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Ergenlerde Cinsiyet Hoşnutsuzluğu

Year 2022, Volume: 22 Issue: 2, 124 - 130, 09.09.2022
https://doi.org/10.26650/jchild.2022.830652

Abstract

Doğumda genetik ve biyolojik olarak belirlenmiş cinsiyet ile cinsiyet kimliğinin uyuşmaması cinsiyet disforisi (cinsiyet hoşnutsuzluğu) olarak tanımlanmaktadır. Çocukluk yaşlarından itibaren görülmekle beraber sekonder seks karakterlerinin geliştiği ergenlik döneminde bu tablo ağırlaşmaktadır. Bu nedenle DSM-V tanı kriterleri ile birey değerlendirilmeli gerekli tıbbi onamlar alındıktan sonra geri dönüşümlü bir tedavi olan GnRH agonistleri ile önce puberte baskılanmalı ve tıbbi endikasyon konulan hastalarda bir sonraki aşama olan istenen cinsiyet yönünde puberte indüksiyonu uygulanmalıdır. Daha sonraki aşamada ise uygun vakalarda cinsiyet değiştirici ameliyatlar yapılmaktadır. Bu ameliyatlar tam olarak geri dönüşümsüz olup uygun endikasyonlar açısından çok titiz davranılmalı ve operasyon kararı için acele edilmemelidir. Bu konuda tam bir konsensus sağlanmalıdır. Ameliyat kararı alınan hastalar için operasyon öncesinde doğurganlık ile ilgili tüm seçenekler ayrıntıları ile sunulmalıdır. Tüm bunların yanında sağlıklı nesillerin devamı açısından cinsel disforisi olan ergenleri yaftalamaktan kaçınılmalı ve bu bireylere tedavinin her aşamasında eşlik eden psikopatolojik durumlar nedeniyle psikolojik destek sağlanmalıdır.

