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BACKGROUND: Facial feminization may be performed to alleviate gender dysphoria among transfeminine patients. The upper third of the face has several characteristics, including hairline shape and position, brow position, and forehead protrusion, that may confer feminine identity. The purpose of this study is to conduct a scoping literature review of techniques performed for forehead feminization and to additionally study clinical outcomes within an institutional cohort. METHODS: A systematic literature review was conducted to review articles that discussed techniques and clinical outcomes associated with procedures performed for feminization of the upper third of the face. A retrospective review of patients undergoing such procedures by the senior author was then conducted. Variables collected included demographic factors, operative details, and postoperative outcomes such as complications, revisions, and re-operations. RESULTS: Initial review yielded sixty-seven articles. Title and abstract review followed by standardized application of inclusion and exclusion criteria resulted in a total of twenty-two studies for analysis. Priorities of forehead feminization entail frontal bossing reduction, frontonasal angle widening, orbital contouring, brow lifting, and hairline advancement. Eighty-five patients were included for analysis. The majority were of Caucasian race (56%) and had type 3 forehead classification (92%). The average planned setback of the anterior table was 4.12 mm. CONCLUSIONS: The core tenets of the feminization of the forehead lie in the overall creation of a harmonic curvature of the forehead with other facial features. Our multi-pronged analysis presents an updated review of these principles, which may help plastic surgeons in performing procedures to feminize the upper third of the face. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

Background: Individuals with GD may suffer from limited access to healthcare services because of negative attitudes from the healthcare providers. Therefore, to promote medical service it is of great importance to address negative attitudes among healthcare providers. The present study aimed to estimate the prevalence of transphobia as well as to assess the association between personality traits and transphobia among students of the University of Medical Sciences, who will hold key positions within the healthcare system. Methods: This cross-sectional study was conducted on 418 students at Tabriz in northwestern Iran in 2024. Convenience sampling method was utilized. Data were gathered through standard self-reported questioners; Genderism and Transphobia Scale (GTS), and Big Five Inventory scale (BFI-44). Linear regression analysis was conducted to estimate standard coefficient with 95% Confidence Intervals (CIs). Results: The response rate was calculated as 98.35% in which 204 (48.8%) out of the participants were female. The mean (SD) age was 23.73 (2.01) years. The adjusted multiple linear regression coefficients indicated that the agreeableness (β = 0.16, p = 0.001), neuroticism (β = 0.11, p = 0.02), and openness (β = -0.27, p = 0.001) were able to effectively explain the variance in transphobia scores. However, conscientiousness (β = 0.06, p = 0.18) and extroversion (β = 0.06, p = 0.05) did not significantly contribute to explaining the variance in transphobia scores. Conclusions: Personality traits may significantly influence attitudes toward transgender individuals, suggesting that interventions designed to reduce transphobia should consider these foundational personality characteristics. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Gender dysphoria is the imparity between a person's experienced gender and their birth-assigned gender. Gender transition is the process of adapting a person's sexual characteristics to match their experienced gender. The number of adults receiving sex hormone therapy for gender dysphoria is increasingly and these pharmacotherapies are increasing being prescribed in a general practice setting. The role of hormone therapy is to reverse or reduce physical sexual characteristics of the birth-assigned gender and enhance and build characteristics aligning to the expressed gender and these therapies apply to both transgender and gender nonconforming patients. Recognizing the options and interpreting the effects of gender transition therapies are fundamental to the discussion and treatment of gender dysphoria. This review summarizes pharmacodynamics, comparative dosing, adverse effects, monitoring, and potential pharmacogenetic influence of current pharmacotherapy. These include the use of 17-beta-estradiol, spironolactone, testosterone, GnRH agonists as well as adjunctive phosphodiesterase-5 inhibitors. The article also addresses gaps within the published literature including optimal routes of administration for individual patients, risks of malignancy and dosing reductions as transgender patients age. [ABSTRACT FROM AUTHOR]

