Abstract
This study examined gender dysphoria (GD) in transgender and cisgender populations in China and aimed to provide validity evidence for two dimensional measures of GD. A total of 293 transgender people (170 transmen, 65 transwomen, and 58 non-binary trans people; mean age, 21.3 years) and 538 cisgender people (296 ciswomen and 242 cismen; mean age, 23.5 years) completed the Utrecht Gender Dysphoria Scale (UGDS), the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA), and demographic information online. The UGDS and the GIDYQ-AA had good reliability and validity for the Chinese population. Transgender people reported higher intensity of GD than cisgender people. Cisgender women reported higher intensity of GD than cisgender men. Non-binary transgender people reported lower intensity than binary transgender people. However, transmen reported higher intensity than transwomen for the UGDS but not for the GIDYQ-AA. Transgender people with gender-affirming hormonal treatment experience reported higher intensity of GD than those without treatment. Moreover, transgender people coming out to parents reported higher intensity than those who did not. The cutoff values of the UGDS and the GIDYQ-AA in the original version show high sensitivity for transgender people and specificity for cisgender people. Our findings indicate that the UGDS and the GIDYQ-AA are validated measures of GD in China.
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References
Åhs, J. W., Dhejne, C., Magnusson, C., Dal, H., Lundin, A., Arver, S., Dalman, C., & Kosidou, K. (2018). Proportion of adults in the general population of Stockholm County who want gender-affirming medical treatment. PLoS ONE, 13(10), e0204606. https://doi.org/10.1371/journal.pone.0204606
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Press.
Becker, I., Ravens-Sieberer, U., Ottová-Jordan, V., & Schulte-Markwort, M. (2017). Prevalence of adolescent gender experiences and gender expression in Germany. Journal of Adolescent Health, 61(1), 83–90. https://doi.org/10.1016/j.jadohealth.2017.02.001
Beek, T. F., Cohen-Kettenis, P., & Kreukels, B. P. C. (2016). Gender incongruence/gender dysphoria and its classification history. International Review of Psychiatry, 28(1), 5–12. https://doi.org/10.3109/09540261.2015.1091293
Beijing LGBT Center & Department of Sociology, Peking University. (2017). The survey report on the living status of transgender population in China 2017. https://max.book118.com/html/2018/1007/8103104122001125.html
Blakemore, J. E. O., & Hill, C. A. (2008). The Child Gender Socialization Scale: A measure to compare traditional and feminist parents. Sex Roles, 58, 192–207. https://doi.org/10.1007/s11199-007-9333-y
Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease, 177(10), 616–623. https://doi.org/10.1097/00005053-198910000-00004
Bouman, W. P., de Vries, A. L. C., & T’Sjoen, G. (2016). Gender dysphoria and gender incongruence: An evolving inter-disciplinary field. International Review of Psychiatry, 28(1), 1–4. https://doi.org/10.3109/09540261.2016.1125740
Brumbaugh-Johnson, S., & Hull, K. E. (2019). Coming out as transgender: Navigating the social implications of a transgender identity. Journal of Homosexuality, 66(8), 1148–1177. https://doi.org/10.1080/00918369.2018.1493253
Cheung, A. S., Leemaqz, S. Y., Wong, J. W. P., Chew, D., Ooi, O., Cundill, P., Silberstein, N., Locke, P., Zwickl, S., Grayson, R., Zajac, J. D., & Pang, K. C. (2020). Non-binary and binary gender identity in Australian trans and gender diverse individuals. Archives of Sexual Behavior, 49(7), 2673–2681. https://doi.org/10.1007/s10508-020-01689-9
Chew, D., Anderson, J., Williams, K., May, T., & Pang, K. (2018). Hormonal treatment in young people with gender dysphoria: A systematic review. Pediatrics, 141(4). https://doi.org/10.1542/peds.2017-3742
Cohen-Kettenis, P., & van Goozen, S. H. M. (1997). Sex reassignment of adolescent transsexuals: A follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 36(2), 263–271. https://doi.org/10.1097/00004583-199702000-00017
Cohen-Kettenis, P. T., & Pfafflin, F. (2010). The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 499–513. https://doi.org/10.1007/s10508-009-9562-y
Costa, R., & Colizzi, M. (2016). The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: A systematic review. Neuropsychiatric Disease and Treatment, 12, 1953–1966.
