Adverse childhood experiences in transgender and gender diverse youth seeking care

Abstract Background Gender-affirming medical care for transgender and gender diverse (TGD) adolescents remains at the center of socio-political debate. A growing narrative suggests that recent increases in gender clinic referrals may be driven by adolescents with adverse childhood experiences (ACEs), who are presumed to ‘misidentify’ as TGD and to derive limited benefit from gender-affirming care. However, there is currently no empirical evidence supporting temporal increases in ACEs among TGD adolescents or linking ACEs exposure to diminished psychological benefits from care. Methods We examine (1) temporal trends in ACEs prevalence among adolescents referred to gender clinics in the Netherlands (2002-2022), and (2) whether ACEs attenuate reductions in psychological distress following gender-affirming medical care. Data comes from intake records and follow-up assessments during and after care. ACEs are coded across three domains: household challenges, abuse, neglect. ARIMA and regression discontinuity models will assess trends; linear mixed models will evaluate ACEs as moderators of psychological change. Results Data collection is in its final stages, with over 2,000 adolescent clinical intake records spanning two decades already identified and extracted. Analyses of secondary data will commence in June 2025. Conclusions This research will provide the first empirical examination of long-term ACEs trends in TGD youth referred to gender clinics and assess their psychological outcomes following care. Results will inform best practices in clinical settings and potentially challenge/nuance unsupported narratives that restrict access to care.