Introduction: Gender dysphoria (GD) is associated with profound mental health challenges, including heightened suicide risk. This study aimed to explore the mental health status and attitudes toward suicide among individuals with GD in Iran. Methods: A comprehensive assessment was conducted using three validated tools: the General Health Questionnaire (GHQ-28) to gauge emotional distress and psychological well-being, the Beck Depression Inventory (BDI-II) to evaluate the severity of depressive symptoms, and the Predicament Questionnaire (PQ) to measure attitudes toward suicide in the context of social crises. Results: Among the 78 participants, 43 (55.1%) were identified as experiencing significant mental health issues, while 21 (26.9%) were found to suffer from severe depression. The average PQ score was 57.92, which aligns with findings from similar populations in previous studies, highlighting a concerning trend in suicide-related attitudes. Further statistical analysis revealed significant correlations between psychological distress (GHQ-28 scores) and attitudes toward suicide (PQ scores), as well as between depressive symptoms (BDI-II scores) and suicide-related attitudes. Conclusions: These findings indicate a pervasive prevalence of psychological disorders, particularly depression, within this group, and underscore the strong association between depressive states and suicidal ideation. The study underscores the urgent need for targeted mental health interventions and comprehensive healthcare policies tailored to the specific needs of individuals with GD in Iran. Given the substantial mental health burden observed, particularly the risk of suicide, this research highlights the critical importance of integrating mental health care into broader support systems for this population. [ABSTRACT FROM AUTHOR]

Background. Overall, children and adolescents diagnosed with dyslexia or ADHD show an increased risk for psychological and mental health problems, and dyslexia and ADHD tend to coexist frequently. Thus, the main objective of this study was to examine psychological and mental health problems in dyslexia. Method. Participated 95 adolescents with dyslexia (DG), comorbid dyslexia + attention-deficit hyperactivity disorder, combined subtype (D + ADHD-CG), and a comparison group with typical development (TDCG). Self-reported measures of anxiety and depression, and parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ) were used. Results. Self-reports of internalizing problems showed that adolescents in the GD and D + ADHD-CG groups had more depression and stated anxiety problems with a very high percentage above the clinical cut-off point than the CG. Both the parent and teacher reports showed that the DG and D + ADHD-CG groups obtained higher mean values and a higher number of adolescents above the clinical cut-off of internalizing, externalizing, and total problems than the TDCG. The comorbid D + ADHD-CG group had the highest internalizing and externalizing problems. Conclusions. In conclusion, our findings indicate that the internalizing and externalizing problems experienced by adolescents with dyslexia and comorbid ADHD should be recognized early and treated promptly by education professionals. [ABSTRACT FROM AUTHOR]

The association between autism spectrum disorder (ASD) and gender dysphoria (GD) has attracted a great deal of interest among child and adolescent psychiatrists in Japan. In clinical settings, it is common to hear complaints or concerns related to GD from adolescents with ASD. In the past few years, several review articles have been published on ASD and GD. The Initial Clinical Guidelines for co-occurring ASD and GD in adolescents were published in 2018, suggesting the increasing need of intervention for these conditions worldwide. Although a large amount of evidence has been accumulated regarding the co-occurrence of ASD and GD, all review articles were based solely on case reports and articles published in English. In this article, we performed a bilingual literature review using English- and Japanese-language literature databases. We found 13 case reports in English and 11 case reports in Japanese. The Japanese literature included articles on gender-related symptoms in ASD, but not limited to ASD with comorbid GD. Wattel and her colleagues proposed 15 theories on the link between ASD and GD. We classified the reported cases into one or more of the fifteen theories proposed by Wattel. These theories seemed useful in understanding the co-occurrence of ASD and GD, especially in AMAB cases. Wattel's 15 theories are categorized into biological, psychological, and social factors, respectively. With regard to the social factors, we discussed Japanese school culture and psychological burden among gender-dysphoric students. Further studies are awaited. [ABSTRACT FROM AUTHOR]

Summary: Gender disappointment can be defined as subjective feelings of sadness when discovering that the sex/gender of a child is the opposite of what the parent had hoped or expected. Wanting a boy (or 'son preference') has long been noted in many cultures, particularly in South and East Asian communities, but it is now becoming more recognised in the UK, Europe and North America. This article aims to improve understanding of gender disappointment by exploring medical and social sciences research; it also discusses the clinical and risk implications of assessing and managing gender disappointment (or not doing so) when individuals present to perinatal and/or community mental health services. [ABSTRACT FROM AUTHOR]

The article explores the argument that obesity should be recognized as a qualifying disability under the Americans with Disabilities Act (ADA) due to weight discrimination faced by millions of adults in the US. It discusses court cases that have addressed the issue, showing a divide in opinions on whether obesity should be considered a disability under the ADA, with some circuits requiring an underlying physiological cause. The text suggests that while the ADA may offer some protections, federal legislation outlawing weight discrimination nationally could be beneficial in addressing the rights of individuals of all body sizes to equal opportunities and freedom from prejudice. [Extracted from the article]

