17. Development and Validation of new Gender Distress and Gender Positivity Scales for Young Transgender Adolescents in Canada


      Existing measures of gender dysphoria or gender distress for research and clinical practice do not currently take into account non-binary identities, or differentiate distress based on sexed aspects of the body or social gender. The existing measures also contain non-equivalent questions based on sex assigned at birth, and do not include measures of positive aspects of gender identity, which we conceptualized as differing from mere absence of distress. For the Trans Youth CAN! cohort study of young adolescents [ages 10-15] in gender clinics across Canada [N=161] we developed and tested new gender distress (TYC-GDS) and gender positivity (TYC-GPS) scales to address these issues, and to improve sensitivity to early non-surgical changes to clinical care, such as prescribed puberty blockers or hormones.


      Based on existing research and youth lived experience, the TYC-GDS (16 items) and TYC-GPS (12 items) were each developed with two subscales of related to social gendered experiences (Social) and sexed body experiences (Body). Items use a 5-point summated rating scale disagreeing or agreeing to the statements. Measures were administered at the first clinic visit for gender affirming hormone care in English or French. Validation of the scales involved inter-item polychoric correlations; internal consistency reliability; confirmatory factor analyses; convergent/divergent validation with a number of existing measures such as depressive symptoms, self-harm, quality of life, and parental support; and congruence/divergence between the TYC-GDS and TYC-GPS and subscales.


      Based on inter-item correlations and internal consistency, we dropped one item from each of the TYC-GDS and TYC-GPS, and shifted one TYC-GDS item to the Body subscale, and one TYC-GPS item to the Social subscale. CFA factor loadings confirmed a 2-factor correlated solution for both TYC-GDS (r=0.73, p<.001) and TYC-GPS (r=0.32, p=0.001). TYC-GDS total and subscale scores were significantly correlated with measures of distress, depression, social avoidance, and self-harm; Body subscale was correlated with desire for surgery and disordered eating, and Social with suicidality (all p<.05 to p<.001). As hypothesized, TYC-GPS total and subscale scores were significantly correlated with family connectedness, school connectedness, life quality and positive feelings about gender, and total and Body subscale (but not Social) with parental support (all p<.05 to p<.001). The final TYC-GDS and TYC-GPS scores were negatively correlated with each other (r=-0.53, p<0.001); however, most youth reported high levels of both gender distress and gender positivity. Subscales were also negatively correlated between the scales (Body, r=-0.65, p<.001; Social, r=-0.19, p<.001).


      Results support that gender distress and gender positivity related to social gender and sexed body experiences among young trans adolescents are distinct constructs, with both distress and positivity co-occurring rather than along a continuum. While we found evidence to support validity in the small clinical population for which the scales were designed, they should be evaluated for older adolescents, non-clinical trans and non-binary youth, and young adults for their ongoing salience, and in subsequent longitudinal studies for sensitivity to change over time.

      Sources of Support

      Grant #MOP-148641 from the Canadian Institutes of Health Research.