Supporting Institution

YOK

References

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  • 2. Skordis N, Kyriakou A, Dror S, Mushailov A, Nicolaides NC. Gender dysphoria in children and adolescents: an overview. Hormones (Athens) 2020;19(3):267-76. google scholar
  • 3. Claahsen-van der Grinten H, Verhaak C, Steensma T, Middelberg T, Roeffen J, Klink D. Gender incongruence and gender dysphoria in childhood and adolescence- current insights in diagnostics, management, and follow-up. Eur J Pediatr 2021;180(5):1349-57. google scholar
  • 4. Matthys I, Defreyne J, Elaut E, Fisher AD, Kreukels BPC, Staphorsius A, et al. Positive and Negative Affect Changes during Gender-Affirming Hormonal Treatment: Results from the European Network for the Investigation of Gender Incongruence (ENIGI). J Clin Med 2021;10(2):296. google scholar
  • 5. Liszewski W, Peebles JK, Yeung H, Arron S. Persons of Nonbinary Gender - Awareness, Visibility, and Health Disparities. N Engl J Med 2018;379:2391. google scholar
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  • 13. Gooren L. The biology of human psychosexual differentiation. Horm Behav 2006;50(4):589-601. google scholar
  • 14. Dessens AB, Slijper FM, Drop SL. Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Arch Sex Behav 2005;34:389-97. google scholar
  • 15. de Vries AL, Doreleijers TA, Steensma TD, Cohen-Kettenis PT. Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry 2011;52(11):1195-202. google scholar
  • 16. Wallien MS, Zucker KJ, Steensma TD, Cohen- Kettenis PT. 2D: 4D finger-length ratios in children and adults with gender identity disorder. Hormones and Behavior 2008;54(3):450-4. google scholar
  • 17. van Beijsterveldt CE, Hudziak JJ, Boomsma DI. Genetic and environmental influences on cross-gender behavior and relation to behavior problems: a study of Dutch twins at ages 7 and 10 years. Arch Sex Behav 2006;35(6):647-58. google scholar
  • 18. Blanchard R, Zucker KJ, Cohen-Kettenis PT, Gooren LJ, Bailey JM. Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males. Archives of Sexual Behavior 1996;25(5):495-514. google scholar
  • 19. Hoekzema E, Schagen SE, Kreukels BP, Veltman DJ, Cohen-Kettenis PT, Delemarre-van de Waal H, et al. Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain. Psychoneuroendocrinology 2015;55:59-71. google scholar
  • 20. Coleman E, Bockting W, Botzer M, Cohen- Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender- nonconforming people, version 7. International Journal of Transgenderism 2012;13(4):165-232. google scholar
  • 21. Schagen SE, Cohen-Kettenis PT, Delemarre-van de Waal HA, Hannema SE. Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. J Sex Med 2016;13(7):1125-32. google scholar
  • 22. Mansfield MJ, Beardsworth DE, Loughlin JS, Crawford JD, Bode HH, Rivier J, et al. Long-term treatment of central precocious puberty with a long-acting analogue of luteinizing hormone-releasing hormone. Effects on somatic growth and skeletal maturation. N Engl J Med 1983;309(21):1286-90. google scholar
  • 23. Lee PA, Klein K, Mauras N, Neely EK, Bloch CA, Larsen L, et al. Efficacy and safety of leuprolide acetate 3-month depot 11.25 milligrams or 30 milligrams for the treatment of central precocious puberty. J Clin Endocrinol Metab 2012;97:1572. google scholar
  • 24. Klein K, Yang J, Aisenberg J, Wright N, Kaplowitz P, Lahlou N, et al. Efficacy and safety of triptorelin 6-month formulation in patients with central precocious puberty. J Pediatr Endocrinol Metab 2016; 29:1241. google scholar
  • 25. Eugster EA, Clarke W, Kletter GB, Lee PA, Neely EK, Reiter EO, et al. Efficacy and safety of histrelin subdermal implant in children with central precocious puberty: a multicenter trial. J Clin Endocrinol Metab 2007;92:1697-704. google scholar
  • 26. Olson J, Garofalo R. The peripubertal gender-dysphoric child: puberty suppression and treatment paradigms. Pediatr Ann 2014;43(6):e132-e137. google scholar
  • 27. de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 2011;8(8):2276-83. google scholar
  • 28. Rafferty J, AAP Committee on Psychosocial Aspect of Child and Familiy Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay, Bisexual, and Transgender Health. Ensuring Comprehensive Care and Support for Transgender and Gender- Diverse Children and Adolescents. Pediatrics 2018;142(4):e20182162 google scholar
  • 29. Siomou E, Kosmeri C, Pavlou M, Vlahos AP, Argyropoulou MI, Siamopoulou A. Arterial hypertension during treatment with triptorelin in a child with Williams-Beuren syndrome. Pediatr Nephrol 2014;29(9):1633-6. google scholar
  • 30. Hough D, Bellingham M, Haraldsen IR, McLaughlin M, Rennie M, Robinson JE, et al. Spatial memory is impaired by peripubertal GnRH agonist treatment and testosterone replacement in sheep. Psychoneuroendocrinology 2017;75:173-82. google scholar
  • 31. Chew D, Anderson J, Williams K, May T, Pang K. Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review. Pediatrics 2018;141(4):e20173742. google scholar
  • 32. Klink D, Caris M, Heijboer A, van Trotsenburg M, Rotteveel J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross- sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab 2015;100(2):270-5. google scholar
  • 33. Drescher J, Cohen-Kettenis P, Winter S. Minding the body: situating gender identity diagnoses in the ICD-11. Int Rev Psychiatry 2012;24(6):568-77. google scholar
  • 34. Olson J, Forbes C, Belzer M. Management of the transgender adolescent. Arch Pediatr Adolesc Med 2011;165:171-6. google scholar
  • 35. Jones SC. Subcutaneous estrogen replacement therapy. J Reprod Med 2004;49(3):139-42. google scholar
  • 36. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006;91(6):1995-2010. google scholar
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  • 39. Levy A, Crown A, Reid R. Endocrine intervention for transsexuals. Clin Endocrinol (Oxf) 2003;59(4):409-18. google scholar
  • 40. Fisher AD, Castellini G, Ristori J, Casale H, Cassioli E, Sensi C, et al. Cross-Sex Hormone Treatment and Psychobiological Changes in Transsexual Persons: Two-Year Follow-Up Data. J Clin Endocrinol Metab 2016;101:4260-9. google scholar
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  • 44. Kaçamak D, Özbaran B. Ergenlerde Cinsiyet Disforisi. Bildik T, editör. Ergenlik Dönemi ve Ruhsal Bozukluklar. Ankara: Türkiye Klinikleri; 2018. p.201-206. google scholar
  • 45. Turan Başara G. Türk Medeni Kanunu’nun 40’ıncı maddesi kapsamında cinsiyet değişikliği ve hukuki sonuçları. Türkiye Barolar Birliği Dergisi 2012;103:245-66. google scholar
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Gender Dysphoria in Adolescents