Hormone blockers are defined as substances that suppress the release of sex hormones, thus inhibiting the development of secondary sexual characteristics in teenagers. There is currently an increase in young people seeking healthcare services due to a mismatch between their birth-assigned gender and their perceived or self-identified gender. In early childhood, individuals are not usually affected by their physical appearance. Dysphoria may arise during the initial stages of adolescence and if the self-perceived gender does not align with the external appearance. This may have a negative impact on adolescents' mental health. Could the use of hormone blockers have a positive effect on mental health? The primary objective of this review is to assess whether the use of hormone blockers can have positive effects on the mental health of transgender youth. The review also seeks to evaluate the usage of hormone blockers and the diagnosis of gender dysphoria. A literature search of scientific evidence was conducted across various databases—PUBMED, CUIDEN, ELSEVIER, COCHRANE, DIMENSIONS, SCIELO, PSYCINFO, and CINAHL—alongside a review of the latest publications in high-impact scientific journals and the gray literature. The following terms were used: , , , , , , and . A time period was specified, covering the last ten years (2014–2024). The initial search identified a total of 290 references, which were subsequently narrowed down to 5 studies, with 1 additional study retrieved through other methods. The literature findings are clear. They show that the use of hormone blockers in transgender adolescents can be beneficial, as a reduction in mental health issues was observed during and after their use. Mental healthcare in transgender teenagers is of crucial importance to their physical, psychological, social, and academic spheres. It is also very important for their families. Nurses must be aware of this knowledge to improve the care provided to these individuals and their families during the difficult time surrounding decisions about the use of hormone blockers. [ABSTRACT FROM AUTHOR]

Transgender individuals struggle with a misalignment between their biological and interpersonal self, in order to rectify this issue gender affirming health care is used to re-align the two aspects of themselves. The American Psychiatric Association defines transgender individuals as those who are assigned one gender identity at birth and identify as another later in life (Yarbrough 2023). There are various different gender orientations that a person canidentify with but most of the examples will focus on male-to-female (MTF) or female-to-male (FTM) transgender experiences. The current standard on gender affirming care focuses on various steps of diagnosis, traditional therapy, hormone therapy and surgical interventions (Yarbrough 2023). Transgender children suffer academically and socially due to having an internal struggle with their gender dysphoria, often affecting their everyday life (Boyle 2022). The argument against gender affirming care for minors focuses on the ability of minors to conceptualize the long-lasting effects the care will have on their body as well as the fear theindividual will change their mind over time. The argument for gender affirming care for minors views the issue as necessary medical care that treats a life-threatening issue. This paper will conduct a thorough review of current opinions on gender affirming care for minors, addressing gaps in understanding of what care is given and the effects the care has on the individual with a special note on beneficence, non-maleficence, and autonomy using a deontological ethical framework.

INTRODUCTION: Transgender and nonbinary (TGNB) individuals are highly stigmatized members of society and are significantly at higher risk of having mood or anxiety-related disorders compared to non-TGNB individuals. METHODS: In this retrospective cohort study, antidepressant prescribing data were collected from TGNB adults diagnosed with gender dysphoria (GD) and mood or anxiety-related disorder between January 2005 and October 2021. The primary outcome was to compare the number of active outpatient antidepressant prescriptions at the time of GD diagnosis between gender identities. The secondary outcomes were to compare antidepressant class utilization between gender identities as well as the prevalence of concurrent mood or anxiety-related disorder diagnoses between gender identities. RESULTS: Of 131 patients who met inclusion criteria, there was no significant difference in number of active antidepressant prescriptions between gender identities at the time of the GD diagnosis (p = .357). However, transgender females were prescribed bupropion at significantly higher rates than other gender identities (p = .046). Approximately 38% of patients did not have an active antidepressant prescription at the time of GD diagnosis despite concurrent mood or anxiety-related diagnoses. The prevalence of generalized anxiety disorder was significantly greater among transgender males (p = .044). DISCUSSION: Although the number of active antidepressant prescriptions between gender identities were similar in this study, we found 38% of patients were not prescribed any antidepressants at time of GD and mood or anxiety-related disorders. This serendipitous finding elucidates a potential gap in mental health care among transgender adults.

