Levels of physical activity and barriers to sport participation in young people with gender dysphoria
-
Misha Gilani
Abstract
Objectives
To determine the levels of physical activity (PA) in young people with gender dysphoria (GD) and help identify factors which deter participation.
Methods
Fifty-six young people who attended paediatric endocrinology because of GD, June to October 2019, and were on treatment with gonadotrophin-releasing hormone (GnRH) analogue were approached to participate in a survey.
Results
A total of 55 young people (98%) responded to the survey. Thirty-eight (69%) participated in PA for >1 h/week. Thirty-two (58%) reported high motivation level for exercise. Those had median age of 15.9 years (10.7, 18.7) at the time of survey, and 13.6 years (9.7, 17.6) at start of GnRH analogue compared to 16.7 years (13.9, 18.5) (p, 0.047) and 15.4 years (11.2, 18.0) (p, 0.009) of the 23 (42%) who reported low motivation. Forty-one (74.5%) reported barriers when accessing PA, such as not being as good as others (75%), revealing sports clothing (73%) and not satisfied with body image (47%). Those were older (16.4 years [10.9, 18.7] vs. 14.7 years [10.7, 18.4] [p, 0.011]) at the time of survey and at start of GnRH analogue (14.9 years [9.7, 18.0] vs. 12.5 years [10.6, 15.2] [p, 0.0001]) than those 14 (25.5%) who reported facing no barriers. Twelve (85.7%) of those reporting no barriers stated high motivation levels compared to 20 (48.8%) of those reporting barriers (p, 0.026).
Conclusions
Strategies aimed at improving participation are twofold: first to improve motivation, especially in post-pubertal young people, and secondly to achieve societal change to help eliminate barriers.
Research funding: None declared.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Competing interest: The authors have no financial disclosures or conflicts of interests relevant to this article to disclose. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Informed consent: Not applicable.
Ethical approval: The local Institutional Review Board deemed the study exempt from review. All procedures performed in the study were in accordance with ethical standards of the national research committee and with the 1964 Helsinki declaration as revised in 2013. We sought to gauge opinion and engagement of our client base in a service development to improve participation in physical activity and sport. It was deemed that this consultation, prior to a service development, did not require ethical approval, according to national guidance (http://www.hra-decisiontools.org.uk/research/, which is based on the Defining Research Table http://www.hra-decisiontools.org.uk/research/docs/DefiningResearchTable_Oct2017-1.pdf).
References
1. World Health Organization. International statistical classification of diseases and related health problems (11th Revision); 2018.Search in Google Scholar
2. Hembree, WC, Cohen-Kettenis, PT, Gooren, L, Hannema, SE, Meyer, WJ, Murad, MH, et al.. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2017;102:3869–903. https://doi.org/10.1210/jc.2017-01658.Search in Google Scholar
3. Kyriakou, A, Nicolaides, NC, Skordis, N. Current approach to the clinical care of adolescents with gender dysphoria. Acta Biomed 2020;91:165–75. https://doi.org/10.23750/abm.v91i1.9244.Search in Google Scholar
4. Skordis, N, Butler, G, de Vries, MC, Main, K, Hannema, SE. ESPE and PES international survey of centers and clinicians delivering specialist care for children and adolescents with gender dysphoria. Horm Res Paediatr 2018;90:326–31. https://doi.org/10.1159/000496115.Search in Google Scholar
5. Martinerie, L, Condat, A, Bargiacchi A Bremont-Weill, C, de Vries, MC, Hannema, SE. Management of endocrine disease: approach to the management of children and adolescents with gender dysphoria. Eur J Endocrinol 2018;179:R219–37. https://doi.org/10.1530/eje-18-0227.Search in Google Scholar
6. WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.Search in Google Scholar
7. Cöster, ME, Rosengren, BE, Karlsson, C, Dencker, M, Karlsson, MK. Effects of an 8-year childhood physical activity intervention on musculoskeletal gains and fracture risk. Bone 2016;93:139–45. https://doi.org/10.1016/j.bone.2016.09.021.Search in Google Scholar
8. Kumar, B, Robinson, R, Till, S. Physical activity and health in adolescence. Clin Med (Lond) 2015;15:267–72. https://doi.org/10.7861/clinmedicine.15-3-267.Search in Google Scholar
9. Jones, BA, Arcelus, J, Bouman, WP, Haycraft, E. Sport and transgender people: a systematic review of the literature relating to sport participation and competitive sport policies. Sports Med 2017;47:701–16. https://doi.org/10.1007/s40279-016-0621-y.Search in Google Scholar
10. Moor, M, Beem, AL, Stubbe, J, Boomsma, D, Geus, E. Regular exercise, anxiety, depression and personality: a population-based study. Prev Med 2006;42:273–9. https://doi.org/10.1016/j.ypmed.2005.12.002.Search in Google Scholar
11. Maltby, J, Day, L. The relationship between exercise motives and psychological Well-being. J Psychol 2001;135:651–60. https://doi.org/10.1080/00223980109603726.Search in Google Scholar
