title: Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development.
abstract: BACKGROUND
  Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development.
  
  
  METHODS
  Structured quantitative retrospective chart review and qualitative analysis of case files of all adolescent SR applicants who entered the assessment by the end of 2013.
  
  
  RESULTS
  The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.
  
  
  CONCLUSIONS
  The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.
authors: University of Tampere, School of Medicine, 33014 University of Tampere, Tampere, Finland ; Department of Adolescent Psychiatry, Tampere University Hospital, 33380 Pitkäniemi, Finland.
authors: Riittakerttu
authors: R
authors: Kaltiala-Heino
authors: Department of Adolescent Psychiatry, Tampere University Hospital, 33380 Pitkäniemi, Finland.
authors: Maria
authors: M
authors: Sumia
authors: Department of Adolescent Psychiatry, Tampere University Hospital, 33380 Pitkäniemi, Finland.
authors: Marja
authors: M
authors: Työläjärvi
authors: Faculty of Medicine, University of Helsinki, BOX 33, 00014 Helsinki University, Helsinki, Finland ; Forensic Psychiatry, Helsinki University Hospital, Helsinki, Finland.
authors: Nina
authors: N
authors: Lindberg
keywords: Adolescent development; Gender dysphoria; Sex reassignment; Transsexualism