Newsletter Transvisie 2019

Machine Translated by Google
NEWSLETTER
Volume 2019 #2
CONTENTS Dear volunteer, donor and

interested,
1. About EPATH
2. Looking back at EPATH 2019 by Lisa before you is the second newsletter of
Transvisie in 2019.
3. Experience of EPATH by Saskia
4. Opening session This time a special issue, which is
5. Workshop: Alternative representation/presentations of gender entirely devoted to the EPATH
dysphoria, Los Angelos Gender Center congress held in Rome in April
6. Does the age of referral influence the further transition? 2019. Lisa and Saskia visited the
conference for Transvisie. These have
and treatment of children
been busy days, with many
7. Psychosocial treatment outcomes in transgender youth impressions, interesting
referred to Hamburg Gender Identity Service presentations and good contacts. Lisa
and Saskia have made a summary of
8. Transgender youth and impact of gender affirming
all the presentations attended, which
(cross-sex) hormones on their well-being
has already been published in full on
9. Psychological well-being and self-esteem among children who is our website. Because not everyone
reads the website, we also process
related to hormone treatment
the report in parts
10. How many young people stop taking puberty inhibitors and why?
11. How well informed and open young people make the choice newsletter. This newsletter is entirely
for treatment with puberty inhibitors? devoted to topics related to children and
12. Looking back last year: Mental health young people.
13. Review last year: Children and adolescents
14. Review of the past year: Endocrinology We also pay attention to the module
15. Parent psychological support group for parents as intervention for professionals in youth care that
tool in the care of families with gender diverse families in Turin came online in April, called 'Young
16. The impact of coming out for siblings, psychotherapists group and transgender'.
in Turin
17. Trans youth and their families in Switzerland

Enjoy reading.
18. Workshop: Gender Dysphoria, Beyond the Diagnosis
19. Workshop: A systemic family therapy clinic for Lisa and Saskia,
the board and editors of
young people and their families
Transvision
20. Body dissatisfaction and internalizing problems predict health
related quality of life outcomes in transgender adolescents
21. Suicidality in Adolescents diagnosed with gender dysphoria: A
cross-national, cross-clinical comparative analysis
22. An overview of numbers and of the well-being of the Flemish
youth in the pediatric gender clinic, UZ Gent
23. Gender dysphoria related to psychopathology and quality of life
in Swiss transgender youth
24. Online training Young and Transgender
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1. About Epath (^Contents)
The EPATH (European Professional Association for Transgender Health) focuses on the
exchange of scientific research results between scientists, healthcare providers and transgender
people and organisations. Science is a specific, defined way of looking at reality. This can sometimes
have an alienating effect: things that the majority would intuitively assume to be true often only
gain a place in the scientific debate after they have been methodically investigated. It is also useful
to examine certain questions repeatedly, in different contexts and/or in different ways.
This way of working scientifically can also be seen in some lectures. Sometimes conclusions
feel like open doors, sometimes it's knowledge we already had based on previous research.
Sometimes they are small steps in addition to research that we have seen before (at the WPATH
in 2018 or the EPATH in 2017).
The EPATH in Rome has 606 participants from all over Europe and beyond.
2. Looking Back at EPATH 2019 by Lisa (^Contents)

The EPATH was again larger this year than previous times. Not only did the visitors come from all
conceivable countries, but the diversity in the researchers/research institutes was also great.
There were quite a few 'newcomers' at that point. This is a positive development, because
new research institutes and new researchers also bring new perspectives, which can complement
established institutes such as those from the Netherlands and the United Kingdom. The new
researchers can still make a growth step in the thoroughness and scope of their research.
Sometimes the numbers of respondents were very small to allow meaningful conclusions to be
drawn.
The EPATH is a conference for scientists in transgender care. It is positive that the organization
has created clear space for the perspective of transgender people this year. Not only were we
invited, but there is also a stage in the plenary lectures for researchers who are transgender
themselves, and who made a strong plea for the reduction of pathologisation in transgender care.
What is striking is that the different perspectives are present at the congress, but that they hardly
interact with each other. As far as we are concerned, future editions should focus more on
a substantive debate. Not only between transgender people and healthcare professionals and
researchers, but also between healthcare professionals themselves.
The guidelines talk about multidisciplinary collaboration, but the multidisciplinary debate was
almost completely absent at the congress. While it is precisely there that the translation of results
from scientific research into concrete care in practice can be made, which
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professionals give to transgender people on a daily basis. Wouldn't science become more valuable
if healthcare is more central at a conference like this and if transgender people and their loved ones
are allowed to fully participate in the discussion, even without scientific publications in
their back pockets? Is a congress like this intended to improve science alone or also care for
transgender people?
See also the video that Lisa recorded https://www.transvisie.nl/twee-videos-over-de
european-conference-for-transgendercare/
3. Saskia's Experience of EPATH (^Contents)

As a school information officer at Transvisie and mother of my transgender son (10 years old), I
was particularly interested in research and experiences about and from children and young
people. A lot of research is being done on transgender children and young people, as this report
also shows, so they are certainly present as a research target group at this congress. At the
moment, the emphasis is still mostly on the figures and less on the feelings among trans young
people and their families. Four parents were present at this EPATH. As parents, we got the
impression that we represented the emotional layer of our and other trans children, which was quite
intense. Sometimes it seemed as if all those tests that gender clinics believe are necessary for
a good diagnosis of gender dysphoria, mainly serve to collect enough data for researchers to
obtain a scientific result. It does not take into account the impact of these studies on the well-
being of our children. Fortunately, the workshops of Johanna Olsen-Kennedy and Ayden
Olsen were a welcome exception because they showed great commitment to transgender children
and young people and mainly focused on the experiences of the young people. The importance
of supportive parents, family, school and peers for transgender young people is confirmed by
research (if you help parents, you help the children), but support for those groups is
unfortunately still not always part of the care.
In countries around us we see an Informed Consent model, in which transgender people have
control over their process. I would also wish this for parents and their children who want it.
And of course it would be nice if a child or young person would speak at a next EPATH
conference with their experiences, which could give a voice to our children.
See also Saskia's video, https://www.transvisie.nl/twee-videos-over-de-europese-conference voor-
transgenderzorg/
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4. Opening session (^Contents)

(Thursday 11 April 12.30)
“Hello, I am a butterfly” says the butterfly

“Hello caterpillar, you are a caterpillar” says the snail
5. Workshop: Alternative Representation/Presentations of Gender Dysphoria,

