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Merkmale von Kindern und Jugendlichen mit Geschlechtsdysphorie in der Hamburger Spezialsprechstunde
(2014)
Given the increasing demand for counselling in gender dysphoria in childhood in Germany, there is a definite need for empirical data on characteristics and developmental trajectories of this clinical group. This study aimed to provide a first overview by assessing demographic characteristics and developmental trajectories of a group of gender variant boys and girls referred to the specialised Gender Identity Clinic in Hamburg. Data were extracted from medical charts, transcribed and analysed using qualitative content analysis methods. Categories were set up by inductive-deductive reasoning based on the patients' parents' and clinicians' information in the files. Between 2006 and 2010, 45 gender variant children and adolescents were seen by clinicians; 88.9% (n = 40) of these were diagnosed with gender identity disorder (ICD-10). Within this group, the referral rates for girls were higher than for boys (1:1.5). Gender dysphoric girls were on average older than the boys and a higher percentage of girls was referred to the clinic at the beginning of adolescence (> 12 years of age). At the same time, more girls reported an early onset age. More girls made statements about their (same-sex) sexual orientation during adolescence and wishes for gender confirming medical interventions. More girls than boys revealed self-mutilation in the past or present as well as suicidal thoughts and/or attempts. Results indicate that the presentation of clinically referred gender dysphoric girls differs from the characteristics boys present in Germany; especially with respect to the most salient age differences. Therefore, these two groups require different awareness and individual treatment approaches.
Persistent feelings of gender dysphoria (GD) are accompanied by distress and body dissatisfaction in most clinically referred adolescents and adults. Transition-related medical interventions (e.g., puberty suppression, hormones, or surgery) may alleviate body dissatisfaction. The aim of the present cross-sectional study was to compare multidimensional body image across clinically referred adolescents and adults undergoing different transition-related medical interventions. Two clinical samples of adolescents (n = 82) and adults (n = 120) referred to specialized departments of four different transgender health services in Germany participated in the study. In total, 202 individuals from the female-to-male (FtM individuals) and male-to-female (MtF individuals) spectrum aged 14-74 years were included at different stages of their transition. Four scales assessing multidimensional aspects of body image (measured by the Body Image Assessment Questionnaire, FBeK) were compared across three groups: sample, gender, and medical interventions (while controlling for age and treatment duration). The results indicated less favorable body image scores compared with the norm in both adolescents and adults with GD. Individuals who had undergone transition-related medical interventions presented a significantly better body image on two of the four scales. Differences according to gender and age were also present. These findings suggest that medical interventions, especially gender-affirming hormones and surgery, are generally beneficial to the body image in individuals with GD. However, not all of the less favorable outcomes in multidimensional body image were positively influenced by the treatment conditions and may thus benefit from additional integrative counseling before and during transition.
In Germany, the situation of health care services for children and adolescents with gender dysphoria is insufficient. In 2006 a specialized multiprofessional outpatient clinic was founded at the University Medical Center Hamburg-Eppendorf. Goals were improvement of health services for gender dysphoric children, development of treatment concepts, and gain of knowledge through research. After finishing a thorough interdisciplinary assessment an individualized, case-by-case treatment starts. Besides psychotherapy an interdisciplinary treatment (e. g. puberty suppression and cross-sex hormones) is provided if indicated. During childhood a watchful waiting and carefully observing attitude is necessary. If a marked increase of gender dysphoria occurs during the first phases of puberty development, puberty suppression and later cross sex-hormones might be indicated.
Die klimabedingte Zunahme extremer Wetterereignisse ist eine der Herausforderungen in der gegenwärtig durch Krisen geprägten Zeit. Gefahren gehen sowohl von ausgeprägten Extremniederschlägen als auch langanhaltenden Dürreperioden aus. Das Schadpotenzial hängt maßgeblich von den lokalen Bedingungen in Stadt und Raum ab. Ein Starkregen richtet im Flachland mit versickerungsfähigen Böden wesentlich weniger Schäden an als in einem engen Tal, wenn dort die Hochwasserwelle auf bebaute Talbereiche trifft. Auch sind die Folgen einer als urbane Sturzflut bezeichneten Überflutung in dicht besiedelten Räumen in der Regel dramatischer als bei ländlich geprägten Siedlungsstrukturen.
Neben Starkregen führen auch Trockenheit und Hitze vor allem in Innenstädten immer häufiger zu Bedingungen, in denen das Leben und Arbeiten zur Belastung wird. Vielerorts sinkende Grundwasserspiegel stellen die Bewirtschaftung natürlicher Wasserressourcen und damit einhergehend sowohl die Bewässerung in der
Landwirtschaft als auch die öffentliche Wasserversorgung in Deutschland vor bislang weitgehend unbekannte Herausforderungen.
Einen absoluten Schutz gegen Überflutungen und vor Hitzeperioden gibt es nicht,
aber wir müssen Vorsorge betreiben, um die Belastungen zu begrenzen und die eigene Resilienz zu erhöhen. Dazu erforderliche Konzepte greifen die Wassertage
Münster 2025 auf. Zur nachhaltigen Bewirtschaftung der Ressource Wasser dienen
in hohem Maße die Talsperren, auf die ein Blick sowohl weltweit als auch in NRW
geworfen wird. Thematisiert werden weiterhin die neuesten Entwicklungen der Wasserwiederverwendung und des Abwassers als alternative Wasserressource. Die
wasserbewusste Stadtentwicklung bildet den Rahmen für weitere aktuelle Diskussionen zu blau-grüner Infrastruktur, Starkregen und Sturzfluten, Dürre und Hitze sowie der Niederschlagswasserbehandlung.