ABSTRACT Objectives: Establishing a stable identity is considered an important developmental task during adolescence. One salient identity domain is gender identity or the inner sense of gender. Gender dysphoria (GD) may occur when this inner sense of gender does not align with the sex registered at birth. Both poorer overall identity development and GD have been connected to mental health problems in adolescence. The aim of this study was to investigate the associations between mental health problems and identity development among adolescents with GD. Materials and methods: We conducted a study on 114 adolescents (94 birth-registered females and 20 birth-registered males, aged 12–18 (mean age (sd) 16.2 (0.1) years) seeking medical gender reassignment (GR) in specialized gender identity services in Finland. Identity development was measured in terms of “impaired personality functioning” with the 58-item self-report questionnaire Assessment of Identity Development in Adolescence (AIDA). Psychiatric morbidity was assessed by reference to previous psychiatric treatment history, ICD-10 psychiatric diagnoses and psychiatric symptoms recorded in the participants’ case histories before and during the gender identity assessment. The data were analysed using cross-tabulations with chi-square statistics and t-test, and multivariate associations using linear and logistic regression as appropriate. Results: Contrary to our expectations, the AIDA scores were not associated with psychiatric morbidity variables. We suggest that it is, thus, imperative to conduct a comprehensive and holistic evaluation of adolescents seeking medical GR, not relying solely on self-reports. However, higher AIDA scores indicating poorer identity development were connected to not being considered eligible for medical GR. Conclusions: The inclusion of identity development self-assessment can only provide some indications on overall maturity and preparedness for medical GR.

Abstract Context Clinical data on transgender children and adolescents are scarce, and sample sizes often do not allow for comparisons according to sex assigned at birth. Besides, most gender identity clinics have pointed to a recent switch in favor of an increase in the number of adolescents assigned females at birth (AFAB) over assigned males at birth (AMAB). Method We collected data on sociodemographic characteristics, and psychiatric and social vulnerabilities according to sex assigned at birth for all youths who were treated at the French largest gender identity clinic. In addition, management modalities for gender transition were discussed in multidisciplinary concertation meetings. Results We collected data from 239 youths [162(68%) AFAB, 74(32%) AMAB, and 3(1%) intersex; mean age = 14.5(± 3.16) years]. The distribution of age at referral was better explained by two clusters (C1: N = 61, mean age = 11.3 years, with more AMAB; C2: N = 175, mean age = 15.9 years with more AFAB). 215(91%) youths had gender incongruence, with 32% reporting it before puberty. School drop-out, suicidality, depression, and anxiety were common and occurred significantly more often in the AFAB group. 178(74%) youths experienced social transition within the family, and 144(61%) at school [mean age = 15.13(± 2.06) years]. The social transition was more frequent in the AFAB group. Twenty-six (11%) youths received puberty blockers [mean age = 13.87(± 2.31) years], and 105(44%) received gender-affirming hormones [mean age = 16.87(± 1.4) years]. AMABs were more likely to take puberty blockers, and there was no difference in the proportion of AMAB and AFAB taking gender-affirming hormones. Surgical requests (mainly torsoplasty) were very rare. Conclusion Age at referral should be considered when exploring gender incongruence. During adolescence, we found that gender incongruence has substantial social and psychological effects, particularly on AFAB youths, possibly explaining their higher referral rates to specialized centers, as in other specialized clinics around the world.

Abstract Background United States military policies regarding service by transgender service members have shifted several times within the past decade. The relationships between policy changes and electronic health record documentation of gender dysphoria, a current and historic policy requisite for gender affirming care receipt, in active duty service members remain unknown. Methods Bayesian estimator of abrupt change, seasonality, and trend models identified changepoints in the proportion of service members who had new and then historical medical record documentation consistent with gender dysphoria from January 2015 to August 2022. Changepoints were evaluated as they related to salient military policy-related events. Results Approximately 3,853 active duty and activated National Guard or Reserve service members received a documented diagnosis corresponding to gender dysphoria from January 2015 to August 2022. Four significant changepoints were identified across both time series. Salient historical events that occurred during the changepoint periods were identified for contextualization. Conclusions Clinical documentation of gender dysphoria oscillated with changes to policies and public statements by government leaders, which may in turn, impact military recruitment and retention. This study highlights the need for equitable policies that optimize the strength of a diverse military force. Equity-oriented monitoring is needed to continually examine the impact of military service policies on readiness and retention to support actionable, data-driven improvements to policies and their implementation.