Los Angelos Gender Center (^ Contents)
(Aydin Olson-Kennedy aolsonkennedy@lagendercenter.com) Friday, April 12, 4:30 p.m
Aydin works with transgender people and their parents as a social worker and is transgender herself. In
his workshop he shows that being transgender is much more complex and chaotic than the current
diagnostic criteria of gender dysphoria show.
Diagnostic criteria are defined by what cis people find different than 'normal' - not fitting into the cis M/F
boxes - but this M/F behavior is based on gender socialization and often ignores the experiences of
trans people.
Trans people have a 'Coming in' before they have a 'Coming out'
'Coming in' is a process of many moments. The trans person initially begins to realize that they
experience things differently than other people. A question mark comes up.
Coming in is a process of investigating what is going on: why am/think/feel different? Coming in is
also a process of searching the internet for symptoms and stress. Trans people try to find a language
for their feelings. It is often an individual, private quest that is not shared. Gender dysphoria is
magnified by the information found. It takes courage to live through and survive all the stereotypes and
fears that exist in the outside world about transgender people, such as 'amn't I just a huge
attention seeker', 'I must have misunderstood', 'it is definitely a phase, it will pass', 'maybe I'm crazy',
'am I sure? maybe I'll regret it later'. This transphobia causes even more stress...
'Coming out for trans people usually doesn't happen because they're so excited about it, but more
because they need help, otherwise they can't be authentic. Reactions from the people with whom they
first share that they are trans or don't feel comfortable in their current gender are usually unhelpful,
because these friends or parents also go through a coming in process and present the trans person with
all the doubts they have. themselves had already conceived and lived through. Their feelings keep
getting questioned, which is stressful. For example, they are too young to know they are transgender
(children are often told this), or they are too old, then they would have
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should have figured it out by now. They face a scenario of a big puzzle, where the pieces don't
exactly fit. So stressful.
When transgender children come out to their parents, the parents have a similar coming in
process: they also search the internet frantically, what their child is talking about and talk about it
with others (friends or partners). Parents are slowly starting to respect the position of their trans son
or daughter. They don't have to feel responsible for their child's coming in process, because
that is usually already behind them. However, their coming in process does not run parallel to their
child's coming in process. This continues with other family members, friends, etc. who often have
the coming in process one after the other. For example, the transgender person often continues
to receive the same questions: e.g. (SK) 'Do you just want to be unique?' 'This is not right, I still
see a girl/boy (birth gender) in you'; 'I had that too, a phase in which I climbed trees, but that
passed', 'I wouldn't do that to my child'?
Aydin calls this 'Gender dysphoria noise in your head'. This is a term for the cacophony of
internal voices in the heads of transgender people. Those internal voices are sometimes so loud
that they drown out everything else, especially when trans people are still in the coming in phase.
Later, (some of those) voices may still be present after their coming out.
The voices may become less strong after puberty inhibitors or cross-sex hormones, but they will still
be there. These voices distract the trans person 24/7 from what he is doing, from school tasks, work,
conversations, etc. They are a distraction, but at the same time they can also serve as
protection not to be completely in the here and now with all the stress.
Physical adjustment to the desired sex through hormones and/or surgery helps, but the body is not
the only thing that counts, it is also the internal voices, feelings and thoughts that one experiences
privately. The voices are not only about the body (too big/small hands, too big/small, thick/thin,
chest, hair growth) but also about the voice, gait, the fear of being identified as transgender.
In clinics, gender stress is overvalued when diagnosed, because if you have too little dysphoria
you are not eligible for treatment. Gender euphoria should be just as important as a signal for
diagnosis. These are moments when the voices stop for a moment / disappear / are softer. For they
presuppose dysphoria at other times. Because trans people are afraid of being admitted to
institutions or hospitals, they usually do not speak openly about suicidal thoughts, but remain
stuck with them (implode). This is much more dangerous than bringing it out (exploding). Sometimes
trans young people say: 'It's not so much that the outside world has to accept you. It's more of a
struggle to accept and love yourself the way you are, when the world around you has told you
otherwise' [about being transgender].
Example of gender dysphoria noise in your head in a video 'Her story' (found on Youtube), made
by a trans person about an interview. The trans woman is being interviewed by a cis woman and
is so preoccupied with the voices in her head that she can hardly focus her attention on the
interviewer, afraid that she will be 'recognised' as a transgender woman because she has bigger
has hands. She thinks: 'don't pay attention to my hands, otherwise she will also watch my hands',
'maybe I should just say it', 'but then she will be completely distracted by my hands', etc.).
5
Exercise to illustrate transgender voices in your head. Four people each get their own piece of paper
with some sort of internal voices on it, which they read aloud at the same time and keep repeating, and
one person sits on a chair and represents a transgender person. He has to retell a presentation about
the spine as best as possible, while the four voices are on. The trainer always encourages the trans
person, you can do it!
Phase 1: 4 voices are on: no information comes in;
Phase 2: you're out, so there's one vote less (now three): feeling it's impossible, giving up that it will
ever work out;
Phase 3: you are on hormone therapy, so another vote less (only two) now something comes in and I
can see the images but it is still limited, slightly desperate;
Trainer asks how this would be, if this didn't go on all the time, 24/7? Horrible!
What could you do? Meditate, then the voices might get even worse? Yoga? These are still very
healthy strategies. Many trans people turn to drugs to stop the voices or cut themselves.
Trainer: If I offered to give you a 30 minute break after a month in exchange for cutting yourself, would
you? Sure, because those jammers drive me crazy!
The four voices of internalized social transphobia always stay with you, to a greater or lesser extent, even
when you are completely done with your transition. They are invisible to others, so others do not
understand. It is not surprising that many transgender people suffer from migraines or headaches
because they get tired of those voices. That is why it is important that we focus our help for
transgender people on dealing with those voices that keep us disconnected from our environment and
at the same time protect us from the harsh reality.
6. Does the age of referral influence the further transition and

treatment of children? (^ Contents)
(Accessing of physical interventions by age of first referral: Does age of first referral matter?) (Una Masic
& Polly Carmichael), Thursday, April 11, 2:30 PM
The study presented here was about the influence of age on treatment of children with puberty
blockers. The research was done in 2018 among young people (n=3052) of
14-17 years old with at least 6 appointments at the GIDS clinic in London. It had the following
results:
• Where previously 1.3% (2000) of the children had a referral before their 12th year, this is in
2017 sharply increased to 33.3%.
• 40% started or had already started taking puberty inhibitors and 60% did not.
• In percentage terms, more transgender girls took puberty inhibitors than transgender
guys.
• Those who were referred to the GIDS when they were older than 12 years made less
more frequent use of puberty inhibitors at the age of 14 than children who were referred at a
younger age than 12 years.
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What could these results mean? For young people who were referred after the age of 12 and did not take
puberty inhibitors, it could be that they did not take puberty inhibitors because they could
think longer about whether or not to opt for treatment programs related to their gender identity. The
latter is a hypothesis of the researchers and should be further investigated. (Note from Saskia: There
could also be another reason, namely: that young people were too late and the growth of secondary sexual
characteristics could no longer be stopped by puberty inhibitors.)
7. Psychosocial Treatment Outcomes Among Transgender Youth

