Schrager, S.M., Belzer, M., Simons, L.K., & Clark, L.F. (2015). Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. Journal of Adolescent Health, 57, 374–380.
84. Olson, J., Durwood, L., DeMeules, M., & McLaughlin, K.A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137, 1–8.
85. Pasterski, V., Gilligan, L., & Curtis, R. (2014). Traits of autism spectrum disorders in adults with gender dysphoria. Archives of Sexual Behavior, 43, 387–393.
86. Rametti, G., Carrillo, B., Gómez-Gil, E., Junque, C., Zubiarre-Elorza, L., Segovia, S., … & Guillamon, A. (2011). The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment. A DTI study. Journal of Psychiatric Research, 45, 949–954.
87. Reardon, S. (2016). Largest ever study of transgender teenagers set to kick off. Nature, 531, 560.
88. Richter-Appelt, H., Discher, C., & Gedrose, B. (2005). Gender identity and recalled gender related childhood play-behaviour in adult individuals with different forms of intersexuality. Anthropologischer Anzeiger, 63, 241–256.
89. Rosenthal, S.M. (2015). Approach to the patient: Transgender youth: Endocrine considerations. In L. Wartofsky (Ed.), A clinical approach to endocrine and metabolic diseases (pp. 54–71). Washington, DC: The Endocrine Society.
90. Ryan, C., Huebner, D., Diaz, R.M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346–352.
91. Ryan, C., Russell, S.T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23, 205–213.
92. Schagen, S.E., Cohen-Kettenis, P.T., de Delemarre-van Waal, H.A., & Hannema, S.E. (2016). Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. The Journal of Sexual Medicine, 13, 1125–1132.
93. Shields, J.P., Cohen, R., Glassman, J.R., Whitaker, K., Franks, H., & Bertolini, I. (2013). Estimating population size and demographic characteristics of lesbian, gay, bisexual, and transgender youth in middle school. Journal of Adolescent Health, 52, 248–250.
94. Singh, D. (2012). A follow-up study of boys with gender dysphoria. Toronto, Canada: University of Toronto.
95. Skagerberg, E., Davidson, S., & Carmichael, P. (2013). Internalizing and externalizing behaviors in a group of young people with gender dysphoria. International Journal of Transgenderism, 14, 105–112.
96. Spack, N.P., Edwards-Leeper, L., Feldman, H.A., Leibowitz, S., Mandel, F., Diamond, D.A., & Vance, S.R. (2012). Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics, 129, 418–425.
97. Steensma, T.D., & Cohen-Kettenis, P.T. (2011). Gender transitioning before puberty? Archives of Sexual Behavior, 40, 649–650.
98. Steensma, T.D., McGuire, J.K., Kreukels, B.P., Beekman, A.J., & Cohen-Kettenis, P.T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 582–590.
99. Steensma, T.D., Van der Ende, J., Verhulst, F.C., & Cohen-Kettenis, P.T. (2013). Gender variance in childhood and sexual orientation in adulthood: A prospective study. The Journal of Sexual Medicine, 10, 2723–2733.
100. Steensma, T.D., Kreukels, B.P., de Vries, A.L., & Cohen-Kettenis, P.T. (2013). Gender identity development in adolescence. Hormones and Behavior, 64, 288–297.
101. Steensma, T.D., Zucker, K.J., Kreukels, B.P., VanderLaan, D.P., Wood, H., Fuentes, A., & Cohen-Kettenis, P.T. (2014). Behavioral and emotional problems on the Teacher's Report Form: A cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents. Journal of Abnormal Child Psychology, 42, 635–647.
102. Stolberg, S. (2017). Bathroom Case Puts Transgender Student on National Stage, in New York Times.
103. Strang, J.F., Kenworthy, L., Dominska, A., Sokoloff, J., Kenealy, L.E., Berl, M., … & Luong-Tran, C. (2014). Increased gender variance in autism spectrum disorders and attention deficit hyperactivity disorder. Archives of Sexual Behavior, 43, 1525–1533.
104. Strang, J.F., Meagher, H., Kenworthy, L., deVries, A.L., Menvielle, E., Leibowitz, S., … & Pleak, R.R. (2016). Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents. Journal of Clinical Child and Adolescent Psychology, 46, 1–11.
105. Swaab, D.F., & Garcia-Falgueras, A. (2009). Sexual differentiation of the human brain in relation to gender identity and sexual orientation. Functional Neurology, 24, 17–28.
106. Travers, R., Bauer, G., & Pyne, J. (2012). Impacts of strong parental support for trans youth: A report prepared for Children's Aid Society of Toronto and Delisle Youth Services. Trans Pulse.
