Psychological symptoms and service utilization in prepubertal and pubertal transgender and gender-diverse patients

To describe the demographics and psychological symptoms of gender diverse patients and to compare symptoms between prepubertal and pubertal subgroups. This is a retrospective chart review of all gender diverse patients seen by at least one provider at the Nemours Gender Wellness Program from March 2015-December 2020. Extracted data included demographics and psychosocial characteristics at baseline and 1-year follow-up visits. Pubertal status was determined by Tanner staging by a pediatric endocrinologist or gynecologist. Descriptive statistics were used to compare these variables between prepubertal and pubertal subgroups. Our sample included 177 individuals at baseline and 96 subjects at the 1-year follow-up visit. Most patients were White (83.0%), non-Hispanic (92.0%), transgender male (72.9%), and pubertal (90.4%). Compared with prepubertal patients, at the baseline visit, pubertal patients had significantly higher rates of current (68.1% vs. 17.6%, p < .001) and lifetime (80.0% vs. 23.5%, p < .001) depressive symptoms, current anxiety symptoms (70.0% vs. 41.2%, p = .01), lifetime suicide attempts (12.5% vs. 0%, p < .001), and a formal diagnosis of an eating disorder (5.0% vs. 0%, p < .001). Symptoms did not change significantly over time from the baseline to the 1-year follow-up visit. We found elevated rates of psychological symptoms and diagnoses in gender diverse youth, with higher rates in pubertal compared with prepubertal patients. By elucidating how the psychosocial characteristics of gender diverse children and adolescents differ based on pubertal status, these data can be used to improve current outreach and treatment strategies for transgender pediatric patients.