Beyond Gender Identity: Clinicians’ Perspectives on Comorbidity, Traumatic Events, and Diagnostic Complexity in Children and Adolescents with Gender Dysphoria

This qualitative study maps the features of care for children and adolescents with gender dysphoria (GD) from the perspective of Czech clinicians. Given the high identity plasticity in adolescence and scarce data on minor populations, it explores expert conceptualisations of anamnestic data, developmental contexts, and social influences to define needs for informed clinical decision-making. Data were collected via interviews (n = 26) and focus groups (n = 2) with 35 clinicians (psychologists, sexologists, specialist physicians) reflecting on care for 75 clients, and analyzed using reflexive thematic analysis. Findings reveal tension between depathologisation ideals and high clinical complexity marked by comorbidities, unresolved trauma, or attachment disorders. Diagnostic overshadowing indicates that gender fixation may displace deeper etiopathogenetic factors. Furthermore, digital socialization fosters “scripted case histories,” while assigned female at birth (AFAB) populations exhibit “somatic panic” as a defence against puberty. The study calls for clinical caution and redefines psychotherapy as an integral component of affirmative care rather than a gatekeeping tool. Serving as a secure base for identity exploration, the therapeutic relationship respects developmental plasticity and utilizes a psychological moratorium to prevent hasty medicalization and the risk of detransition.