Skip to main content
Log in

Measuring Gender Dysphoria: A Multicenter Examination and Comparison of the Utrecht Gender Dysphoria Scale and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

This study examined two instruments measuring gender dysphoria within the multicenter study of the European Network for the Investigation of Gender Incongruence (ENIGI). The Utrecht Gender Dysphoria Scale (UGDS) and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) were examined for their definitions of gender dysphoria and their psychometric properties, and evaluated for their congruence in assessing the construct. The sample of 318 participants consisted of 178 male-to-females (MtF) and 140 female-to-males (FtM) who were recruited from the four ENIGI gender clinics. Both instruments were significantly correlated in the group of MtFs. For the FtM group, there was a trend in the same direction but smaller. Gender dysphoria was found to be defined differently in the two instruments, which led to slightly different findings regarding the subgroups. The UGDS detected a difference between the subgroups of early and late onset of gender identity disorder in the group of MtFs, whereas the GIDYQ-AA did not. For the FtM group, no significant effect of age of onset was found. Therefore, both instruments seem to capture not only similar but also different aspects of gender dysphoria. The UGDS focusses on bodily aspects, gender identity, and gender role, while the GIDYQ-AA addresses subjective, somatic, social, and sociolegal aspects. For future research, consistency in theory and definition of gender dysphoria is needed and should be in line with the DSM-5 diagnosis of gender dysphoria in adolescents and adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aldwin, C. M., Sutton, K. J., Chiara, G., & Spiro, A. (1996). Age differences in stress, coping, and appraisal: Findings from the normative aging study. Journal of Gerontology: Psychological Science B, 51, 179–188.

    Article  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Google Scholar 

  • Amirkhan, J., & Auyeung, B. (2007). Coping with stress across the lifespan: Absolute vs. relative changes in strategy. Journal of Applied Developmental Psychology, 28, 298–317. doi:10.1016/j.appdev.2007.04.002.

    Article  Google Scholar 

  • Benjamin, H. (1966). The transsexual phenomenon: A scientific report on transsexualism and sex conversion in the human male and female. New York: Julian.

    Google Scholar 

  • Blanchard, R. (1989). The classification and labeling of nonhomosexual gender dysphorias. Archives of Sexual Behavior, 18, 315–334.

    Article  PubMed  Google Scholar 

  • Blanchard, R., Clemmensen, L. H., & Steiner, B. W. (1987). Heterosexual and homosexual gender dysphoria. Archives of Sexual Behavior, 16, 139–152.

    Article  PubMed  Google Scholar 

  • Cerwenka, S., Nieder, T. O., & Richter-Appelt, H. (2012). Sexuelle Orientierung und Partnerwahl transsexueller Frauen und Männer vor körpermedizinischen geschlechtsanpassenden Maßnahmen [Sexual orientation and partner-choice of transsexual women and men before gender-confirming interventions]. Psychotherapie, Psychosomatik, Medizinische Psychologie, 62, 214–222. doi:10.1055/s-0032-1309030.

    Article  PubMed  Google Scholar 

  • Cohen-Kettenis, P. T., & Pfäfflin, F. (2010). The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 499–513. doi:10.1007/s10508-009-9562-y.

    Article  PubMed  Google Scholar 

  • Cohen-Kettenis, P. T., & van Goozen, S. H. M. (1997). Sex reassignment of adolescent transsexuals: A follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 263–271. doi:10.1097/00004583-199702000-00017.

    Article  PubMed  Google Scholar 

  • Coleman, E., Adler, R., Bockting, W., Botzer, M., Brown, G., Cohen-Kettenis, P., … Zucker, K. (2011). Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. International Journal of Transgenderism, 13, 165–232.

  • de Vries, A. L. C., Cohen-Kettenis, P. T., & Delemarre-van de Waal, H. (2006). Clinical management of gender dysphoria in adolescents. International Journal of Transgenderism, 9(3–4), 83–94. doi:10.1300/J485v09n03_04.

    Article  Google Scholar 

  • Deogracias, J. J., Johnson, L. L., Meyer-Bahlburg, H. F. L., Kessler, S. J., Schober, J. M., & Zucker, K. J. (2007). The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. Journal of Sex Research, 44, 370–379. doi:10.1080/00224490701586730.

    Article  PubMed  Google Scholar 

  • Diel, M., Coyle, N., & Labouvie-Vief, G. (1996). Age and sex differences in strategies of coping and defence across the life span. Psychology and Aging, 11, 127–139.

    Article  Google Scholar 

  • Doorn, C. D., Poortinga, J., & Verschoor, A. M. (1994). Cross-gender identity in transvestites and male transsexuals. Archives of Sexual Behavior, 23, 185–201.

    Article  PubMed  Google Scholar 

  • Fisk, N. M. (1973). Gender dysphoria syndrome (The how, what, and why of a disease). In D. R. Laub & P. Gandy (Eds.), Proceedings of the second interdisciplinary symposium on gender dysphoria syndrome (pp. 7–14). Palo Alto, CA: Standford University Press.

    Google Scholar 

  • Fisk, N. M. (1974). Gender dysphoria syndrome: The conceptualization that liberalizes indications for total gender reorientation and implies a broadly based multi-dimensional rehabilitative regimen. Western Journal of Medicine, 120, 386–391.

    PubMed  PubMed Central  Google Scholar 

  • Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia, PA: Saunders.

    Google Scholar 

  • Kreukels, B. P., Haraldsen, I. R., De Cuypere, G., Richter-Appelt, H., Gijs, L., & Cohen-Kettenis, P. T. (2012). A European Network for the Investigation of Gender-Incongruence: The ENIGI Initiative. European Psychiatry, 27, 445–450.

