Annelou de Vries | Vrije Universiteit Amsterdam (original) (raw)
Papers by Annelou de Vries
Introduction: For youth with psychiatric conditions, sexual and gender identity development can b... more Introduction: For youth with psychiatric conditions, sexual and gender identity development can be challenging. Mental health care professionals (MHPs) often avoid communication about sexuality, sexual side effects, and gender diversity with youth. The aim of this study is to gain insight into the perspectives of youth in mental health care and professionals about sexuality and gender diversity communication. Methods: In-depth interviews with 21 adolescent patients (aged 15–22 years) and focus groups were conducted with 20 MHPs (aged 26–55 years) at a mental health care institution in Amsterdam. During analysis, the experiences, needs, and underlying inhibiting and facilitating factors of both groups were derived and analyzed. Results: Both youth patients and MHPs stated that sexuality and gender identity should be a part of mental health care. Youth described the impact and interplay between mental health, sexuality (e.g., sexual experiences, romantic relations, sexual orientation)...
BMC Medical Ethics
Background Decision-making competence is a complex concept in the care for transgender and gender... more Background Decision-making competence is a complex concept in the care for transgender and gender diverse adolescents, since this type of care concerns one’s developing gender identity and involves treatment options that often lack international consensus. Even despite competence assessments, moral challenges arise in the decision-making process. Here, traditional forms of clinical ethics support such as moral case deliberation might not fit as these do not provide thematic guidance. This study therefore aimed to develop a practice-oriented ethics support tool to assist care providers when dealing with moral challenges around decision-making competence in transgender adolescent care. Methods The study followed a participatory design to develop a tool in close collaboration with care providers; they had a say in all phases of development and dissemination. Firstly, nine care providers were interviewed about experienced moral challenges and needs for ethics support. Based on this, the...
BMJ Open, 2021
IntroductionGender Identity Development Services (GIDS) worldwide have experienced a significant ... more IntroductionGender Identity Development Services (GIDS) worldwide have experienced a significant increase in referrals in recent years. However, little is currently known about the experiences of the children and young people (CYP) and their families attending these services and the influences on their well-being. Most published qualitative studies have explored gender identity and gender questioning CYP from either a parental perspective or in an adolescent sample. Consequently, there is a need for research to explore the voices of younger children and adolescents who are referred to GIDS. This study aims to address current gaps in understanding of the experiences of CYP referred to the UK GIDS, specifically regarding the personal, familial, educational, and social contexts in which CYP and their parents/caregivers are navigating gender identity, social and physical transition, and the healthcare system.Methods and analysisA prospective longitudinal qualitative study examining the ...
European Child & Adolescent Psychiatry, 2020
Pediatrics, 2020
OBJECTIVES: Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender d... more OBJECTIVES: Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender dysphoria. In this study, we aim to inform prescribing professionals on the long-term effects of PS treatment on the development of sex characteristics and surgical implications. METHODS: Participants received PS according to the Endocrine Society guideline at Tanner 2 or higher. Data were collected from adolescents who received PS between 2006 and 2013 and from untreated transgender controls. Data collection pre- and post-PS and before surgery included physical examination and surgical information. RESULTS: In total, 300 individuals (184 transgender men and 116 transgender women) were included. Of these, 43 individuals started PS treatment at Tanner 2/3, 157 at Tanner 4/5, and 100 used no PS (controls). Breast development was significantly less in transgender men who started PS at Tanner 2/3 compared with those who started at Tanner 4/5 and controls. Mastectomy was more frequently omitte...
The Journal of Sexual Medicine, 2020
Background There is a general lack of recommendations for and basic information tailored at sexol... more Background There is a general lack of recommendations for and basic information tailored at sexologists and other health-care professionals for when they encounter trans people in their practice. Aim We present to clinicians an up-to-date overview of clinical consensus statements on trans health care with attention for sexual function and satisfaction. Methods The task force consisted of 7 clinicians experienced in trans health care, selected among European Society for Sexual Medicine (ESSM) scientific committee. The consensus was guided by clinical experience and a review of the available literature and by interactive discussions on trans health, with attention for sexual function and satisfaction where available. Outcomes The foci of the study are assessment and hormonal aspects of trans health care. Results As the available literature for direct recommendations was limited, most of the literature was used as background or indirect evidence. Clinical consensus statements were deve...
