7 - (IOP 32) Interventions for Gender Dysphoria and Related Health Problems in Transgender and Gender-expansive Youth: A Systematic Review

Introduction: Transgender and gender expansive (TGE) individuals can experience gender dysphoria, or distress associated with sex characteristics that are not aligned with their gender identity. Professional organizations outline standards of care that include interventions, both psychosocial and medical, for gender dysphoria. However, access to these interventions is becoming increasingly limited by policy decisions, particularly for TGE youth. This systematic review summarized (1) the available research on outcomes of interventions for gender dysphoria in TGE youth and (2) the amount and certainty of evidence available for outcomes within broad intervention categories. The full details of the review are published in a report (Recommended Reading #1); this presentation will orient attendees to the review and highlight aspects of the findings that are especially relevant to cognitive-behavioral therapy practitioners.

Methods: We conducted a systematic review of peer-reviewed research on outcomes from interventions for gender dysphoria for TGE youth aged 25 or younger published between the years 1990-2023. Team members used a standardized template to extract key information from each study that was used to (a) assess the methodological quality of each study and (b) summarize effect estimates and clinical significance of each intervention outcome. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria to determine certainty of evidence, or the level of confidence that an intervention’s estimated effect on an outcome represents its actual effects.

Results: We reviewed 105 studies, which reported on outcomes from seven intervention categories: TGE-affirming psychosocial, hormonal (i.e., puberty-suppressing hormones and hormone replacement therapy), surgical, and reproductive health interventions, as well as treatment for co-occurring mental disorders and gender identity and expression change efforts (GIECE). Generally, interventions recommended by standards of care (i.e., affirming care) were broadly associated with improvements in gender dysphoria, depression, suicide risk, and other mental health outcomes – as well as additional intervention-specific outcomes when relevant. Alternatives to the standards of care (i.e., GIECE, treatment for co-occurring mental health diagnoses) were associated with a lack of improvement in or sometimes deterioration of these same outcomes. In general, GRADE criteria suggested very low to low certainty in research outcomes for all intervention categories.

Discussion: Research outcomes support interventions highlighted in standards of care for TGE youth over proposed alternatives. Despite the low certainty of this evidence base, using the best available evidence to inform decisions about care for TGE youth is imperative for practitioners and policymakers. Researchers can use our findings to inform efforts to strengthen the evidence base by producing higher-certainty evidence with greater practice and policy relevance.