Year 2022, Volume: 22 Issue: 2, 124 - 130, 09.09.2022
https://doi.org/10.26650/jchild.2022.830652

Abstract

The incompatibility of genetically and biologically determined gender at birth and gender identity is defined as gender dysphoria (gender discontentment). Although it is seen from childhood, this picture is aggravated in adolescence when secondary sex characteristics develop. Therefore, the individual should be evaluated with the DSM-V diagnostic criteria, and after obtaining the necessary medical consents, puberty should be suppressed with GnRH agonists, which is a reversible treatment, and the next step, puberty induction, should be applied in patients with medical indications. For sex-changing surgeries, rushing should be avoided as it is completely irreversible, and the subject should be considered in detail. In case of an indication, all fertility options should be presented in detail before the operation. In addition to all these, stigmatizing adolescents with sexual dysphoria should be avoided for the continuation of healthy generations, and psychological support should be provided to these individuals due to the psychopathological conditions accompanying them at every stage of treatment.

References

  • 1. American Psychiatric Association. Gender dysphoria. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p.451. google scholar
  • 2. Skordis N, Kyriakou A, Dror S, Mushailov A, Nicolaides NC. Gender dysphoria in children and adolescents: an overview. Hormones (Athens) 2020;19(3):267-76. google scholar
  • 3. Claahsen-van der Grinten H, Verhaak C, Steensma T, Middelberg T, Roeffen J, Klink D. Gender incongruence and gender dysphoria in childhood and adolescence- current insights in diagnostics, management, and follow-up. Eur J Pediatr 2021;180(5):1349-57. google scholar
  • 4. Matthys I, Defreyne J, Elaut E, Fisher AD, Kreukels BPC, Staphorsius A, et al. Positive and Negative Affect Changes during Gender-Affirming Hormonal Treatment: Results from the European Network for the Investigation of Gender Incongruence (ENIGI). J Clin Med 2021;10(2):296. google scholar
  • 5. Liszewski W, Peebles JK, Yeung H, Arron S. Persons of Nonbinary Gender - Awareness, Visibility, and Health Disparities. N Engl J Med 2018;379:2391. google scholar
  • 6. Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine Treatment of Gender-Dysphoric/ Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017;102(11):3869-903. doi: 10.1210/jc.2017-01658. Erratum in: J Clin Endocrinol Metab. 2018 Feb 1;103(2):699. Erratum in: J Clin Endocrinol Metab. 2018 Jul 1;103(7):2758-2759. google scholar
  • 7. Zucker KJ. Gender identity development and issues. Child Adolesc Psychiatr Clin N Am 2004;13:551. google scholar
  • 8. Klein DA, Roberts TA, Adirim TA, Landis CA, Susi A, Schvey NA, et al. Transgender Children and Adolescents Receiving Care in the US Military Health Care System. JAMA Pediatr 2019;173(5):491-2. google scholar
  • 9. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People The World Professiona Association for Transgender Health. Available:https://www.wpath.org/media/ cms/Documents/SOC%20v7/Standards%20of%20Care_V7%20 Full%20Book_English.pdf/ Accessed date: 20/08/ 2020 google scholar
  • 10. Winter S, Diamond M, Green J, Karasic D, Reed T, Whittle S, et al. Transgender people: health at the margins of society. Lancet. 2016;388(10042):390-400. google scholar
  • 11. Johns MM, Lowry R, Andrzejewski J, Barrios LC, Zewditu Demissie Z, McManus T, et al. Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students - 19 States and Large Urban School Districts, 2017. MMWR Morb Mortal Wkly Rep 2019; 68:67. google scholar
  • 12. Rider GN, McMorris BJ, Gower AL, Coleman E, Eisenberget ME. Health and Care Utilization of Transgender and Gender Nonconforming Youth: A Population-Based Study. Pediatrics 2018; 141. google scholar
  • 13. Gooren L. The biology of human psychosexual differentiation. Horm Behav 2006;50(4):589-601. google scholar
  • 14. Dessens AB, Slijper FM, Drop SL. Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Arch Sex Behav 2005;34:389-97. google scholar
  • 15. de Vries AL, Doreleijers TA, Steensma TD, Cohen-Kettenis PT. Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry 2011;52(11):1195-202. google scholar
  • 16. Wallien MS, Zucker KJ, Steensma TD, Cohen- Kettenis PT. 2D: 4D finger-length ratios in children and adults with gender identity disorder. Hormones and Behavior 2008;54(3):450-4. google scholar
  • 17. van Beijsterveldt CE, Hudziak JJ, Boomsma DI. Genetic and environmental influences on cross-gender behavior and relation to behavior problems: a study of Dutch twins at ages 7 and 10 years. Arch Sex Behav 2006;35(6):647-58. google scholar
  • 18. Blanchard R, Zucker KJ, Cohen-Kettenis PT, Gooren LJ, Bailey JM. Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males. Archives of Sexual Behavior 1996;25(5):495-514. google scholar
  • 19. Hoekzema E, Schagen SE, Kreukels BP, Veltman DJ, Cohen-Kettenis PT, Delemarre-van de Waal H, et al. Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain. Psychoneuroendocrinology 2015;55:59-71. google scholar