Psychosomatic Medicine, 2019
The Journal of Sexual Medicine, 2018
Background Information on the psychosexual outcome of individuals with disorders of sex developme... more Background Information on the psychosexual outcome of individuals with disorders of sex development (DSDs) and intersex conditions is of great importance for sex assignment at birth of newborns with DSD. Aim To assess gender change and gender dysphoria in a large sample of individuals with different DSDs. Methods A cross-sectional study was conducted in 14 European centers with 1,040 participants (717 female-identifying and 311 male-identifying persons and 12 persons identifying with another gender) with different forms of DSD. The cohort (mean age = 32.36 years, SD = 13.57) was divided into 6 major subgroups: women with 45,X DSD and variants (Turner syndrome; n = 325), men with 47,XXY DSD and variants (Klinefelter syndrome; n = 219), women with XY DSD without androgen effects (n = 107) and with androgen effects (n = 63), men with XY DSD (n = 87), and women with 46,XX congenital adrenal hyperplasia (n = 221). Data on psychosexual outcome were gathered by medical interviews and quest...
Journal of Psychosomatic Research, 2018
Journal of Child Psychology and Psychiatry, 2018
Journal of the American Academy of Child & Adolescent Psychiatry, 2018
Archives of sexual behavior, Jan 18, 2018
Treatment teams providing transgender-affirming medical care are inherently faced with various ki... more Treatment teams providing transgender-affirming medical care are inherently faced with various kinds of moral and ethical dilemmas and questions, which are becoming even more pressing due to increasing treatment numbers and public attention for transgender care. Little is known about what kinds of moral and ethical challenges manifest in clinical practice. The aim of the present research was to map the moral and ethical challenges of healthcare professionals working in a specialized multidisciplinary transgender care center. Over a period of 7 months, during a focused ethnographic study, data were collected through participant observation of multidisciplinary team meetings, observation of individual psychodiagnostic assessment sessions with clients, and analysis of transcripts and reports of a series of moral case deliberations. A thematic content analysis of the data identified various implicit and explicit moral and ethical challenges around the following six themes: (1) assessing...
Journal of the American Academy of Child and Adolescent Psychiatry, 2018
European child & adolescent psychiatry, Jan 18, 2017
Adolescents seeking professional help with their gender identity development often present with p... more Adolescents seeking professional help with their gender identity development often present with psychological difficulties. Existing literature on psychological functioning of gender diverse young people is limited and mostly bound to national chart reviews. This study examined the prevalence of psychological functioning and peer relationship problems in adolescents across four European specialist gender services (The Netherlands, Belgium, the UK, and Switzerland), using the Child Behavioural Checklist (CBCL) and the Youth Self-Report (YSR). Differences in psychological functioning and peer relationships were found in gender diverse adolescents across Europe. Overall, emotional and behavioural problems and peer relationship problems were most prevalent in adolescents from the UK, followed by Switzerland and Belgium. The least behavioural and emotional problems and peer relationship problems were reported by adolescents from The Netherlands. Across the four clinics, a similar pattern...
Fertility and Sterility, 2017
Child psychiatry and human development, Jan 18, 2017
Evidence from general population studies shows the contribution of various temperament traits to ... more Evidence from general population studies shows the contribution of various temperament traits to the development of child psychopathology. Little is known about which traits are associated with internalizing and externalizing problems in young clinically referred children. The current study assessed temperament and internalizing and externalizing problems in 216 referred children (M = 4.35 years, SD 0.89, 81% boys). A comparison was made with an age and gender matched general population sample. Referred children showed less effortful control than general population children. Less effortful control and more negative affectivity were associated with more internalizing and externalizing problems across groups. Surgency, and specifically temperamental impulsivity, was more strongly associated with externalizing problems in referred children compared to general population. Less soothability, less inhibitory control and more frustration predicted (sub)clinical levels of comborbid internal...