Deogracias, J. J., Johnson, L. L., Meyer-Bahlburg, H. F. L., Kessler, S. J., Schober, J. M., & Zucker, K. J. (2007). The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. Journal of Sex Research, 44(4), 370–379. https://doi.org/10.1080/00224490701586730
Dhejne, C., Van Vlerken, R., Heylens, G., & Arcelus, J. (2016). Mental health and gender dysphoria: A review of the literature. International Review of Psychiatry, 28(1), 44–57. https://doi.org/10.3109/09540261.2015.1115753
Fisher, A. D., Castellini, G., Bandini, E., Casale, H., Fanni, E., Benni, L., Ferruccio, N., Meriggiola, M. C., Manieri, C., Gualerzi, A., Jannini, E., Oppo, A., Ricca, V., Maggi, M., & Rellini, A. H. (2014). Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria. Journal of Sexual Medicine, 11(3), 709–719. https://doi.org/10.1111/jsm.12413
Freeman, N. K. (2007). Preschoolers’ perceptions of gender appropriate toys and their parents’ beliefs about genderized behaviors: Miscommunication, mixed messages, or hidden truths? Early Childhood Education Journal, 34(5), 357–366. https://doi.org/10.1007/s10643-006-0123-x
Galupo, M. P., & Pulice-Farrow, L. (2020). Subjective ratings of gender dysphoria scales by transgender individuals. Archives of Sexual Behavior, 49(2), 479–488. https://doi.org/10.1007/s10508-019-01556-2
Iliadis, S. I., Axfors, C., Friberg, A., Arinell, H., Beckman, U., Fazekas, A., Frisen, L., Sandström, L., Thelin, N., Wahlberg, J., Södersten, M., & Papadopoulos, F. (2020). Psychometric properties and concurrent validity of the Transgender Congruence Scale (TCS) in the Swedish setting. Scientific Reports, 10, 18701. https://doi.org/10.1038/s41598-020-73663-3
Jessen, R. S., Wæhre, A., David, L., & Stänicke, E. (2021). Negotiating gender in everyday life: Toward a conceptual model of gender dysphoria in adolescents. Archives of Sexual Behavior, 50(8), 3489–3503. https://doi.org/10.1007/s10508-021-02024-6
Kaptan, S., Cesur, E., Başar, K., & Yüksel, Ş. (2021). Gender dysphoria and perceived social support: A matched case-control study. Journal of Sexual Medicine, 18(4), 812–820. https://doi.org/10.1016/j.jsxm.2021.01.174
Koehler, A., Eyssel, J., & Nieder, T. O. (2018). Genders and individual treatment progress in (non-)binary trans individuals. Journal of Sexual Medicine, 15(1), 102–113. https://doi.org/10.1016/j.jsxm.2017.11.007
Kuyper, L., & Wijsen, C. (2014). Gender identities and gender dysphoria in the Netherlands. Archives of Sexual Behavior, 43(2), 377–385. https://doi.org/10.1007/s10508-013-0140-y
Lai, M. C., Chiu, Y. N., Gadow, K. D., Gau, S. S. F., & Hwu, H. G. (2010). Correlates of gender dysphoria in Taiwanese university students. Archives of Sexual Behavior, 39(6), 1415–1428. https://doi.org/10.1007/s10508-009-9570-y
McGuire, J. K., Berg, D., Catalpa, J. M., Morrow, Q. J., Fish, J. N., Rider, G. N., Steensma, T., Cohen-Kettenis, P., & Spencer, K. (2020). Utrecht Gender Dysphoria Scale—Gender Spectrum (UGDS-GS): Construct validity among transgender, nonbinary, and LGBQ samples. International Journal of Transgender Health, 21(2), 194–208. https://doi.org/10.1080/26895269.2020.1723460
Meerwijk, E. L., & Sevelius, J. M. (2017). Transgender population size in the United States: A meta-regression of population-based probability samples. American Journal of Public Health, 107(2), e1–e8. https://doi.org/10.2105/AJPH.2016.303578a
Sandnabba, N. K., & Ahlberg, C. (1999). Parents’ attitudes and expectations about children’s cross-gender behavior. Sex Roles, 40, 249–263. https://doi.org/10.1023/a:1018851005631
Schneider, C., Cerwenka, S., Nieder, T. O., Briken, P., Cohen-Kettenis, P., De Cuypere, G., Haraldsen, I. R., Kreukels, B. P. C., & Richter-Appelt, H. (2016). Measuring gender dysphoria: A multicenter examination and comparison of the Utrecht Gender Dysphoria Scale and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. Archives of Sexual Behavior, 45(3), 551–558. https://doi.org/10.1007/s10508-016-0702-x
Shulman, G. P., Holt, N. R., Hope, D. A., Mocarski, R., Eyer, J., & Woodruff, N. (2017). A review of contemporary assessment tools for use with transgender and gender nonconforming adults. Psychology of Sexual Orientation and Gender Diversity, 4(3), 304–313. https://doi.org/10.1037/sgd0000233
Sina Weibo Data Center. (2021). Weibo user development report in 2020. https://data.weibo.com/report/reportDetail?id=456.
