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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. Dutch transgender youths ages 12-17 reported fewer sexual and romantic experiences than peers in the general population.

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2. Gender differences were seen between transgirls and transboys in terms of frequency and type of sexual experiences, however both genders had similar numbers of romantic relationships.

Study Rundown:

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In recent years, a growing number of gender dysphoric (GD) adolescents have received referrals to gender identity clinics for potential gender-affirming medical treatments (puberty suppression, cross-sex hormones, and gender-affirmative surgery). Despite the need for baseline information to assist in the care and transition of the transgender population, a paucity of information exists regarding the sexual behaviors of transgender adolescents. In this study, researchers addressed this knowledge gap by surveying transgender youth prior to gender affirmative treatments regarding sexual feelings and behaviors. Survey responses were compared with responses from adolescents within the general population. Results revealed differences between transboys (birth-assigned females) and transgirls (birth-assigned males) in terms of quantity of specific sexual/romantic experiences and that transgender adolescents, overall, had fewer sexual and romantic relationships and rated sex as less important than their non-transgender peers. However, a significant portion of transgender participants reported experience with romantic relationships.

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Data gathered in this study represents an important addition to existing literature. Results from this study suggest that development of sexuality presents a greater challenge for transgender adolescents, highlighting the importance of appropriate counseling and discussions around sexuality with these patients. Participants were recruited directly from the gender identity clinic, so it is results may be limited in generalization beyond more privileged transgender adolescents with strong support systems. Future studies with larger, more diverse participant populations of transgender youth are warranted to confirm results found here.

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Study Author, Dr. Sara L. Bungener, MD, talks to 2 Minute Medicine: Child and Adolescent Psychiatrist (de Bascule), Researcher (VUmc):

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“1. This first study on the sexual experiences of transgender youth shows that before medical gender affirming treatment sexuality is more challenging compared with peers. 2. For health care providers it is important to discuss sexuality with transgender adolescents.”

In-depth [cross-sectional analysis]:

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Researchers enrolled transgender adolescents referred to the Center of Expertise on Gender Dysphoria at the Vrije Universiteit Medical Center in Amsterdam between 2011 and 2013. Participants were asked to complete questionnaires addressing sexual activity at the start of the diagnostic process at the GD clinic. A total of 137 transgender adolescents (n = 60 transgirls, n = 77 transboys) completed and returned all questionnaires. Data was collected on a number of measures related to sexuality, relationship experiences, and satisfaction. This information was compared to data collected from a representative 3820 Dutch adolescents.

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Results showed that transgender adolescents in both age groups had significantly fewer sexual experiences in nearly all domains (e.g. falling in love, sexual fantasies, petting while undressed) compared to their peers. Among transgender adolescents, 24% valued sex as “important” compared to 48% of the general population. Both groups of adolescents cited “being too young” (56% transgender, 47% general population) as the most common reason for not participating in sexual intercourse. The second most common reason noted was “being ashamed of my own body” (44%) in the transgender population and “it just hasn’t happened yet” (45%) in the general population. Of note, questionnaire differences made it difficult to compare the specific effects of body image on sexual relationships between the 2 populations as “being ashamed of my own body” was not an option on the questionnaire offered to the general population.

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Additional results showed transboys were more experienced than transgirls in terms of sexual fantasies, French kissing, and petting while undressed, while transgirls were only more experienced in terms of sexual intercourse (9% vs. 1%). No gender differences were seen in terms of falling in love or number of romantic relationships among the transgender group. Of those surveyed, 50% of transgirls and 43% of transboys stated they had not yet defined their sexual orientation.

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