12. Schagen, SEE, Cohen-Kettenis, PT, Delemarre-van de Waal, HA, Hannema, SE. Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. J Sex Med 2016;13:1125–32. https://doi.org/10.1016/j.jsxm.2016.05.004.Search in Google Scholar
13. Klink, D, Caris, M, Heijboer, A, van Trotsenburg, M, Rotteveel, J. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab 2015;100:E270–5. https://doi.org/10.1210/jc.2014-2439.Search in Google Scholar
14. Schagen, SEE, Wouters, FM, Cohen-Kettenis, PT, Gooren, LJ, Hannema, SE. Bone development in transgender adolescents treated with GnRH analogues and subsequent gender-affirming hormones. J Clin Endocrinol Metab 2020;105:dgaa604. https://doi.org/10.1210/clinem/dgaa604.Search in Google Scholar
15. Beck, BR, Snow, CM. Bone health across the lifespan—exercising our options. Exerc Sport Sci Rev 2003;31:117–22. https://doi.org/10.1097/00003677-200307000-00003.Search in Google Scholar
16. Karlsson, MK, Rosengren, BE. Exercise and peak bone mass. Curr Osteoporos Rep 2020;18:285–90. https://doi.org/10.1007/s11914-020-00588-1.Search in Google Scholar
17. Freeman, JV, Cole, TJ, Chinn, S, Jones, PR, White, EM, Preece, MA. Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child 1995;73:17–24. https://doi.org/10.1136/adc.73.1.17.Search in Google Scholar
18. Biddle, SJH, Asare, M. Physical activity and mental health in children and adolescents: a review of reviews. Br J Sports Med 2011;45:886–95. https://doi.org/10.1136/bjsports-2011-090185.Search in Google Scholar
19. Mangerud, WL, Bjerkeset, O, Lydersen, S, Indredavik, MS. Physical activity in adolescents with psychiatric disorders and in the general population. Child Adolesc Psychiatr Ment Health 2014;8:2. https://doi.org/10.1186/1753-2000-8-2.Search in Google Scholar
20. Bishop, A, Overcash, F, McGuire, J, Reicks, M. Diet and physical activity behaviors among adolescent transgender students: school survey results. J Adolesc Health 2020;66:484–90. https://doi.org/10.1016/j.jadohealth.2019.10.026.Search in Google Scholar
21. Aparicio-García, ME, Díaz-Ramiro, EM, Rubio-Valdehita, S, López-Núñez, MI, García-Nieto, I. Health and well-being of cisgender, transgender and non-binary young people. Int J Environ Res Publ Health 2018;15:2133. https://doi.org/10.3390/ijerph15102133.Search in Google Scholar
22. Stewart, L, O’Halloran, P, Buckley, K. Trans women australian sport and group physical activity: a qualitative study. La Trobe University, School of Psychology and Public Health; 2015. Available from: https://scholars.latrobe.edu.au/display/publication53397 [Accessed 10 December 2020].Search in Google Scholar
23. Deci, EL, Ryan, RM. The ‘what’ and ‘why’ of goal pursuits: human needs and the self-determination of behavior. Psychol Inq 2000;11:227–68. https://doi.org/10.1207/s15327965pli1104_01.Search in Google Scholar
24. Lawler, M, Heary, C, Nixon, E. Variations in adolescents’ motivational characteristics across gender and physical activity patterns: a latent class analysis approach. BMC Publ Health 2017;17:661. https://doi.org/10.1186/s12889-017-4677-x.Search in Google Scholar
25. Dhejne, C, Van Vlerken, R, Heylens, G, Arcelus, J. Mental health and gender dysphoria: a review of the literature. Int Rev Psychiatr 2016;28:44–57. https://doi.org/10.3109/09540261.2015.1115753.Search in Google Scholar
26. Symons, C, Sbaraglia, M, Hillier, L, Mitchell, A. Victoria University (Melbourne VIC), Institute of Sport E and AL, Victoria University (Melbourne VIC), School of Sport and Exercise Science. Come out to play: the sports experiences of lesbian, gay, bisexual and transgender LGBT) people in Victoria. Institute of Sport, Exercise and Active Living: School of Sport and Exercise Science. Victoria University; 2010. Available from: https://www.vu.edu.au/sites/default/files/Come%20Out%20To%20Play%20May%202010.pdf [Accessed 10 December 2020].Search in Google Scholar
27. National Union of Students (NUS). Out in Sport. LGBT students’ experiences of sport. University of East London; 2012. Available from: https://www.nusconnect.org.uk/resources/out-in-sport-lgbt-students-experiences-of-sport-2012 [Accessed 10 December 2020].Search in Google Scholar
28. López-Cañada, E, Devís-Devís, J, Valencia-Peris, A, Pereira-García, S, Fuentes-Miguel, J, Pérez-Samaniego, V. Physical activity and sport in trans persons before and after gender disclosure: prevalence, frequency, and type of activities. J Phys Activ Health 2020;17:650–6. https://doi.org/10.1123/jpah.2019-0192.Search in Google Scholar
29. López-Cañada, E, Devís-Devís, J, Pereira-García, S, Pérez-Samaniego, V. Socio-ecological analysis of trans people’s participation in physical activity and sport. Int Rev Sociol Sport 2019;56:62–80. https://doi.org/10.1177%2F1012690219887174.10.1177/1012690219887174Search in Google Scholar
© 2021 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review Article
- Provocative growth hormone testing in children: how did we get here and where do we go now?