Referred to Hamburg Gender Identity Service (^Contents)
(Psychosocial health after gender affirming treatment in young adults diagnosed with Gender Dysphoria
referred to the Hamburg Gender Identity Service: first follow-up results)
(Inga Becker-Hebly: i.becker@uke.de) Thursday, April 11, 2:45 PM
More transgender boys (85%) than transgender girls (15%) participated in this study (n=204 at start and
n=75 at follow-up study) and their mean age is 15.5 years. The study found the following:
1. The psychological functioning of the young people improved significantly after treatment with
GnRHa and cross-sex hormones, compared to the norm group.
2. Quality of life of young people is significantly related to the degree of
internalizing problems and body dissatisfaction before treatment. Quality of life has remained the
same in trans people with depression after cross-sex hormones or surgery.
3. Body image remained the same with puberty inhibitors, but was significantly improved after treatment with
cross-sex hormones or gender-affirming surgery. Body satisfaction was higher in samples with cross-
sex hormones than the samples with puberty inhibitors or no treatment.
Conclusions and implications:

• We see an improvement in psychosocial functioning in young people, especially after cross-sex hormones
and gender-confirming operations. This is in line with other studies.
• There is not one and the same “one fits all” solution for all young people, because they have
different problems and needs. A multidisciplinary approach is needed to support them properly.
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8. Transgender youth and the impact of gender-affirming

(cross-sex) hormones on their well-being (^ Contents)
(Transgender youth and gender affirming hormones; a prospective 5-7 years follow-up, Los
Angeles, USA) (Johanna Olson-Kennedy) Thursday 11 April 15.00
This is a 5-7 year follow-up study of satisfaction after treatment with cross-sex hormones.
The study population consists of a total of n=65, of which n=23 in treatment, n=42 out of treatment,
of which 58% transgender men and 42% transgender women aged 18-30 years.
Results from this study were:
• 75% of respondents had average to high life satisfaction scores.

On the other hand, 12.5% of the transgender girls were not satisfied with their lives.
• Body image has improved significantly: young people under 16 years of age saw a
greater improvement in body appreciation.
• No regrets among the population in trans women (n=27) and trans men (n=37).
Well 1 that stopped because it was too expensive to
pay. • Qualitative answers confirm the figures that the transgender person who is cross-sex
hormones got very happy with their choice.
In this clinic in Los Angeles, the Informed Consent

model is used, i.e. individualized care,
where the information is given to transgender young
people and adults so that they can decide for
themselves what they need.
9. Psychological well-being and self-esteem among children and

adolescents, which is related to hormone treatment (^ Contents)
(Psychological well-being and self-image in children and adolescents diagnosed with gender
dysphoria in relation to hormonal treatment)(Elise Ruysschaert & Justine Janssen et al, UZ Gent)
Thursday 11 April 15.15
Literature research shows that gender dysphoric young people more often suffer from minority stress,
anxiety disorders and depression, suicidal thoughts (>50%) and suicide attempts (33%). Lifelong
self-mutilation occurs in 43% and this group scores lower on life satisfaction
compared to non-gender dysphoric children.
At UZ Gent, the Informed Consent model is used, which checks for psychological limitations
(comorbidity) and the client's social network after diagnosis of gender dysphoria.
This was the start of the study (baseline) and then puberty inhibitors or cross-sex hormones were
started. After 4 months, the same people are examined again and results
8
compared. It concerns 177 children and young people at UZ Gent, average age 16, about 20% trans
girls and the rest trans boys. The following emerges from this research:
• Less self-mutilation takes place after treatment with puberty inhibitors and cross-sex
hormones.
• Lowest scores for physical appearance and general self-esteem for the baseline group were
significantly increased by testosterone use among transgender boys and this improvement
was less for estrogen use among transgender girls.
• Transgender women are less satisfied with their primary sex characteristics than transgender
men. Trans men are more satisfied after testosterone treatment.
• Orgametril appears to increase the risk of suicidal thoughts and self-mutilation. Perhaps this can be
explained by the fact that this drug only inhibits menstruation and does not stop breast
growth, for example.
10. How many young people stop taking puberty inhibitors and why? (^
Contents)
(A follow up study of transgender adolescents who stopped their medical treatment with puberty
suppression) (M. Arnoldussen et al, Amsterdam UMC.) Thursday 11 April 15.30
Quantitative research of data from the Netherlands shows that:
• Between 2000-2017, 683 young people in Amsterdam UMC started with

puberty inhibitors, of which 11 discontinued this treatment (1.6%).
• Between 2000-2018, 139 young people in Leiden UMC started taking puberty inhibitors and
6 dropped out (4.3%).
Why do young people stop taking puberty inhibitors? Through in-depth interviews with 10 young people,
the researchers are trying to find out why they stopped taking puberty inhibitors. The research is not yet
finished and only the first two stories of two young people were presented:
• Tess has tried puberty inhibitors, but stopped taking them because it didn't bring what was
expected. Tess does not regret the puberty blocker treatment as it was part of the
process of figuring out what is best for her.
• Laura has had puberty inhibitors and stopped because they did not make her feel better.
After being given medication for autism, she did feel better.
The provisional conclusion is that the vast majority of young people continue their treatment with
puberty inhibitors. The gender identity of these two young people who quit was still developing
during treatment and several aspects influence this process.
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11. How well informed and open do young people make the choice for
treatment with puberty inhibitors? (^ Contents)
(Puberty blocking in transgender adolescents: How well-informed and open to change are the
choices made at young age)(Lieke Vrouenarts et al, Leiden UMC) Thursday 11 April 15.45
Observational studies show that transgender children who are eligible for puberty inhibitors are also
decision-making competent. This study checks these observations by asking 10 young people
themselves how they look back on this selection process for treatment with puberty inhibitors.
For the young people studied, the suppression of physical changes was the main reason for
starting puberty inhibitors and they were therefore relieved that physical changes did not occur.
These young people therefore did not want inhibitors because they would need more time to
experiment and investigate their gender identity, which is usually given as the main reason by the
clinical staff. It was already clear to these children that they are transgender and wanted this
treatment.
Another reason they gave afterwards for choosing puberty inhibitors is that this gave family
members in particular more time to get used to them as a transgender boy/girl. Perhaps
'more time' therefore applies more to cis relatives and medical staff than to the young person
himself. Most said “I didn't fully understand the information, but enough”.
They said they were too young to fully understand the information about puberty blocker treatment, but
not too young to decide on it. Also because it was a reversible choice and because parents thought
along with them, they could make this decision. They take the possible side effects for granted and
this applied to both quitters and persistence.
The conclusion is that transgender young people themselves are not too young to decide on
treatment with puberty inhibitors.
12. Looking Back Last Year: Mental Health (^ Contents)