LGBT health, 2017
Controversy exists as to if, and when, gender affirmative (GA) treatment should be offered to ind... more Controversy exists as to if, and when, gender affirmative (GA) treatment should be offered to individuals with gender dysphoria (GD) and co-existing psychosis. Concerns exist regarding a high risk of misdiagnosis, regret afterward due to impulsive decision making, and deterioration of psychotic symptoms. This case series aims at extending the sparse literature on GA treatment in this population by identifying challenges in diagnosis and treatment and offering recommendations to overcome them. The authors present case descriptions of two transgender men and two transgender women in the age range of 29-57 years with a diagnosis of GD and a schizophrenia-related diagnosis. All had undergone GA treatment with a minimum follow-up of 3 years. The gender diagnosis was complicated by the fact that feelings of GD were only shared after the onset of psychosis, and GA treatment was hampered by the persistence of mild psychotic symptoms despite antipsychotic treatment. Close communication with ...
Pediatrics, 2017
In various Western countries early medical gender-affirmative treatment has become increasingly a... more In various Western countries early medical gender-affirmative treatment has become increasingly available for transgender adolescents. Research conducted before the start of medical gender-affirming treatment has focused on psychological and social functioning, and knowledge about the sexual health of this specific young group is lacking. Gender identity clinics referred 137 adolescents: 60 transgirls (birth-assigned boys, mean age 14.11 years, SD 2.21) and 77 transboys (birth assigned girls, mean age 15.14 years, SD 2.09; P = .05). A questionnaire on sexual experiences (kissing, petting while undressed, sexual intercourse), romantic experiences (falling in love, romantic relationships), sexual orientation, negative sexual experiences, and sexual satisfaction was administered. Experiences of the transgender adolescents were compared with data for same-aged youth of a Dutch general population study (N = 8520). Of the transgender adolescents, 77% had fallen in love, 50% had had a roma...
Introduction: For youth with psychiatric conditions, sexual and gender identity development can b... more Introduction: For youth with psychiatric conditions, sexual and gender identity development can be challenging. Mental health care professionals (MHPs) often avoid communication about sexuality, sexual side effects, and gender diversity with youth. The aim of this study is to gain insight into the perspectives of youth in mental health care and professionals about sexuality and gender diversity communication. Methods: In-depth interviews with 21 adolescent patients (aged 15–22 years) and focus groups were conducted with 20 MHPs (aged 26–55 years) at a mental health care institution in Amsterdam. During analysis, the experiences, needs, and underlying inhibiting and facilitating factors of both groups were derived and analyzed. Results: Both youth patients and MHPs stated that sexuality and gender identity should be a part of mental health care. Youth described the impact and interplay between mental health, sexuality (e.g., sexual experiences, romantic relations, sexual orientation)...
BMC Medical Ethics
Background Decision-making competence is a complex concept in the care for transgender and gender... more Background Decision-making competence is a complex concept in the care for transgender and gender diverse adolescents, since this type of care concerns one’s developing gender identity and involves treatment options that often lack international consensus. Even despite competence assessments, moral challenges arise in the decision-making process. Here, traditional forms of clinical ethics support such as moral case deliberation might not fit as these do not provide thematic guidance. This study therefore aimed to develop a practice-oriented ethics support tool to assist care providers when dealing with moral challenges around decision-making competence in transgender adolescent care. Methods The study followed a participatory design to develop a tool in close collaboration with care providers; they had a say in all phases of development and dissemination. Firstly, nine care providers were interviewed about experienced moral challenges and needs for ethics support. Based on this, the...
