Yaish Iris, Greenman Yona, Tordjman Karen M
The Transgender Health Center, Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
PLoS One. 2025 Apr 29;20(4):e0322201. doi: 10.1371/journal.pone.0322201. eCollection 2025.
The factors driving the global increase in the number of transgender individuals remain unclear. It has been suggested that early-life events may interact with biological predispositions, yet little research has explored specific early-life circumstances that might contribute to gender incongruence. One such factor is adoption, as a few pediatric gender identity clinics have reported an overrepresentation of adoptees. However, no study has systematically examined whether this trend extends to adult transgender health centers, nor has the psychosocial profile of adopted transgender individuals been characterized in adulthood.
This retrospective study was conducted in two phases to evaluate the prevalence and characteristics of adoptees among adult transgender patients seeking gender-affirming therapy. In Phase 1, we analyzed a cohort of 671 new adult subjects presenting between 2015 and 2021. In Phase 2, the nested case-control analysis, the 15 adoptees identified were matched in a 1:4 ratio with non-adopted controls based on age, assigned sex at birth, and presentation timing. Data on demographics, psychosocial factors, psychiatric diagnoses, and parental support were extracted from electronic records, and augmented by telephone interviews when needed.
Adoptees constituted 2.2% of the clinic population, an order of magnitude higher than the national rate (P < 0.0001), with an unprecedented assigned-female-at-birth (AFAB) ratio of 73.3%. After matching, 60% of adoptees had at least one psychiatric co-morbidity, almost twice the rate of non-adopted controls (OR = 3.23, 95% CI: 1.02-10.21, P = 0.042). Despite coming from higher socioeconomic status homes (P < 0.001), adoptees had lower odds of achieving college education (P = 0.031), and receiving full parental support for transition (OR = 0.20, 95% CI: 0.05-0.71, P = 0.015). Notably, 28.6% of adoptees had attempted suicide vs 3.3% of non-adopted controls (OR = 11.6, 95% CI: 1.87-71.97, P = 0.01).
Adopted transgender individuals represent a vulnerable subgroup within the transgender population, characterized by unique psychosocial challenges. Our findings underscore the importance of tailored interventions and heightened support within transgender health clinics for adoptees seeking gender-affirming therapy. Further research is warranted to elucidate the interplay of adoption, biological predispositions, and social factors in the development of gender incongruence.
全球跨性别者数量增加的驱动因素尚不清楚。有人提出，早期生活事件可能与生物易感性相互作用，但很少有研究探讨可能导致性别不一致的具体早期生活情况。其中一个因素是收养，因为一些儿科性别认同诊所报告称，被收养者的比例过高。然而，没有研究系统地考察这种趋势是否也适用于成人跨性别健康中心，也没有对成年后被收养的跨性别者的心理社会状况进行描述。
这项回顾性研究分两个阶段进行，以评估寻求性别肯定治疗的成年跨性别患者中被收养者的患病率和特征。在第一阶段，我们分析了2015年至2021年间就诊的671名成年新患者队列。在第二阶段，即巢式病例对照分析中，根据年龄、出生时指定的性别和就诊时间，将确定的15名被收养者与未被收养的对照以1:4的比例进行匹配。从电子记录中提取人口统计学、心理社会因素、精神科诊断和父母支持方面的数据，并在需要时通过电话访谈进行补充。
被收养者占诊所患者总数的2.2%，比全国比例高出一个数量级（P < 0.0001），出生时被指定为女性（AFAB）的比例达到前所未有的73.3%。匹配后，60%的被收养者至少有一种精神科合并症，几乎是非被收养对照者比例的两倍（OR = 3.23，95%置信区间：1.02 - 10.21，P = 0.042）。尽管被收养者来自社会经济地位较高的家庭（P < 0.001），但他们获得大学教育的几率较低（P = 0.031），并且在过渡过程中获得父母全力支持的几率也较低（OR = 0.20，95%置信区间：0.05 - 0.71，P = 0.015）。值得注意的是，28.6%的被收养者曾尝试自杀，而非被收养对照者的这一比例为3.3%（OR = 11.6，95%置信区间：1.87 - 71.97，P = 0.01）。
被收养的跨性别者是跨性别群体中的一个弱势群体，具有独特的心理社会挑战。我们的研究结果强调了在跨性别健康诊所为寻求性别肯定治疗的被收养者提供量身定制干预措施和更多支持的重要性。有必要进一步研究以阐明收养、生物易感性和社会因素在性别不一致发展过程中的相互作用。