- Original Articles
- Mental and somatic health in university students with type 1 diabetes: new results from DiaSHoT18, a cross sectional national health and well-being survey
- Prevalence of elevated liver enzymes and their association with type 2 diabetes risk factors in children
- What is the relationship between obesity and new circadian rhythm parameters in Turkish children and adolescents? A case-control study
- Body fat distribution in trunk and legs are associated with cardiometabolic risk clustering among Chinese adolescents aged 10–18 years old
- Is overweight/obesity a risk factor for atopic allergic disease in prepubertal children? A case–control study
- Importance of individualizing treatment decisions in girls with central precocious puberty when initiating treatment after age 7 years or continuing beyond a chronological age of 10 years or a bone age of 12 years
- Blood pressure dynamics after pubertal suppression with gonadotropin-releasing hormone analogs followed by estradiol treatment in transgender female adolescents: a pilot study
- Levels of physical activity and barriers to sport participation in young people with gender dysphoria
- Serum sclerostin concentration is associated with specific adipose, muscle and bone tissue markers in lean adolescent females with increased physical activity
- Validation of a continuous measure of cardiometabolic risk among adolescents
- Clinical characteristics and molecular genetic analysis of a cohort with idiopathic congenital hypogonadism
- The genetics and clinical manifestations of patients with vitamin D dependent rickets type 1A
- Switching from conventional therapy to burosumab injection has the potential to prevent nephrocalcinosis in patients with X-linked hypophosphatemic rickets
- Case Reports
- Asymptomatic pituitary apoplexy induced by corticotropin-releasing hormone in a 14 year-old girl with Cushing’s disease
- Two patients from Turkey with a novel variant in the GM2A gene and review of the literature
- Familial hyperphosphatemic tumoral calcinosis in an unusual and usual sites and dramatic improvement with the treatment of acetazolamide, sevelamer and topical sodium thiosulfate
- Pediatric diabetic ketoacidosis presenting with Streptococcus intermedius brain abscess
Articles in the same Issue
- Frontmatter
- Review Article
- Provocative growth hormone testing in children: how did we get here and where do we go now?
- Original Articles
- Mental and somatic health in university students with type 1 diabetes: new results from DiaSHoT18, a cross sectional national health and well-being survey
- Prevalence of elevated liver enzymes and their association with type 2 diabetes risk factors in children
- What is the relationship between obesity and new circadian rhythm parameters in Turkish children and adolescents? A case-control study
- Body fat distribution in trunk and legs are associated with cardiometabolic risk clustering among Chinese adolescents aged 10–18 years old
- Is overweight/obesity a risk factor for atopic allergic disease in prepubertal children? A case–control study
- Importance of individualizing treatment decisions in girls with central precocious puberty when initiating treatment after age 7 years or continuing beyond a chronological age of 10 years or a bone age of 12 years
- Blood pressure dynamics after pubertal suppression with gonadotropin-releasing hormone analogs followed by estradiol treatment in transgender female adolescents: a pilot study
- Levels of physical activity and barriers to sport participation in young people with gender dysphoria
- Serum sclerostin concentration is associated with specific adipose, muscle and bone tissue markers in lean adolescent females with increased physical activity
- Validation of a continuous measure of cardiometabolic risk among adolescents
- Clinical characteristics and molecular genetic analysis of a cohort with idiopathic congenital hypogonadism
- The genetics and clinical manifestations of patients with vitamin D dependent rickets type 1A
- Switching from conventional therapy to burosumab injection has the potential to prevent nephrocalcinosis in patients with X-linked hypophosphatemic rickets
- Case Reports
- Asymptomatic pituitary apoplexy induced by corticotropin-releasing hormone in a 14 year-old girl with Cushing’s disease
- Two patients from Turkey with a novel variant in the GM2A gene and review of the literature
- Familial hyperphosphatemic tumoral calcinosis in an unusual and usual sites and dramatic improvement with the treatment of acetazolamide, sevelamer and topical sodium thiosulfate
- Pediatric diabetic ketoacidosis presenting with Streptococcus intermedius brain abscess