Background Objectives and Methods Results Conclusion Longitudinal studies investigating hormone therapy in transgender individuals are rare and often limited to 1‐ to 2‐year follow‐up periods.We examined changes in body composition, muscle volumes, and fat distribution as well as muscle strength, arterial stiffness, and cardiometabolic biomarkers in both transgender men (TM; n = 17, age 25 ± 5 years) and transgender women (TW; n = 16, age 28 ± 5 years) at baseline and after 1 and 5–6 years of hormone therapy in a longitudinal prospective cohort design. Whole‐body and regional fat and muscle volumes were analyzed using magnetic resonance imaging, and blood samples were taken.Skeletal muscle size increased in TM (21% after 6 years) and decreased in TW (7% after 5 years). Muscle strength increased 18% after 6 years in TM (p = 0.003) but was statistically unchanged in TW. Muscle fat infiltration changed (p < 0.05) almost completely toward the affirmed sex phenotype after 1 year of therapy in both TM and TW. The most notable changes in fat volume distribution were that TW increased total adiposity but decreased visceral fat volume, whereas TM showed increased visceral fat (70%) and liver fat but relatively stable total adipose tissue levels. Although arterial stiffness and blood pressure did not change, there was a significant increase in triglyceride and LDL cholesterol levels and a decrease in HDL levels in TM after 6 years.These unique longitudinal data underscore the importance of continued clinical monitoring of the long‐term health effects of gender‐affirming hormone therapy in both TW and, perhaps especially, TM. [ABSTRACT FROM AUTHOR]

Transgender and gender-diverse (TGD) menstruators are individuals assigned female at birth (AFAB)*, who retain the capacity to menstruate and have a gender identity that differs from their natal sex. Reports indicate up to 1.6 million individuals in the US identify as TGD. Until recently, the mainstream menstrual discourse has failed to capture the experience of transmenstruators. However, a better understanding of the menstrual experiences of TGD-AFAB will allow for more individualized patient-centered care. In this review, we provide the relevant data necessary to inform the psychiatric management of menstruation in TGD-AFAB individuals, including experiences of menstruation, preferences for menstrual management, and the impact on mental health. Our review indicates that menstrual care in TGD patients must be tailored to the individual; clinicians should remain open-minded to the unique experience of transmenstruators; gender-affirming menstrual care is necessary to reduce psychological burden. It should not be assumed that TGD-AFAB menstruators are utilizing appropriate contraceptive methods and should receive contraceptive and fertility preservation counseling. We highlight the importance of having these conversations early in the reproductive arch, even before puberty onset. Keeping in mind the gender minority stress model, in the upcoming sections, we discuss the limited body of literature on mood disorders in TGD-AFAB individuals who menstruate, undergo menstrual suppression, or continue to ovulate. The psychological impact of hormonal therapies is also reviewed. [ABSTRACT FROM AUTHOR]

Congenital Adrenal Hyperplasia (CAH) is a group of autosomal recessive endocrine disorders characterized by alteration in adrenal hormonal secretions. The most common form is caused by CYP21A2 mutations that result in 21-hydroxylase deficiency. Clinical features can vary, from salt-wasting forms, characterized by a lack of mineralocorticoid activity with a risk of perinatal-onset adrenal crises, to "simple-virilizing" forms with sufficient aldosterone secretion, up to milder "non-classical" forms, with a variable grade of hyperandrogenism but no severe hormonal deficiencies. During pregnancy, CAH 46,XX fetuses are exposed to elevated androgen levels, leading to a variable grade of virilization and potential central nervous system effects if untreated. These patients are usually (but not always) assigned female at birth, but some cases may be misdiagnosed and assigned male, potentially inducing fertility, gender identity, and sexual behavior issues in adulthood. In these patients, the benefits and risks of a late gender transition should be carefully evaluated. In this paper, we reviewed the literature concerning the most interesting peculiarities of these conditions. [ABSTRACT FROM AUTHOR]

