Gender and Psychiatric History

n (%) or Mean ± SD
Gender history
 Living in full-time gender role at presentationa89 (91.8)
 Demonstrated cross-gender behavior before age 5b44 (45.4)
 Age living in full-time gender role, y13.6 ± 3.8
 Age of medical intervention, y15.6 ± 2.8
 Started medical intervention immediately (<1 wk) after first CHB evaluation56 (57.7)
 If not started immediately, time to medical treatment, mo9.0 ± 6.7
Psychiatric history
 With psychiatric diagnosis before CHB evaluationc43 (44.3)
 On psychiatric medications35 (36.1)
 With prior psychiatric hospitalizations9 (9.3)
 History of self-mutilation20 (20.6)
 History of suicide attempts9 (9.3)
Psychiatric diagnosesd
 Depression25 (58.1)
 General anxiety disorder7 (16.3)
 Bipolar disorder7 (16.3)
 Pervasive developmental disorder (nonautism)4 (9.3)
 Eating disorder3 (7.0)
 Attention-deficit/hyperactivity disorder or attention-deficit disorder2 (4.7)
 Autism1 (2.3)
 Panic disorder1 (2.3)
 Posttraumatic stress disorder1 (2.3)
  • CHB, Children’s Hospital Boston.

  • a “Living in full-time gender role” means socially presenting oneself as the gender of the nonbiological gender; this includes having a cross-gender name and wearing cross-gender clothing.

  • b Five patients were on medications before presenting to CHB. Medical intervention includes pubertal suppressive medications (GnRH agonists or sex hormone receptor antagonists) and cross-sex hormones (testosterone for biological female patients and estrogens for biological male patients).

  • c Eight patients presented with more than 1 psychiatric diagnosis.

  • d Percentages relative to 43 patients with psychiatric diagnoses.