Singh, D., Deogracias, J. J., Johnson, L. L., Bradley, S. J., Kibblewhite, S. J., Owen-Anderson, A., & Zucker, K. J. (2010). The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults: Further validity evidence. Journal of Sex Research, 47(1), 49–58. https://doi.org/10.1080/00224490902898728
Smith, Y. L., Van Goozen, S. H., Kuiper, A. J., & Cohen-Kettenis, P. T. (2005). Transsexual subtypes: Clinical and theoretical significance. Psychiatry Research, 137(3), 151–160. https://doi.org/10.1016/j.psychres.2005.01.008
Steensma, T. D., Kreukels, B. P. C., J€urgensen, M., Thyen, U., de Vries, A. L. C., & Cohen-Kettenis, P. T. (2013). The Utrecht Gender Dysphoria Scale: A validation study (pp. 41–56). In From gender variance to gender dysphoria: Psychosexual development of gender atypical children and adolescents. Ridderprint.
Strang, J. F., Meagher, H., Kenworthy, L., de Vries, A. L. C., Menvielle, E., Leibowitz, S., Janssen, A., Cohen-Kettenis, P., Shumer, D. E., Edwards-Leeper, L., Pleak, R. R., Spack, N., Karasic, D. H., Schreier, H., Balleur, A., Tishelman, A., Ehrensaft, D., Rodnan, L., Kuschner, E. S., & Anthony, L. G. (2018). Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents. Journal of Clinical Child and Adolescent Psychology, 47(1), 105–115. https://doi.org/10.1080/15374416.2016.1228462
Twist, J., & de Graaf, N. M. (2019). Gender diversity and non-binary presentations in young people attending the United Kingdom’s National Gender Identity Development Service. Clinical Child Psychology and Psychiatry, 24(2), 277–290. https://doi.org/10.1177/1359104518804311
van Beijsterveldt, C. E. M., Hudziak, J. J., & Boomsma, D. I. (2006). Genetic and environmental influences on cross-gender behavior and relation to behavior problems: A study of Dutch twins at ages 7 and 10 years. Archives of Sexual Behavior, 35(6), 647–658. https://doi.org/10.1007/s10508-006-9072-0
Van Caenegem, E., Wierckx, K., Elaut, E., Buysse, A., Dewaele, A., Van Nieuwerburgh, F., De Cuypere, G., & T’Sjoen, G. (2015). Prevalence of gender nonconformity in Flanders, Belgium. Archives of Sexual Behavior, 44(5), 1281–1287. https://doi.org/10.1007/s10508-014-0452-6
Wang, Y., Feng, Y., Su, D., Wilson, A., Pan, B., Liu, Y., Wang, N., Guo, B., Han, M., Zucker, K. J., & Chen, R. (2021). Validation of the Chinese version of the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. Journal of Sexual Medicine, 18(9), 1632–1640. https://doi.org/10.1016/j.jsxm.2021.05.007
Wang, Y., Hu, Z., Peng, K., Xin, Y., Yang, Y., Drescher, J., & Chen, R. (2019). Discrimination against LGBT populations in China. The Lancet Public Health, 4, e440–e441.
Wang, Y. Y., Yu, H., Yang, Y., Drescher, J., Li, R., Yin, W., Yu, R., Wang, S., Deng, W., Jia, Q., Zucker, K., & Chen, R. (2020). Mental health status of cisgender and gender-diverse secondary school students in China. JAMA Network Open, 3(10), e2022796. https://doi.org/10.1001/jamanetworkopen.2020.22796
World Health Organization. (2018). ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 Version. World Health Organization. https://icd.who.int/browse11/l-m/en.
Zhu, X., Gao, Y., Gillespie, A., Xin, Y., Qi, J., Ou, J., Zhong, S., Peng, K., Tan, T., Wang, C., & Chen, R. (2019). Health care and mental wellbeing in the transgender and gender-diverse Chinese population. The Lancet Diabetes and Endocrinology, 7(5), 339–341. https://doi.org/10.1016/S2213-8587(19)30079-8
Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health, 14(5), 404–411. https://doi.org/10.1071/SH17067
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This research is sponsored by Fundamental Research Funds for the Central Universities (SWU2209237) and Innovation Research 2035 Pilot Plan of Southwest University (SWUPilotPlan006).
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Li, Y., Zheng, L. Validation of Two Measures of Gender Dysphoria/Incongruence in Transgender and Cisgender Populations in China. Arch Sex Behav 52, 1019–1030 (2023). https://doi.org/10.1007/s10508-022-02517-y
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DOI: https://doi.org/10.1007/s10508-022-02517-y