Characteristics of Dutch Gender Clinic-Referred Adolescents Who Did Not Pursue Gender-Affirming Medical Treatment

This study aimed to explore reasons to not pursue gender-affirming medical treatment (GAMT) and describe demographic characteristics, gender dysphoria, body image and mental health of Dutch clinic-referred adolescents who did not pursue GAMT, comparing them to those who did. Retrospective file review of all consecutively referred 1,470 adolescents from 2009-2019 was conducted and reasons for not pursuing GAMT were identified. Two hundred sixty-four adolescents (18%) did not pursue GAMT. Reasons were not being diagnosed as having gender dysphoria (38.3%), or gender dysphoric feelings were present, but a diagnostic trajectory was not feasible (27.7%). Non-pursuers reported less gender dysphoria and a less negative body image at baseline compared to adolescents who started GAMT. Moreover, non-pursuers reported more problems in psychological functioning. Of all adolescents who did not pursue GAMT, 28.8% (N = 76) reapplied for GAMT at our clinic in adulthood. Adolescents who did not pursue GAMT presented with gender identity questions and gender dysphoric feelings. No gender dysphoria diagnosis or interfering mental health or identity development problems were among the reasons not to pursue GAMT. These findings underline the importance of comprehensive diagnostic exploratory trajectories, with attention to whether adolescence is the right timing for such a trajectory and the adolescent's general functioning.