107. T'Sjoen, G., De Cuypere, G., Monstrey, S., Hoebeke, P., Freedman, F.K., Appari, M., … & Cools, M. (2011). Male gender identity in complete androgen insensitivity syndrome. Archives of Sexual Behavior, 40, 635–638.
108. Turban, J. (2017a). Connecticut Bans Conversion Therapy for LGBT Youth, in Psychology Today.
109. Turban, J. (2017b). Book forum: becoming Nicole. Journal of the American Academy of Child and Adolescent Psychiatry, 56, 91–92.
110. Turban, J., & VanSchalkwyk, G. (2017c) “Gender dysphoria” and autism spectrum disorder: Is the link real?. Journal of the American Academy of Child & Adolescent Psychiatry. In press.
111. Turban, J.L. (2017d). Transgender youth: The building evidence base for early social transition. Journal of the American Academy of Child and Adolescent Psychiatry, 56, 101–102.
112. Turban, J., Zucker, K. & DeVries, A. (2017). Gender dysphoria and gender incongruence. In A. Martin, M. Bloch & F. Volkmar (Eds.), Lewis's child and adolescent psychiatry: A comprehensive textbook (5th edn). Baltimore, MD: Lippincott Williams & Wilkins.
113. Turban, J., Ferraiolo, T., Martin, A., & Olezeski, C. (2017). Ten things transgender and gender nonconforming youth want their doctors to know. Journal of the American Academy of Child and Adolescent Psychiatry, 56, 275–277.
114. Tyson, P. (1982). A developmental line of gender identity, gender role, and choice of love object. Journal of the American Psychoanalytic Association, 30, 61–86.
115. van Beijsterveldt, C.E., Hudziak, J.J., & Boomsma, D.I. (2006). Genetic and environmental influences on cross-gender behavior and relation to behavior problems: A study of Dutch twins at ages 7 and 10 years. Archives of Sexual Behavior, 35, 647–658.
116. Vanderhost, B. (2015). Whither lies the self: Intersex and transgender individuals and a proposal for brain-based legal sex. Harvard Law & Policy Review, 9, 241.
117. Vlot, M.C., Klink, D.T., den Heijer, M., Blankenstein, M.A., Rotteveel, J., & Heijboer, A.C. (2017). Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents. Bone, 95, 11–19.
118. Wallace, R., & Russell, H. (2013). Attachment and shame in gender-nonconforming children and their families: Toward a theoretical framework for evaluating clinical interventions. International Journal of Transgenderism, 14, 113–126.
119. Wallien, M.S., & Cohen-Kettenis, P.T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413–1423.
120. Wallien, M.S., Swaab, H., & Cohen-Kettenis, P.T. (2007). Psychiatric comorbidity among children with gender identity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1307–1314.
121. Webster, C.R., Jr, & Telingator, C.J. (2016). Lesbian, gay, bisexual, and transgender families. Pediatric Clinics North America, 63, 1107–1119.
122. Wierckx, K., Van Caenegem, E., Pennings, G., Elaut, E., Dedecker, D., de Van Peer, F., … & T'sjoen, G. (2012). Reproductive wish in transsexual men. Human Reproduction, 27, 483–487.
123. Wood, H., Sasaki, S., Bradley, S.J., Singh, D., Fantus, S., Owen-Anderson, A., … & Zucker, K.J. (2013). Patterns of referral to a gender identity service for children and adolescents (1976-2011): Age, sex ratio, and sexual orientation. Journal of Sex and Marital Therapy, 39, 1–6.
124. Yadegarfard, M., Meinhold-Bergmann, M.E., & Ho, R. (2014). Family rejection, social isolation, and loneliness as predictors of negative health outcomes (depression, suicidal ideation, and sexual risk behavior) among Thai male-to-female transgender adolescents. Journal of LGBT Youth, 11, 347–363.
125. Yarhouse, M.A., & Carrs, T.L. (2012). MTF transgender Christians’ experiences: A qualitative study. Journal of LGBT Issues in Counseling, 6, 18–33.
126. Zhou, J.N., Hofman, M.A., Gooren, L.J., & Swaab, D.F. (1995). A sex difference in the human brain and its relation to transsexuality. Nature, 378, 68–70.
127. Zucker, K.J.K. (1993). Physical attractiveness of boys with gender identity disorder. Archives of Sexual Behavior, 22, 23–36.
128. Zucker, K.J., & Bradley, S. (1995). Gender identity disorder and psychosexual problems in children and adolescents. Guilford, NY: Guilford Press.
129. Zuger, B. (1984). Early effeminate behavior in boys. Outcome and significance for homosexuality. The Journal of Nervous and Mental Disease, 172, 90–97.