    Article  PubMed  Google Scholar 

  • Kuiper, A. J., & Cohen-Kettenis, P. T. (1988). Sex reassignment surgery: A study of 141 Dutch transsexuals. Archives of Sexual Behavior, 17, 439–457. doi:10.1007/BF01542484.

    Article  PubMed  Google Scholar 

  • Lawrence, A. A. (2005). Sexuality before and after male-to-female sex reassignment surgery. Archives of Sexual Behavior, 34, 147–166.

    Article  PubMed  Google Scholar 

  • Lawrence, A. A. (2010). Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 514–545. doi:10.1007/s10508-009-9594-3.

    Article  PubMed  Google Scholar 

  • Nieder, T. O., Herff, M., Cerwenka, S., Preuss, W. F., Cohen-Kettenis, P. T., De Cuypere, G., … Richter-Appelt, H. (2011). Age of onset and sexual orientation in transsexual males and females. Journal of Sexual Medicine, 8, 783–791. doi:10.1111/j.1743-6109.2010.02142.x.

  • Nieder, T. O., & Richter-Appelt, H. (2012). Transsexualität und Geschlechtsdysphorie [Transsexualism and gender dysphoria]. Gynäkologie und Gynäkologische Onkologie, 8, 60–71.

    Google Scholar 

  • Paap, M. C. S., Kreukels, B. P. C., Cohen-Kettenis, P. T., Richter-Appelt, H., de Cuypere, G., & Haraldsen, I. R. (2011). Assessing the utility of diagnostic criteria: A multisite study on gender identity disorder. Journal of Sexual Medicine, 8, 180–190. doi:10.1111/j.1743-6109.2010.02066.x.

    Article  PubMed  Google Scholar 

  • Singh, D., Deogracias, J. J., Johnson, L. L., Bradley, S. J., Kibblewhite, S. J., Owen-Anderson, A., … Zucker, K. J. (2010). The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults: Further validity evidence. Journal of Sex Research, 47, 49–58. doi:10.1080/00224490902898728.

  • Smith, Y. L. S., van Goozen, S. H. M., Kuiper, A. J., & Cohen-Kettenis, P. T. (2005). Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals. Psychological Medicine, 35, 89–99. doi:10.1017/S0033291704002776.

    Article  PubMed  Google Scholar 

  • Steensma, T. D., Kreukels, B. P. C., Jürgensen, M., Thyen, U., de Vries, A. L. C., & Cohen Kettenis, P. T. (2013). The Utrecht Gender Dysphoria Scale: A validation study. Manuscript submitted for publication.

Download references

Acknowledgments

We are most grateful to all persons who made this research possible, especially the participants of this study. We would also like to thank the collaborating medical and psychosocial staff and colleagues of all four clinics in Belgium, in the Netherlands, in Norway, and in Hamburg. Further, we would like to especially thank the Editor, for his thoughtful comments and his input regarding the statistical analyses. The first author is especially grateful for his patience and support in the process.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hertha Richter-Appelt.

Appendix

Appendix

Utrecht Gender Dysphoria Scale

Female-to-Male Version

Response categories are agree completely, agree somewhat, neutral, disagree somewhat, disagree completely. Items 1, 2, 4–6, and 10–12 are scored from 5 to 1; Items 3 and 7–9 are scored from 1 to 5.

  1. (1)

    I prefer to behave like a boy.

  2. (2)

    Every time someone treats me like a girl I feel hurt.

  3. (3)

    I love to live as a girl.

  4. (4)

    I continuously want to be treated like a boy.

  5. (5)

    A boy’s life is more attractive for me than a girl’s life.

  6. (6)

    I feel unhappy because I have to behave like a girl.

  7. (7)

    Living as a girl is something positive for me.

  8. (8)

    I enjoy seeing my naked body in the mirror.

  9. (9)

    I like to behave sexually as a girl.

  10. (10)

    I hate menstruating because it makes me feel like a girl.

  11. (11)

    I hate having breasts.

  12. (12)

    I wish I had been born as a boy.

Male-to-Female Version

Response categories are agree completely, agree somewhat, neutral, disagree somewhat, disagree completely. Items are all scored from 5 to 1.

  1. (1)

    My life would be meaningless if I would have to live as a boy.

  2. (2)

    Every time someone treats me like a boy I feel hurt.

  3. (3)

    I feel unhappy if someone calls me a boy.

  4. (4)

    I feel unhappy because I have a male body.

  5. (5)

    The idea that I will always be a boy gives me a sinking feeling.

  6. (6)

    I hate myself because I’m a boy.

  7. (7)

    I feel uncomfortable behaving like a boy, always and everywhere.

  8. (8)

    Only as a girl my life would be worth living.

  9. (9)

    I dislike urinating in a standing position.

  10. (10)

    I am dissatisfied with my beard growth because it makes me look like a boy.

  11. (11)

    I dislike having erections.

  12. (12)

    It would be better not to live than to live as a boy.

Scoring and Evaluation

To calculate the total score, all Items of the Male version and Items 1, 2, 4–6, and 10–12 of the female version have to be reversed scored.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schneider, C., Cerwenka, S., Nieder, T.O. et al. Measuring Gender Dysphoria: A Multicenter Examination and Comparison of the Utrecht Gender Dysphoria Scale and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. Arch Sex Behav 45, 551–558 (2016). https://doi.org/10.1007/s10508-016-0702-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-016-0702-x

Keywords

Navigation