(Tim van de grift, Amsterdam UMC, email: t.vandegrift@vumc.nl) Friday, April 12, 9:00 am
Key topics and outcomes of mental health surveys over the past year are:
• Psychological health indicators are important research topics alongside moderating factors
such as self-confidence and resilience. The study (by Scandurra et al, 2018) relates
various factors to each other and examines whether there is a connection between, for example,
internalized transphobia and resilience, stress and anxiety.
This shows that low self-esteem predicts depression and also harassment stress
negatively affected. Negative stress or minority stress and internalized transphobia are
stressors from which one cannot easily protect oneself. Resilience is not completely
protective against fear (see figure below).
10
• Research into autistic traits in gender dysphoric young people was done by John F. Strang et al.
(2019) with the article: Initial Clinical Guidelines for Co-occurring Autism Spectrum Disorder
and Gender Dysphoria or Incongruence in Adolescents. Different findings emerge from different
studies. The question is therefore how sensitive the AQ is to measurements of autism.
13. Looking Back Last Year: Children and Youth (^Contents)

(Jiska Ristori, Psychologist of Florence University) Friday 12 April 9.15
There is a large increase in the number of studies on children and young people. 10 review studies were
done in 2018 and 3 review studies in 2019. This shows that:
• Gender dysphoria in the Netherlands occurs more often than initially measured: 4% of young people (12-
18 years) and children (under 12) is gender incongruent, 1.3% have a diagnosis of
gender dysphoria. There are about twice as many transgender boys than girls who were referred
in this Dutch study. Earlier we saw that more transgender girls came in as children, now more
transgender boys aged 12 or older.
• Studies of the general population show a higher percentage of gender-incongruous children and
adolescents than studies of those referred to a clinic for treatment. There is also a higher % of
gender incongruity among children and young people under 18 compared to adults. This leads to
questions such as: does gender incongruity occur more among young people/children because
they would find coming out easier? Or is gender identity more fluid among young people?
• Is healthcare geared to the needs of transgender children and young people?

The general health among young people was compared with that of transgender young
people, which shows that 66% of transgender young people report poor health compared to 33%
of cis young people, of whom long-term problems: 59% among transgender young people
against 17% among cis young people . Transgender young people visited a care institution more
often. If we look at Gendercare worldwide (from WPATH) we see that it is mainly centered
around Western Europe and the United States and that in many regions no care is offered at all.
(a dot / . stands for a gender clinic).
11
• A study on care thresholds among trans young people showed that young people do not feel assured of
good care. A lack of training on gender-specific topics was seen as the main problem. According
to the young people surveyed, care systems are not always welcoming towards gender diverse young
people, but rather hostile.
Furthermore, trans young people view the gender spectrum much more broadly than healthcare
providers, who still often think in cis M/F boxes.
• Research (by Aparicia-Garcia et al, 2018) among transgender young people (n=856 and age 14-25 years)
shows that they suffer a lot from bullying and violence and are therefore a vulnerable group: o
43% of trans or non-
binary youth suffer from bullying at school and
outside school compared to 25-29% cis young people.
o 24% of transgender young people experience physical violence at school compared to 8% of cis young
people. o Non-binary young
people are more often the target of cyberbullying, according to their research. o Because trans young
people experience more physical and psychological violence at school and outside school, they more
often suffer from depression and anxiety and feel more isolated. These young people are
therefore more likely to think of suicide. Thoughts of suicide occurred in 78% of non-binary youth,
70% of trans youth, compared to 41% of cis youth who sometimes contemplated suicide.
• The link between autism spectrum (APS) and gender incongruity is confirmed by four new studies, although the
nature of the link is not yet clear and needs more research.
• Seven studies on gender affirming care show that gender affirming care for children and young people can
certainly alleviate gender dysphoria and thus increase the well-being of these young people. However,
it is important to individualize the approach, each child has its own path and will therefore have to be
approached in all openness to receive the best care.
• In research into the attitude of transgender young people towards fertility (van Chen et al, 2018), with n=156,
mean age 16.1 years, it appears that 49% think they want children, 28% think not and the rest know it doesn't.
36% of the young people surveyed indicate that they are interested in biological parenting. 71% think of
adoption as an opportunity to have children. Despite the interest and importance, little attention is paid to
fertility by healthcare providers. The study found that 80%
12
of the trans young people studied had never discussed this with the counselor and 65%
had never discussed it with their parents. Only 14% had discussed the effects
of hormone therapy, 61% showed interest in this study to know more about this. A survey
among healthcare providers shows a different picture, because they say they do have
knowledge about the impact of hormone therapy on fertility and 95% can remember the
WPATH recommendations. The conclusion is that fertility issues should be discussed
more with parents and young people by care providers.
• A study from the Netherlands (van Brik et al, 2019) about the use of a treatment for fertility
preservation among transgender girls who have or have had puberty inhibitors (n=35)
between 2011-2017, showed that 91% had received information about this. 38% had made
an attempt to maintain fertility, of which 78% were successful. The following comment
was made by the researchers: 1/3 of the respondents had not had any fertility treatment
because they could not produce sperm - because they were still too early in puberty. These
figures are higher than what came from previous studies from the US.
Conclusion: transgender children and young people are very diverse in their needs and should
therefore be given ethically responsible options, minimizing harm and maximizing well-being,
adapted to their social, educational and health situation.
14. Last Year Review: Endocrinology (^Contents)