BMJ Open, 2021
IntroductionGender Identity Development Services (GIDS) worldwide have experienced a significant ... more IntroductionGender Identity Development Services (GIDS) worldwide have experienced a significant increase in referrals in recent years. However, little is currently known about the experiences of the children and young people (CYP) and their families attending these services and the influences on their well-being. Most published qualitative studies have explored gender identity and gender questioning CYP from either a parental perspective or in an adolescent sample. Consequently, there is a need for research to explore the voices of younger children and adolescents who are referred to GIDS. This study aims to address current gaps in understanding of the experiences of CYP referred to the UK GIDS, specifically regarding the personal, familial, educational, and social contexts in which CYP and their parents/caregivers are navigating gender identity, social and physical transition, and the healthcare system.Methods and analysisA prospective longitudinal qualitative study examining the ...
European Child & Adolescent Psychiatry, 2020
Pediatrics, 2020
OBJECTIVES: Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender d... more OBJECTIVES: Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender dysphoria. In this study, we aim to inform prescribing professionals on the long-term effects of PS treatment on the development of sex characteristics and surgical implications. METHODS: Participants received PS according to the Endocrine Society guideline at Tanner 2 or higher. Data were collected from adolescents who received PS between 2006 and 2013 and from untreated transgender controls. Data collection pre- and post-PS and before surgery included physical examination and surgical information. RESULTS: In total, 300 individuals (184 transgender men and 116 transgender women) were included. Of these, 43 individuals started PS treatment at Tanner 2/3, 157 at Tanner 4/5, and 100 used no PS (controls). Breast development was significantly less in transgender men who started PS at Tanner 2/3 compared with those who started at Tanner 4/5 and controls. Mastectomy was more frequently omitte...
The Journal of Sexual Medicine, 2020
Background There is a general lack of recommendations for and basic information tailored at sexol... more Background There is a general lack of recommendations for and basic information tailored at sexologists and other health-care professionals for when they encounter trans people in their practice. Aim We present to clinicians an up-to-date overview of clinical consensus statements on trans health care with attention for sexual function and satisfaction. Methods The task force consisted of 7 clinicians experienced in trans health care, selected among European Society for Sexual Medicine (ESSM) scientific committee. The consensus was guided by clinical experience and a review of the available literature and by interactive discussions on trans health, with attention for sexual function and satisfaction where available. Outcomes The foci of the study are assessment and hormonal aspects of trans health care. Results As the available literature for direct recommendations was limited, most of the literature was used as background or indirect evidence. Clinical consensus statements were deve...
Psychosomatic Medicine, 2019
The Journal of Sexual Medicine, 2018
Background Information on the psychosexual outcome of individuals with disorders of sex developme... more Background Information on the psychosexual outcome of individuals with disorders of sex development (DSDs) and intersex conditions is of great importance for sex assignment at birth of newborns with DSD. Aim To assess gender change and gender dysphoria in a large sample of individuals with different DSDs. Methods A cross-sectional study was conducted in 14 European centers with 1,040 participants (717 female-identifying and 311 male-identifying persons and 12 persons identifying with another gender) with different forms of DSD. The cohort (mean age = 32.36 years, SD = 13.57) was divided into 6 major subgroups: women with 45,X DSD and variants (Turner syndrome; n = 325), men with 47,XXY DSD and variants (Klinefelter syndrome; n = 219), women with XY DSD without androgen effects (n = 107) and with androgen effects (n = 63), men with XY DSD (n = 87), and women with 46,XX congenital adrenal hyperplasia (n = 221). Data on psychosexual outcome were gathered by medical interviews and quest...
Journal of Psychosomatic Research, 2018
Journal of Child Psychology and Psychiatry, 2018
Journal of the American Academy of Child & Adolescent Psychiatry, 2018
Archives of sexual behavior, Jan 18, 2018
Treatment teams providing transgender-affirming medical care are inherently faced with various ki... more Treatment teams providing transgender-affirming medical care are inherently faced with various kinds of moral and ethical dilemmas and questions, which are becoming even more pressing due to increasing treatment numbers and public attention for transgender care. Little is known about what kinds of moral and ethical challenges manifest in clinical practice. The aim of the present research was to map the moral and ethical challenges of healthcare professionals working in a specialized multidisciplinary transgender care center. Over a period of 7 months, during a focused ethnographic study, data were collected through participant observation of multidisciplinary team meetings, observation of individual psychodiagnostic assessment sessions with clients, and analysis of transcripts and reports of a series of moral case deliberations. A thematic content analysis of the data identified various implicit and explicit moral and ethical challenges around the following six themes: (1) assessing...
