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Table 2 The different groups of gender dysphoric adolescents seeking SR

From: Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development

Early onset gender dysphoria, exacerbates in puberty
a) with no with no significant psychopathology and developmental problems (n = 2) b) with considerable psychopathology and developmental problems (n = 3)
• very mild or no psychopathology across childhood and until the assessment • severe psychopathology that had previously and currently required specialist level child and adolescent psychiatric care (autism spectrum disorder, OCD, Tourette, anorexia nervosa, suspected psychotic episodes or psychosis high risk, specific learning difficulties)
Adolescent onset gender dysphoria, where transsexual identity appeared established
c) without, or with only mild psychopathology and developmental difficulties (n = 10) d) with severe psychopathology and developmental difficulties (n = 9)
• mild to moderate depression or anxiety, could be considered secondary to gender dysphoria, or was transient, and did not impair functioning in social relationships or school • psychiatric problems that warranted specialist level adolescent psychiatric treatment, either in treatment at the beginning of their SR assessment, or treatment contact was arranged during the SR assessment
• age-appropriate social relationships and leisure time activities, participation in age-appropriate educational activities (comprehensive, vocational or upper secondary school) • autism spectrum disorders (3), major depression (3), social phobia (5), substance abuse problems (1) or a history of conduct disorder and trauma (2) (several had two disorders); clearly more severe psychopathology than what was seen in group c
e) Adolescent onset gender dysphoria, identity confused development (n = 23)
• In childhood, no gender dysphoria nor cross-gender behaviors
• For most of their primary school years (age 7–12 years) felt excluded
• Persistent experiences of bullying before the onset of gender dysphoria
• In adolescence, social anxiety and depression, most often with self-harm and suicidal preoccupation if not suicide attempts
• Isolated
• Long periods of not attending school, or if attended school, did not engage in peer contacts outside learning situations arranged by teachers.
• Did not meet with same-aged peers in leisure time, or they met with few peers and only if their parents arranged it; many in contact only with their family members.
• Socially and/or academically marginalized
• Very high expectations that SR would solve their problems in social, academic, occupational and mental health domains