(Gary Butler, Tavistock, GIDS) Friday 12 April 9.45
In endocrinology, research has mainly focused on the safety and efficacy of various hormone
treatments in adolescents and adults:
• From research among transgender women, in which heart attacks were related to
treatment with cross-sex hormones for eight years revealed that trans women are 4 times
more likely to develop venous thromboembolism than cis women. This must be monitored.
• A higher risk of
brain tumors has been found in trans people who used cross-sex hormones, but it still
occurs so rarely that it does not require extra monitoring.
• For young people, gender-confirming hormone treatment appears to be safe in a 2-

year study, so no additional screening is required.
• Do young people get the body shape they want through hormone treatment? Research among
young people up to the age of 22 between 1998-2014 shows that transgender women
at the age of 22 could be compared better with cis women of the same age.
Transgender men fell between cis women and cis men in terms of body
composition (body fat, lean body mass, and waist-to-hip ratio).
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• Research (van Lloyd et al, 2018) on the effect of progestogens on the development of bone mass or
body composition in late pubertal transgender youth (44 trans
boys and 21 trans girls), treated with Lynestrenol or Cyproterone acetate for 10-11
months, pro-androgenic and anti-androgenic progestogens have been shown to cause body
changes towards the desired appearance within a year. In trans girls, bone density is severely
affected by androgen-suppressing hormone therapy. • From research (by Dan Broulik et al,
2018) on the
influence of long term (18 years)
androgen supplementation (testosterone) on bone metabolism in transgender men (n=35) shows
that bone mineral density in the hip is higher than in cis women (and not much different from cis
men) and no differences were found in the spine .
• From research (by Tobin Joseph et al, 2019) on the influence of treatment with
puberty inhibitors on bone mineral density (BMD) among young people (n=70 age 12-14 years
from UK GIDS) with gender dysphoria, show a significant decrease in BMD in the lumbar spine in
the first year and a lower decrease in the second year. • Research (Defreyne et al,
2018) on the influence of cross-sex hormones on behavior shows that there is no correlation between
testosterone levels and anger intensity in transgender people.
• Coming and going of patients: from the Amsterdam Cohort of gender dysphoria studies
(1972-2015) shows from research by Wiepsjes et al 2018 with n=4432 transgender women and
2361 transgender men), that:
o There are 20 times as many registrations in 2015 than in 1980.
o % who started taking gender-affirming hormones within 5 years of their first
visits have declined, from 90% in 1980 to 65% in 2010.
o The % who underwent gonadectomy (gender-confirming surgery) within 5 years of starting
their treatment with cross-sex hormones remained stable (75% of trans women and
84% of trans men)
o Only 0.6% of trans women and 0.3% of trans men experienced regret after
gonadectomy
o The % that did not take place remained small and does not show a growing trend.
15. Parent psychological support group for parents as intervention tool

in the care of families with gender diverse families in Turin, Italy (^ Contents)
(Angela Caldarer, NPI, Turin Italy) Friday, April 12, 2019 11:30
Parenting a gender diverse child can be a challenging experience according to previous studies.
The opportunity to share experiences in groups with other parents has shown positive effects in previous
research (DiCeglie, 2006; Hill and colleagues, 2010; Rosenberg and Jelinek, 2001; Malpas, 2011). In this
study by Calderer, another positive result was seen: parents found it a good tool to better support their child
and to deal with their own uncertainty around their child.
In this case, parents had an individual interview prior to participation. It concerned 11 parents (6 mothers
and 5 fathers) whose gender-diverse child (5-17 years) also received care. It was a stable group of parents
who had a 90-minute group meeting once a month
14
led by a psychiatrist and clinical psychologist. For parents, the relevant themes in the beginning
(March 2018) were:
• sharing experiences
• self-harm
• school dropout
• legal issues in Italy
• Transition process and difficulties the child might encounter
• respect for children, their experiences and autonomy
• factors related to gender development
• gender identity development as a journey.
In the second half of the meetings, there was more interest in the group to learn how to cope:
• with gender diverse children, non-binaryism and the importance of moving beyond gender stereotypes
to look/think and not to look too rigidly for an exact gender identity
• importance of acceptance to support the child
• gender diversity and age
• relationships with others in the family.
So researchers saw a move from being child-centered in the first six sessions to how can we handle
our child being trans and seeing a greater connection and more openness beyond the box in the
later sessions.
Throughout the process, parents took awareness development and clarity home after a meeting. All
parents reported feeling less alone, better understanding their child's gender identity
development, and having a different approach to their child (more understanding, empathetic, and
supportive). What helped them was sharing, feeling no shame, open to change and confrontation.
The research shows an inner process of how parents deal with gender diversity. The group trajectory
followed gives the opportunity to look at their child as a complex human being with different
characteristics, defined not only by gender behavior and identification, but by much more than
that. In addition, it was a process that goes beyond the binary view of gender.
16. The impact of coming out for siblings. Psychotherapists group in

Turin, Italy (^ Contents)
(Patricia Petiva, Turin, Italy) Friday, April 12, 2019 11:45
Petiva investigated through case studies (12 families) results of a systemic approach, based on
family therapy, offering free sessions to the family. In this study, correct
15
brothers and sisters are approached because it is often assumed that they are not important or that the
parents want to spare them the relationship trauma of a social transition. The studies (Branje, Van Lieshout,
Van Aren & Haselager) show that these siblings are an important support for the family system as a whole
and have special relationships with their gender-diverse sibling, precisely because they come from the
same generation (R. de Bernard). The coming out of a trans child is a developmental crisis that affects the
entire family system. The family can be a crucial source of competence, encouragement and resilience
(Petivia, Spirito), namely that a gender diverse child is understood and accepted by family in his/her path.
Siblings and the whole family system have to redefine themselves in relation to other systems (parents,
school, society) in addition to the internal dimensions of the family. The older sibling can be a point of
reference for the younger sibling. When the gender diverse young person is the eldest and younger siblings
are excluded from this process, this leads to social problems for the younger siblings (exclusion from friend
groups, bullying, transgressive behaviour).
This meeting made use of 'mentalizing', a thought process in which you use imagination and empathy about
others and yourself. You look at yourself from the outside and others look at you from the inside.
You view your own and others' behavior and interpret it in terms of intentions, such as needs,
feelings, goals, fantasies, reasons, beliefs, desires, thoughts, misperceptions, or delusions. This helps to
reduce prejudice and respect everyone's perspective. In addition, it develops the capacity of family
members to recognize other people's thoughts and feelings.
17. Trans Youth and their families in Switzerland, Agnodice foundation

