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. Author manuscript; available in PMC: 2024 Mar 1.
Published in final edited form as: J Adolesc Health. 2022 Dec 17;72(3):428–436. doi: 10.1016/j.jadohealth.2022.10.020

Table 3.

Codebook descriptions of Shift Reasons

Ongoing Gender Discovery
Wants more life experiences: The young person describes a desire for more time or to wait for a later stage of maturity prior to pursuing the gender-related medical request.
Exploring gender identity: The young person describes ongoing active exploration of gender, such as trying out new identities, pronouns, and/or the ways they express their gender (i.e. outfits, social cues).
Shifts in gender identity: During the monitoring period, the young person described a clear change in their gender identity. For example, they experienced themselves as transmasculine and then later shifted to a nonbinary identity; or they experienced themselves as nonbinary and then shifted to cisgender.
Interpersonal Influences
Lack of support for gender (external): The young person describes actions on the part of the family and larger community that discouraged gender affirmation and medical gender interventions.
Worries about coming out (internal): The young person describes worries that affirming their gender and commencing medical gender intervention would be negatively perceived. In these cases, there was no concrete evidence that the young person’s family was unsupportive of the young person’s gender affirmation.
Perceived peer pressure: The young person describes peer group influences, in person and/or online, that encouraged them to seek gender affirming medical care.
Additional Reasons
Delusions/thought instability: The young person’s delusions or severely shifting moods/cognitions (i.e from schizophrenia or bipolar disorder) were linked directly to self-perceptions of gender and gender-related medical requests. When the presence of delusions or the mood cycle shifted, the gender-related medical request also shifted.
Reluctance towards maleness: The young people (designated female at birth) report a history of negative experiences with cisgender males, and come to express a reluctance toward becoming male, which impacts their gender-related medical requests.