  • 20. Coleman E, Bockting W, Botzer M, Cohen- Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender- nonconforming people, version 7. International Journal of Transgenderism 2012;13(4):165-232. google scholar
  • 21. Schagen SE, Cohen-Kettenis PT, Delemarre-van de Waal HA, Hannema SE. Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. J Sex Med 2016;13(7):1125-32. google scholar
  • 22. Mansfield MJ, Beardsworth DE, Loughlin JS, Crawford JD, Bode HH, Rivier J, et al. Long-term treatment of central precocious puberty with a long-acting analogue of luteinizing hormone-releasing hormone. Effects on somatic growth and skeletal maturation. N Engl J Med 1983;309(21):1286-90. google scholar
  • 23. Lee PA, Klein K, Mauras N, Neely EK, Bloch CA, Larsen L, et al. Efficacy and safety of leuprolide acetate 3-month depot 11.25 milligrams or 30 milligrams for the treatment of central precocious puberty. J Clin Endocrinol Metab 2012;97:1572. google scholar
  • 24. Klein K, Yang J, Aisenberg J, Wright N, Kaplowitz P, Lahlou N, et al. Efficacy and safety of triptorelin 6-month formulation in patients with central precocious puberty. J Pediatr Endocrinol Metab 2016; 29:1241. google scholar
  • 25. Eugster EA, Clarke W, Kletter GB, Lee PA, Neely EK, Reiter EO, et al. Efficacy and safety of histrelin subdermal implant in children with central precocious puberty: a multicenter trial. J Clin Endocrinol Metab 2007;92:1697-704. google scholar
  • 26. Olson J, Garofalo R. The peripubertal gender-dysphoric child: puberty suppression and treatment paradigms. Pediatr Ann 2014;43(6):e132-e137. google scholar
  • 27. de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 2011;8(8):2276-83. google scholar
  • 28. Rafferty J, AAP Committee on Psychosocial Aspect of Child and Familiy Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay, Bisexual, and Transgender Health. Ensuring Comprehensive Care and Support for Transgender and Gender- Diverse Children and Adolescents. Pediatrics 2018;142(4):e20182162 google scholar
  • 29. Siomou E, Kosmeri C, Pavlou M, Vlahos AP, Argyropoulou MI, Siamopoulou A. Arterial hypertension during treatment with triptorelin in a child with Williams-Beuren syndrome. Pediatr Nephrol 2014;29(9):1633-6. google scholar
  • 30. Hough D, Bellingham M, Haraldsen IR, McLaughlin M, Rennie M, Robinson JE, et al. Spatial memory is impaired by peripubertal GnRH agonist treatment and testosterone replacement in sheep. Psychoneuroendocrinology 2017;75:173-82. google scholar
  • 31. Chew D, Anderson J, Williams K, May T, Pang K. Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review. Pediatrics 2018;141(4):e20173742. google scholar
  • 32. Klink D, Caris M, Heijboer A, van Trotsenburg M, Rotteveel J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross- sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab 2015;100(2):270-5. google scholar
  • 33. Drescher J, Cohen-Kettenis P, Winter S. Minding the body: situating gender identity diagnoses in the ICD-11. Int Rev Psychiatry 2012;24(6):568-77. google scholar
  • 34. Olson J, Forbes C, Belzer M. Management of the transgender adolescent. Arch Pediatr Adolesc Med 2011;165:171-6. google scholar
  • 35. Jones SC. Subcutaneous estrogen replacement therapy. J Reprod Med 2004;49(3):139-42. google scholar
  • 36. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006;91(6):1995-2010. google scholar
  • 37. Pelusi C, Costantino A, Martelli V, Lambertini M, Bazzocchi A, Ponti F, et al. Effects of three different testosterone formulations in female-to-male transsexual persons. J Sex Med 2014;11(12):3002-11. google scholar
  • 38. Moore E, Wisniewski A, Dobs A. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects. J Clin Endocrinol Metab 2003;88(8):3467-73. google scholar
  • 39. Levy A, Crown A, Reid R. Endocrine intervention for transsexuals. Clin Endocrinol (Oxf) 2003;59(4):409-18. google scholar
  • 40. Fisher AD, Castellini G, Ristori J, Casale H, Cassioli E, Sensi C, et al. Cross-Sex Hormone Treatment and Psychobiological Changes in Transsexual Persons: Two-Year Follow-Up Data. J Clin Endocrinol Metab 2016;101:4260-9. google scholar
  • 41. Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, Erwin PJ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf) 2010;72:214-31. google scholar
  • 42. Swiglo BA, Murad MH, Schunemann, HJ, Kunz R, Vigersky RA, Guyatt GH, et al. A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the GRADE system. Journal of Clinical Endocrinology and Metabolism 2008;93:666-73. google scholar
  • 43. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. British Medical Journal 2004;328:1490- 4. google scholar
  • 44. Kaçamak D, Özbaran B. Ergenlerde Cinsiyet Disforisi. Bildik T, editör. Ergenlik Dönemi ve Ruhsal Bozukluklar. Ankara: Türkiye Klinikleri; 2018. p.201-206. google scholar
  • 45. Turan Başara G. Türk Medeni Kanunu’nun 40’ıncı maddesi kapsamında cinsiyet değişikliği ve hukuki sonuçları. Türkiye Barolar Birliği Dergisi 2012;103:245-66. google scholar
  • 46. https://www.resmigazete.gov.tr/eskiler/2010/03/20100306-10. htm (accessed date: 25/08/2020) google scholar
There are 46 citations in total.