psychosocial support and systemic trans youth in school transition
(^ Contents)
(Adele Zufferey) Friday, April 12, 2019 12:15 PM
In the French-speaking part of Switzerland, access to transaffirmation medical care is still very limited.
There are many psychiatric evaluations of young people, but they have had few treatments. Of the
transgender young people under the age of 15, only 4 young people have access to puberty inhibitors and
there is no access to puberty inhibitors in a
earlier stage of puberty. Fortunately, a number of private endocrinologists sometimes take over
the treatment. From the age of 16 (but in practice usually later because of all the research)
there is access to cross-sex hormones. Surgery is possible from the age of 18 (with exceptions
for mastectomy). Psychosocial care is provided by Agnodice Foundation, Le Refuge, psychologists and
psychiatrists in private clinics.
Agnodice helps young people with their coming out at school and has supported 22 coming outs between
2016 and 2018. The protocol has also been adapted, but has not yet been put into practice, as the
research below confirms.
Qualitative research has been done among 10 trans young people aged 8-21 and their parents about
the needs of young people and parents. The main factors for well-being of trans youth were:
• External factors: access to transaffirmative care, school safety
• Relational factors: parental support and peer relationships, and •
Internal factors: identity name and gender; stigma internalization, body image, self-
understanding and coming out.
16
Of the 10 young people, all had psychological complaints ranging from attempted suicide to anxiety or eating
disorders. Needs and expectations of young people did not correspond at all with their experiences in mental
health care institutions: transgender identity was sometimes seen as a psychological disorder, a binary
perspective is missing, in psychotherapy the subject is missing (Don't ask don't tell). There is a lot of
misunderstanding about trans issues and young people are deliberately misgendered. They are more
depressed and anxious and have more suicidal thoughts during their hospitalization than afterwards.
Family/parents of the trans young people are more negative about the psychological well-being of their
child than the young people themselves, because they are afraid of suicide. Coming out is experienced as a
relief. Family members have fear and ambivalence surrounding the transition, which is reflected in their
acceptance of treatment delays through the many scrutiny and gatekeepers of healthcare
institutions. Parents carry a lot of the process: they defend their child against the medical world, the insurance
industry, society (see Andree-Ann Frappier's book: Career as a trans child's parent). Parents also need support.
Young people need better medical access, support and confidentiality. They want theoretical and clinical abuses
to stop. Parents have the needs to be helped by affirming professionals, to be empowered in their role as parents,
to have more access to information and guidelines to get better treatments from medical staff, and last but not
least, they wish for a more hospitable society for their children.
18. Workshop: Gender Dysphoria, Beyond the Diagnosis (^ Contents)

(Johanna Olson-Kennedy, Aydin Olson, Center for Transyouth Health and Development in Children's
hospital, Los Angeles) Friday, April 12, 4:00 p.m.
In the Center for Transyouth Health and Development, the number of referrals has increased from 25 per year in
2010 to 248 per year in 2018. At first, slightly more or an equal number of transgender girls were
referred than transgender boys, but in the last 3 years more boys and also a small number of non-binary young
people to the center. A recent study found that adult transgender people became aware of their 'differentness'
around the age of 13, while the average age of their coming out is 27 in the population studied, so they needed a
period of 14 years before coming in.
Previously, there was only one story about transgender people, a rare story, usually from an adult transgender
woman. Now there are many more different stories and an awareness that adult transgender people were once
trans children. Even though there are stories now
recovered from trans children, trans young people and non-binary trans people, yet most stories are about white
trans people, so there is still some work to be done.
Nowadays, children come to gender clinics earlier, because they see their own experience reflected in the
world around them (in films, books and on TV).
Trans Young people and children more often think about suicide and cut themselves more often or kill
themselves more often than young people without gender dysphoria.
17
People automatically put others in boxes, in this way we give meaning to the people and
things around us. 'Gender' is one of the first boxes and one of the first things we ask about
when someone is pregnant or has had a child. In this way, we build stories around a clear
distinction between boys and girls, which is reinforced by commercials, toys, guns vs. glitter and
genital/gender reveal parties.
Evidence of gender discrimination is everywhere. At the same time, this distinction can
be traumatic for transgender children and damage their self-confidence. They always get the
message: 'how you are/act is not good'. This happens everywhere: at home, at school, in the
supermarket and among friends. It is harmful because it creates neural connections around
this message. An example of this is the internalized embarrassment of a four-year-old child who
tells the mother - when they are at the doctor's office - "don't tell the doctor" when the mother wants
to tell her son that she wants to wear dresses and have long hair. He didn't make that up himself,
but he was told that you shouldn't talk about it because it would be embarrassing.
The whole world is focused and created around cis gender development, the great path that is
never questioned. For transgender people it's a puzzle because there was no path before.
Fortunately, more paths have now been added, adult trans role models, trans actors and
actresses, showing that there is another path. A good example is a video of a mother of a trans
girl: www.howtobeagirlpodcast.com.
18
Despite this, it is still pretending to be transgender

people swim up, against the
current, in a world that flows down. Sometimes
they might come across a bear that eats them.
Criteria surrounding the definition of gender dysphoria in the medical world reflect more the
cisgender boxes and cisgender problems with transdiverse people than they reflect what transgender
people encounter themselves. This is problematic for transgender people. An example is crossdressing;
this is frowned upon by society but could help transgender children well.
Social transition helps to reduce the pressure. At the moment, many transgender people are getting
people in clinics take all kinds of medication such as antidepressants or ADHD medication, but
these drugs do not relieve gender dysphoria. We should let children experiment more with a hat and a bag.
Biggest fallacies:
• It is seen as a problem to help trans children because then we would 'make' them trans children,
which is seen as a problem. But conversely, we don't mind if we turn trans kids into cis kids. Why is
it like that?
• The worst outcome of diagnosis is that a child is 'trans'. This is based on a cis normative
perspective, which assumes that cis is the best way to live.
What happens to transgender youth?
• Internalization of externalized stress

• Trauma, over and over again, because we don't listen to them.
• Symptoms of ADHD, trauma, ASD (Autism Spectrum Disorder) overlap with
gender dysphoria. What causes what? is the big question here. It is assumed that gender
dysphoria is separate from these diagnoses, but it could be that gender dysphoria leads to
stress, leads to ADHD, trauma and ASD.
19
19. Workshop: A Systemic Family Therapy Clinic for Youth and Their
Families (^ Contents)
(Sarah Favier & Sarah Faithorn & Nicholas Stenning, GIDS UK) Friday 12 April 5pm
Family means something different to everyone and the family therapy of GIDS is aimed at talking
about different perspectives of all those involved with regard to coming out and transition.
This therapy was evaluated and researched through a questionnaire to the participants. Participants
were asked to fill in results of a session in the waiting room before the interview. So the therapy
actually started there.
Coming out actually involves a number of negotiations between the different family members and we
use a systemic approach. The 5 Cs of our systemic approach are:
1. Context: the context encompasses various social and power dynamics, including behaviour
is constructed. We give meaning to certain behaviors in context, with parents usually having
more power than children, caregivers more power than patients.
2. Circularity and complexity: life is a continuous feedback loop, in which we co-create reality
together and interact with each other to negotiate meanings and gain understanding.
3. Competence and positively oriented: instead of pathologizing and problem-oriented questions