Introduction: The understanding of gender dysphoria (GD) in children and adolescents is limited in Singapore. This study aims to review the presentation of GD in an outpatient psychiatric clinic, to gain insights into its prevalence and associated factors. Method: We conducted a retrospective review of medical records for patients diagnosed with GD according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth and Fifth editions, at the clinic between 1 January 2017 and 31 December 2021. We collected and analysed demographic, medical and other GD-specific clinical variables. Results: The study included 107 participants (mean age 16.6 years), comprising 47 natal males and 60 natal females. The prevalence of GD was found to be 1:5434 (0.019%). Incidence rates increased from 2.17 to 5.85 per 100,000 population between 2017 and 2021. The mean age of diagnosis was 15.6 years, with an average delay of 5 years between experiencing gender identity-related concerns and seeking formal assistance. Approximately 45% of participants reported social and physical transitions, and 20.6% reported self-harm or suicidal thoughts. Conclusion: The study highlights the presentation of GD in an under-researched Asian setting. Supporting individuals with GD in Asia requires sensitivity to cultural and societal factors with a holistic approach to individual well-being. [ABSTRACT FROM AUTHOR]

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A central feature of David McPherson’s 2022 book The Virtues of Limits is the distinction between two existential stances or attitudes toward the human condition: the choosing-controlling stance and the accepting-appreciating stance. This reflection considers the relevance of this distinction for the discipline of bioethics. Bioethics is concerned with how we negotiate some of the more challenging aspects of our human condition and human embodiment such as unexpected pregnancy, gender dysphoria, and pain and suffering at the end of life. This reflection considers whether, in the spirit of McPherson’s Virtues of Limits, one role of bioethics is to highlight the fact that encountering limits on agency vis-à-vis the human condition can in fact be an occasion for flourishing. [ABSTRACT FROM AUTHOR]

Background: United States military policies regarding service by transgender service members have shifted several times within the past decade. The relationships between policy changes and electronic health record documentation of gender dysphoria, a current and historic policy requisite for gender affirming care receipt, in active duty service members remain unknown. Methods: Bayesian estimator of abrupt change, seasonality, and trend models identified changepoints in the proportion of service members who had new and then historical medical record documentation consistent with gender dysphoria from January 2015 to August 2022. Changepoints were evaluated as they related to salient military policy-related events. Results: Approximately 3,853 active duty and activated National Guard or Reserve service members received a documented diagnosis corresponding to gender dysphoria from January 2015 to August 2022. Four significant changepoints were identified across both time series. Salient historical events that occurred during the changepoint periods were identified for contextualization. Conclusions: Clinical documentation of gender dysphoria oscillated with changes to policies and public statements by government leaders, which may in turn, impact military recruitment and retention. This study highlights the need for equitable policies that optimize the strength of a diverse military force. Equity-oriented monitoring is needed to continually examine the impact of military service policies on readiness and retention to support actionable, data-driven improvements to policies and their implementation. [ABSTRACT FROM AUTHOR]

Objective: Transgender and nonbinary adolescents (TNBA) may experience gender dysphoria arising fromincongruities between their body and their gender. Prior dysphoria measures have largely focused on clinical diagnosis with little regard to comparability of forms for people assigned male or female at birth, overall psychometric performance, or applicability to nonbinary populations. This study develops and validates the Transgender Adolescent Stress Survey-Dysphoria (TASS-D), intended to address these gaps. Methods: The current study recruited a U.S. national sample of TNBA (N = 444, aged 12-17; 65.5% White, 9.5% Black, 9.5% Latine, 15.5% other ethnicity; 34.7% transmasculine, 17.3% transfeminine, 38.3% nonbinary, 9.5% agender). The item pool was developed from life history calendars, a modified Delphi process, and cognitive interviews with TNBA. Scale development included factor analysis, item response theory modeling, measurement invariance testing, and reliability analyses. Associations were examined between the TASS-D and existing measures of gender dysphoria (convergent validity), gender minority stress (divergent validity), and behavioral health outcomes (criterion validity). Results: TASS-D and its subscales (body distress and gender expression burden) were significantly and strongly associated with gender dysphoria; significantly but weakly associated with gender minority stress; and significantly associated with most indicators of psychological distress including depressive, anxiety, and posttraumatic stress symptoms, suicidal behaviors and nonsuicidal self-injury. Conclusions: The TASS-D is a reliable and valid measure of gender dysphoria for TNBA, offering notable benefits over existingmeasures: It is psychometrically sound, inclusive of all gender identities, and does not assume that respondents identify binarily or desire medical transition as a terminal goal. [ABSTRACT FROM AUTHOR]