Details

Primary Language English
Subjects Paediatrics
Journal Section Review
Authors

Hüseyin Dağ 0000-0001-7596-7687

Firdevs Baş 0000-0001-9689-4464

Publication Date September 9, 2022
Published in Issue Year 2022 Volume: 22 Issue: 2

Cite

APA Dağ, H., & Baş, F. (2022). Gender Dysphoria in Adolescents. Journal of Child, 22(2), 124-130. https://doi.org/10.26650/jchild.2022.830652
AMA Dağ H, Baş F. Gender Dysphoria in Adolescents. Journal of Child. September 2022;22(2):124-130. doi:10.26650/jchild.2022.830652
Chicago Dağ, Hüseyin, and Firdevs Baş. “Gender Dysphoria in Adolescents”. Journal of Child 22, no. 2 (September 2022): 124-30. https://doi.org/10.26650/jchild.2022.830652.
EndNote Dağ H, Baş F (September 1, 2022) Gender Dysphoria in Adolescents. Journal of Child 22 2 124–130.
IEEE H. Dağ and F. Baş, “Gender Dysphoria in Adolescents”, Journal of Child, vol. 22, no. 2, pp. 124–130, 2022, doi: 10.26650/jchild.2022.830652.
ISNAD Dağ, Hüseyin - Baş, Firdevs. “Gender Dysphoria in Adolescents”. Journal of Child 22/2 (September 2022), 124-130. https://doi.org/10.26650/jchild.2022.830652.
JAMA Dağ H, Baş F. Gender Dysphoria in Adolescents. Journal of Child. 2022;22:124–130.
MLA Dağ, Hüseyin and Firdevs Baş. “Gender Dysphoria in Adolescents”. Journal of Child, vol. 22, no. 2, 2022, pp. 124-30, doi:10.26650/jchild.2022.830652.
Vancouver Dağ H, Baş F. Gender Dysphoria in Adolescents. Journal of Child. 2022;22(2):124-30.