In couples, this therapy focuses on competences: What are you good at as a family, what are
your strengths?
4. Curiosity: being interested and asking questions instead of interpreting.
5. Conversations & communication: we are dialogical beings. Identities and realities
are seen as co-creations through conversations and relationships. There is not one truth, but
there are several truths.
Van Burnham (1992) proposes social sub-identities. These are areas in which we can differ from
each other, such as economic, political and social class, ethnic background, gender, sexual
orientation, or age. His tool helps us become aware of the assumptions I have as a therapist
about this family, these people, and what assumptions they may have about me. What do we talk
about easily and what not? Metaphor of the therapist, who puts up an umbrella in the rain, as it were:
how would homophobic and transphobic ideas in society (rain) affect me and how would it affect the
family I meet in this way?
20
The family decides who participates in family therapy. It focuses on family strengths, adaptability,
goal setting in a situation where the family is overwhelmed by difficulties, disturbed communication
and problem severity.
GIDS works with the Reflective Team Model of Tom Anderson from Norway (Andersen, 1987, 1992).
There are 4-6 sessions with a family each month. The Reflective Team Model has the
following characteristics:
• When observing the family, the team and the family are equal participants in it
process.
• They target “The Difference That Makes a Difference” by Bateson, so they don't go for one
too big a change, but not too small a change either.
• It assumes good intentions from everyone.
• Team expresses itself modestly: “I may wonder, perhaps I think I have heard”, so does not
take an expert position and does not talk about facts.
• Everyone's image is recognized.
• Reflective team remains positive.
• Use of self and reflectivity with team's own self-experiences.
• Important to have permission from all family members participating to have a team listening
on the other side of the mirror. • Team does not talk directly
to the family and sit separately in the same room, separated from the family by a two-sided
mirror. • Team pays attention to power
differences. Wondering what other explanations
there could be beyond what is said.
Exercise with the Team method

Case of a young transgender person who likes to be called by her new name and 'she' at home:
4 relatives, nuclear family only, father, mother and transgender daughter Alexa and a younger sister
& 4 reflective team members on the other side of the mirror .
One therapist talks to the different family members and asks them what they think or what they think
others will do or think. On the other side of the mirror, we have a group of 4 therapists who listen to
the family conversation and later bring their observations into a conversation they have with
each other, not with the family. The family members can listen to whatever they want.
Interesting method when family members hear things and they are asked what they particularly
remembered or thought about the team observations. It is also challenging to use different
names as a therapist in the conversation, so towards the trans
say younger Alexa and sister/daughter, while to the others, if they are not ready, say the old name/
son. This has a normalizing effect on the new name/gender.
Challenge: Sometimes mother and father have different positions in social transition or gender
affirmation treatments. So using different names can also create a wall through which you
could lose the parent with resistance. The parents have the power and the car, so if the parents
don't come, the child won't come either.
21
20. Body dissatisfaction and internalizing problems predict health

related quality of life outcomes in transgender adolescents, Hamburg
(^ Contents)
(Inga Becker-Hebly: i.becker@uke.de ) Saturday 13 April 11.00
Health related Quality of Life (HrQoL) is a multidimensional research method that examines
5 dimensions of transgender youth well-being, namely: psychological well-being, physical
well-being, relationship with parents and autonomy, relationships with peers and relationships at
school. It is about the perception of your position in life in relation to your goals, expectations,
values and interests (Ravens-Sieberer et alm, 2014). Previous research has identified four
predictors of health-related quality of life, namely internalizing problems, body (dis)satisfaction,
weak peer relationships and concerns about weight and eating problems. In this study,
203 families in the baseline do baseline study in the period
2013-2016. Ultimately, 126 young people participate in the follow-up phase of the study (average
age is 15.5 years, 82% trans boys, 18% trans girls with a gender dysphoria diagnosis and a wish for
medical treatment).
Main results are:

• Transgender young people on average felt less happy, fit, healthy and satisfied with
their daily lives compared to other young people in Europe.
• The dimensions of psychological well-being (e.g., internalized problems, low
self-esteem and self-efficacy) and physical well-being (such as body dissatisfaction)
were lowest among trans youth. There is a tendency to feel less accepted and
less supported by peers, in addition to negative feelings about school.
• A positive aspect was that the young people were mostly satisfied with the relationship with their parents and
their autonomy.
The conclusion is that psychological well-being (including self-respect and self-efficacy) should
be part of a transition process aimed at the well-being of young people. Self-efficacy during
adolescence is necessary to build resilience. Social and family support are needed so that families,
schools and peers can support these trans young people as well as possible in their process.
21. Suicidality in adolescents diagnosed with gender dysphoria: a

cross-national, cross-clinical comparative analysis (^ Contents)
(Sunday 4 November 4:30)
Many studies have been done on suicidality among young people with gender dysphoria, of which
only a few are representative. According to Zucker, most of the studies are clinical sample studies
that compare suicidality among youth who come to the clinic with and without gender dysphoria.
These types of studies show that among young people with gender dysphoria, suicidal thoughts and
attempts are alarmingly high among these young people. From a more general study of students
(by Perez-Brumer et al, 2017) we see that 34% of students with gender dysphoria have suicidal
thoughts in the last 12 months compared to 19% of students without gender dysphoria. Other
research (van Toomey et al, 2018) shows that 51% of transgender women (n=175) and 30% of
transgender men (n=202) have attempted suicide.
22
has done in the last 12 months versus resp. 18% of cis women (n=60973) and 10% of cis men
(n=57871)
Zucker presents research here (De Graaf et al, 2018), comparing three clinics: Toronto
(n=237), Amsterdam UMC (n=250) and GIDS London (n=1578). Result is that:
• About 30% of the trans boys referred to the various clinics talk about suicide, compared to 3%
of the non-referred girls (n=361). % in Amsterdam is slightly lower than in London and Toronto
• About 40% of trans girls in Toronto, 23% of trans girls in Amsterdam and 32% of trans girls in
London talked about suicide. 2 or 3% of the unreferred boys talked about suicide.
Zucker argues that it is better to compare youth with gender dysphoria to youth with other mental
illnesses. He concludes that predictors of suicidality are certainly linked to gender dysphoria-
specific parameters, but also to general risk factors.
22. An overview of numbers and of the well-being of the Flemish youth

in the paediatric gender clinic, UZ Gent (^ Contents)
(Gaia van Cauwenberg of Belgian Flemish Gender Clinic: gaia.vancauwenberg@uzgent.be)
Sat 13-4 11.30
Gaia presents a study on the needs of gender diverse youth aged 12-24
(n=36) and their parents (n=36), who received referrals to UZ Gent in the period 2007-
2016. Results are:
• Referrals and intakes of young people aged 12-18 will increase until 2015, after which a
slight decrease can be seen. Probably due to a limited occupancy at UZ Gent, there
were waiting lists and therefore fewer
intakes. • There were 177 intakes in the period 2007-2016, of which 36% were trans girls and 64% trans
guys. Earlier, more trans girls came in, but around 2012 the researchers see a turn in the
other direction. Average age of intake at UZ Gent was 14.5 years.
• 16% of trans young people discontinued treatment, one-fourth of whom later returned
to treatment as an adult
• Parents and adolescents report more internalized problems (e.g. anxiety, depression)
than externalized problems (e.g. aggression)
• Parents report more externalized problems than young people themselves. •
Young people themselves report more self-harm and suicidal thoughts and attempts than their
parents report. So one must remain alert to this in clinics.
23. Gender dysphoria related to psychopathology and quality of life in

