Transgender and gender diverse youth seeking specialized healthcare: treatment pathways, satisfaction with care and mental health (TransFollow)

• Applicant: Inga Becker-Hebly, Ph.D.
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine ; Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
• Term: since 2026
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 573880441

The project's primary focus is on three key outcomes concerning transgender and gender diverse (TGD) individuals in relation to specialised healthcare: treatment pathways, satisfaction with care, and mental health among TGD young people. The number of TGD youth being referred to specialised healthcare facilities for treatment of gender dysphoria or gender incongruence is currently increasing, as is the diversity in developmental pathways and clinical presentations exhibited by this group. Clinical guidelines recognise that gender identities and their treatment requirements can vary from person to person. As a result, they encourage individualized treatment decisions that aim to reduce psychological distress through different gender-affirming medical interventions (GAMIs). Examples of these interventions include puberty suppression, gender-affirming hormones, or gender-affirming surgery. Limited prospective clinical research exploring consequences and long-term trajectories among TGD young people indicates that GAMIs can generally be associated with improvements in mental health. However, studies have differed in their design and follow-up periods and have therefore reached different conclusions. Most longitudinal studies have included carefully selected TGD young people who have been treat-ed with one specific protocol (“eligibility”), have ignored the role of mental health support, and have not included data on how many young people choose to detransition or regret their treatment in the long term. Furthermore, the existing empirical evidence may not be relevant to new, more diverse clinical presentations involving in-creased psychological problems that do not meet the eligibility criteria of previous outcome studies. This project will be the second follow-up study in Germany, but the first to provide a mid- to long-term description of a larger cohort. It will follow a naturalistic observational design with young people under routine care at one of the largest German specialised Gender Identity Services (Hamburg GIS). The project will comprise a mid-to-long-term retrospective study (Study 1) and a new prospective study (Study 2). Both studies will examine the following primary outcomes relating to treatment at Hamburg GIS: individual pathways (as opposed to traditional treatment), satisfaction with transition and care (as opposed to regret or detransition) and mental health outcomes. The two studies will address current research questions, such as which clinical characteristics and social factors predict treatment outcomes or wishes, and how outcomes differ between treatment modalities over time. The findings from this project will inform the development of clinical practice and guidelines, educate clinicians and individuals working with transgender and gender diverse (TGD) young people, and improve overall TGD healthcare.

• DFG Programme: Research Grants