Outcomes in gender dysphoria with focus on the youth: a mixed-methods project

A substantial increase of individuals seeking for gender dysphoria (GD) has been observed over the last years, especially among younger persons. Individuals with GD are a group at increased risk for mental and physical ill-health, discrimination and violence.

The majority of the studies conducted in the field are methodologically weak and both the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) and the Swedish Research Council for Health, Working Life and Welfare (FORTE) have published related knowledge gaps, emphasizing the need for more research.We aim to provide scientifically robust answers to several of those knowledge gaps and specifically on i) whether gender affirming treatment (GAT) is associated with better outcomes in terms of GD, body satisfaction, mental health and social vulnerability (ie discrimination and violence), ii) whether those on GAT have higher risks for negative somatic (i.e. stroke and myocardial infarction) and psychiatric outcomes (i.e. psychiatric hospitalizations and suicidal behavior), and iii) which factors are of importance for the non-completion of a GD evaluation, the decision to stop a GAT or to undergo a detransition.

We plan to use data from an ongoing large multicenter prospective cohort in Sweden (SKDS), register-based data (10 000 individuals with GD, their siblings, and 200 000 controls) and to conduct qualitative interviews with selected individuals.

The SKDS study will provide us with detailed clinically significant outcome measures, the register data with the adequate statistical power to assess safety concerns, such as more severe but infrequent outcomes (eg stroke), while the qualitative studies will shed light into important factors influencing the decisions of people with GD.

The generated new knowledge will be a substantial contribution on the field, filling important knowledge gaps and helping the authorities setting priorities in service development and policymaking.