Swiss transgender youth (^ Contents)
(Dagmar Pauli, Psychiatric University Clinic Zurich) Saturday 13 April 11.45
Dagmar Pauli presents research on gender dysphoria and compares different clinics, namely the
University Clinic in Zurich (in the German speaking part of Switzerland, UZ Gent in Belgium,
Amsterdam UMC in the Netherlands and GIDS in Great Britain. Results of this comparison are:
23
• In Switzerland, young people with an average age of 17 or later come to the

clinic than young people in the other countries compared. Most young people come from rural areas.
• 80% of Swiss young people do not live in the desired sex prior to the
treatment, while that falls to 40% after one year of treatment. • Swiss
young people suffer from high numbers of associated psychopathological disorders (such as low
self-esteem, depression and anxiety), especially compared to comparable figures of young
people from Dutch, Belgian and British clinics.
• Dutch young people score better on mental health and peer relationships, afterwards
comes Belgium. Great Britain and Switzerland score the lowest. The questionnaire that was answered
among parents paints the same picture.
• During treatment, the associated psychopathology of the adolescents appears to improve
Reduce.
• A fairly large group of young people experience no support from school (76%), peers (34%),
father (50%) or mother (42%).
• Family support can be improved during treatment.
• Life satisfaction improves in relation to the presence of social transition and medical
treatment (puberty inhibitors or cross-sex hormones).
24. Young and Transgender Online Training (^ Contents)

One in 25 children does not feel at home in the category 'boy' or 'girl'. That is an average of one per school
class. Not all of these children have come forward with their story. The chance that a youth health care
professional will encounter a child who has questions about his or her gender identity is therefore high.
That is why it is important that they can pick up signals that indicate this. That is not always easy. Not all
professionals know how to start a conversation about this.
To help them with this, the municipality of Utrecht took the initiative to develop an online training:
'Young and Transgender'. This focuses on children and young people with gender dysphoric feelings
between the ages of 2 and 18.
Through practice-oriented assignments, professionals learn how to identify gender issues in children and
young people at an early stage and how to discuss them. This module is about children aged 2 to 18
years. The online training has been accredited so far
24
for nurses, nurse specialists and doctor's assistants. Accreditation for paediatricians is expected in July.
Other applications are still pending.
The training is produced by the Transketeers in collaboration with numerous experts. Two of our volunteers
also contributed to the development of this training. Transvisie is happy with this training.
Training availability
• The training is available free of charge to youth professionals through the

https://www.jgzaacademie.nl/index.php. In an hour and a half they can learn how to deal
appropriately with children with gender questions and their parents or carers.
• This training is available to others free of charge at https://www.movisie.nl/artikel/develop sensitivity-

gendervragen-kinderen-jongeren. You must first create a free account with Movisie.
Some statements about this training:

• Youth nurse Joanne
“Colleagues often ask me about experiences from my daily practice. I can point them out now
this tool. It provides guidelines for how to address a child, what to ask, what to say
and do if you have a child or parents in front of you who have questions about gender identity.
In a playful and varied way, the training leads you through cases and
practical examples.”
• Victor Everhardt, alderman for Public Health in Utrecht
“I think it is important that every child can grow up safe and healthy. There is one in almost every class
child who does not feel at home in the category 'boy' or girl'. We need these kids
take it seriously and listen to them. With the online training, healthcare professionals increase their
knowledge on the subject of gender identity. This enables them to signal help in time
provide and refer when necessary.
• Pauline, older
“Our child was very relieved and so were we when we finally knew what was going on
and he was given space to discover and experiment. Didn't have to choose so much. A
child just wants to 'be' and doesn't think in boxes.”
25

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Newsletter Transvisie 2019

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CONTENTS Dear volunteer, donor and

17. Trans youth and their families in Switzerland

1. About Epath (^Contents)

2. Looking Back at EPATH 2019 by Lisa (^Contents)

3. Saskia's Experience of EPATH (^Contents)

4. Opening session (^Contents)

“Hello, I am a butterfly” says the butterfly

5. Workshop: Alternative Representation/Presentations of Gender Dysphoria,

Phase 1: 4 voices are on: no information comes in;

6. Does the age of referral influence the further transition and

7. Psychosocial Treatment Outcomes Among Transgender Youth

Conclusions and implications:

8. Transgender youth and the impact of gender-affirming

• 75% of respondents had average to high life satisfaction scores.

In this clinic in Los Angeles, the Informed Consent

9. Psychological well-being and self-esteem among children and

Quantitative research of data from the Netherlands shows that:

• Between 2000-2017, 683 young people in Amsterdam UMC started with

12. Looking Back Last Year: Mental Health (^ Contents)

13. Looking Back Last Year: Children and Youth (^Contents)

• Is healthcare geared to the needs of transgender children and young people?

(a dot / . stands for a gender clinic).

14. Last Year Review: Endocrinology (^Contents)

• For young people, gender-confirming hormone treatment appears to be safe in a 2-

15. Parent psychological support group for parents as intervention tool

16. The impact of coming out for siblings. Psychotherapists group in

17. Trans Youth and their families in Switzerland, Agnodice foundation

18. Workshop: Gender Dysphoria, Beyond the Diagnosis (^ Contents)

Despite this, it is still pretending to be transgender

What happens to transgender youth?

• Internalization of externalized stress

3. Competence and positively oriented: instead of pathologizing and problem-oriented questions

Exercise with the Team method

20. Body dissatisfaction and internalizing problems predict health

Main results are:

21. Suicidality in adolescents diagnosed with gender dysphoria: a

22. An overview of numbers and of the well-being of the Flemish youth

23. Gender dysphoria related to psychopathology and quality of life in

• In Switzerland, young people with an average age of 17 or later come to the

24. Young and Transgender Online Training (^ Contents)

• The training is available free of charge to youth professionals through the

• This training is available to others free of charge at https://www.movisie.nl/artikel/develop sensitivity-

Some statements about this training:

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