Malin Indremo: Epidemiological and clinical aspects in gender dysphoria

Abstract

This thesis explores epidemiological and clinical aspects of gender dysphoria (GD), a condition marked by distress or discomfort arising from incongruence between one’s experienced gender and sex assigned at birth.

Study I investigated national trends in GD-diagnoses in Sweden from 2004 to 2015 using national register data. The results revealed a substantial increase in GD diagnoses, particularly among adolescents and young adults. However, the Swedish National Patient Register presents limitations that complicate interpretation, such as low coverage in the early 2000s and variability in diagnostic coding. The study highlights the importance of using clear case definitions in register-based research, as varying criteria yield different prevalence estimates.

Study II examined associations between media coverage and referral patterns to pediatric gender identity services. Using a classification based on public reception of media content as “positive” or “negative”, the study found that negative, widely publicized media coverage was followed by a decline in referral rates lasting up to nine months after publication. These findings suggest that media discourse may influence care-seeking behavior and access to gender-affirming care among youth, underscoring the importance of nuanced reporting in a sensitive clinical field.

Study III assessed the effects of gender-affirming hormone therapy and chest surgery on gender incongruence, gender dysphoria, and body satisfaction, as well as the potential influence of autism on treatment outcomes. Using a target trial emulation (TTE) design with a control group of individuals with GD who had requested but not yet accessed treatment, the study found that those accessing gender-affirming treatment experienced lasting reductions in gender incongruence. Gradual improvements were also observed in gender dysphoria and body satisfaction, although the precision of these estimates decreased over time. There was no evidence that autism significantly influenced treatment outcomes. These results are a further contribution to the evidence base of gender-affirming treatments to alleviate GD; an area where randomized controlled trials are often not feasible.

Study IV involved qualitative interviews with individuals reporting experiences of detransition or changed gender-related healthcare needs. Five main themes were identified, highlighting diverse and evolving experiences shaped by a combination of internal and external factors. The study emphasizes the heterogeneity of this population and the need to respect individual terminology and self-understanding.