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. 2020 Feb 13;49(2):455–465. doi: 10.1007/s10508-020-01652-8

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© The Author(s) 2020

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — CEOAE response amplitude in the left (a) and right (b) ears of assigned-at-birth male and female control and GD groups for the three age/treatment groups. Error bars represent the 95% confidence interval. CEOAE, click-evoked otoacoustic emission; TN, treatment-naïve; GnRHa, gonadotropin-releasing hormone analog, puberty suppression; CSH, cross-sex hormone treatment; trans girls, female gender identity, male assigned at birth; trans boys, male gender identity, female assigned at birth; early/mid/late, early/mid/late-adolescent age. Pulled over sex and condition, the early/TN group had significantly stronger left-ear CEOAEs than the late/CSH group (*), right-ear CEOAEs were significantly weaker in participants with GD when receiving CSH (plus GnRHa) compared to treatment-naïve participants (*), and the CSH-receiving trans boys had significantly weaker right-ear CEOAEs than the late-adolescent control girls (**),*p ≤ .05; **p ≤ .01