Journal of the American Academy of Child and Adolescent Psychiatry, 2018
European child & adolescent psychiatry, Jan 18, 2017
Adolescents seeking professional help with their gender identity development often present with p... more Adolescents seeking professional help with their gender identity development often present with psychological difficulties. Existing literature on psychological functioning of gender diverse young people is limited and mostly bound to national chart reviews. This study examined the prevalence of psychological functioning and peer relationship problems in adolescents across four European specialist gender services (The Netherlands, Belgium, the UK, and Switzerland), using the Child Behavioural Checklist (CBCL) and the Youth Self-Report (YSR). Differences in psychological functioning and peer relationships were found in gender diverse adolescents across Europe. Overall, emotional and behavioural problems and peer relationship problems were most prevalent in adolescents from the UK, followed by Switzerland and Belgium. The least behavioural and emotional problems and peer relationship problems were reported by adolescents from The Netherlands. Across the four clinics, a similar pattern...
Fertility and Sterility, 2017
Child psychiatry and human development, Jan 18, 2017
Evidence from general population studies shows the contribution of various temperament traits to ... more Evidence from general population studies shows the contribution of various temperament traits to the development of child psychopathology. Little is known about which traits are associated with internalizing and externalizing problems in young clinically referred children. The current study assessed temperament and internalizing and externalizing problems in 216 referred children (M = 4.35 years, SD 0.89, 81% boys). A comparison was made with an age and gender matched general population sample. Referred children showed less effortful control than general population children. Less effortful control and more negative affectivity were associated with more internalizing and externalizing problems across groups. Surgency, and specifically temperamental impulsivity, was more strongly associated with externalizing problems in referred children compared to general population. Less soothability, less inhibitory control and more frustration predicted (sub)clinical levels of comborbid internal...
LGBT health, 2017
Controversy exists as to if, and when, gender affirmative (GA) treatment should be offered to ind... more Controversy exists as to if, and when, gender affirmative (GA) treatment should be offered to individuals with gender dysphoria (GD) and co-existing psychosis. Concerns exist regarding a high risk of misdiagnosis, regret afterward due to impulsive decision making, and deterioration of psychotic symptoms. This case series aims at extending the sparse literature on GA treatment in this population by identifying challenges in diagnosis and treatment and offering recommendations to overcome them. The authors present case descriptions of two transgender men and two transgender women in the age range of 29-57 years with a diagnosis of GD and a schizophrenia-related diagnosis. All had undergone GA treatment with a minimum follow-up of 3 years. The gender diagnosis was complicated by the fact that feelings of GD were only shared after the onset of psychosis, and GA treatment was hampered by the persistence of mild psychotic symptoms despite antipsychotic treatment. Close communication with ...
Pediatrics, 2017
In various Western countries early medical gender-affirmative treatment has become increasingly a... more In various Western countries early medical gender-affirmative treatment has become increasingly available for transgender adolescents. Research conducted before the start of medical gender-affirming treatment has focused on psychological and social functioning, and knowledge about the sexual health of this specific young group is lacking. Gender identity clinics referred 137 adolescents: 60 transgirls (birth-assigned boys, mean age 14.11 years, SD 2.21) and 77 transboys (birth assigned girls, mean age 15.14 years, SD 2.09; P = .05). A questionnaire on sexual experiences (kissing, petting while undressed, sexual intercourse), romantic experiences (falling in love, romantic relationships), sexual orientation, negative sexual experiences, and sexual satisfaction was administered. Experiences of the transgender adolescents were compared with data for same-aged youth of a Dutch general population study (N = 8520). Of the transgender adolescents, 77% had fallen in love, 50% had had a roma...