A critical discussion of pediatric gender measures to clarify the utility and purpose of “measuring” gender

Background: Pediatric gender clinics and researchers commonly use scales to measure different dimensions of gender (e.g. identity, dysphoria, satisfaction). There has been little investigation into the relevance and consumer acceptability of these scales within contemporary understandings and experiences of gender. Aims: This study aimed to comparatively review and evaluate measures of gender used with children and adolescents, to inform the use of gender measures in pediatric populations. Methods: A narrative review of the literature was conducted to identify measures that are used to describe dimensions of gender within pediatric populations. The measures were evaluated for their inclusivity, validity, and utility. Results: 19 measures were identified. Our results found that most pediatric gender measures are not inclusive of non-binary genders, and do not accommodate some understandings and expressions of gender. Many are based on outdated terminology and stereotyped expectations of gender expression, and some are potentially distressing for the young person completing the measure. Some gender measures, used in conjunction with self-identification and as an adjunct to clinical interviews, hold clinical utility for understanding gender. If a measure is deemed clinically helpful, it is vital that the purpose of the measure is explained to the young person, and they are supported through the administration of the measure. Discussion: This review is a guide for choosing gender measures for clinical practice or research purposes. Specialist gender services and researchers should aim to provide an open, accepting, and affirmative approach; any gender measure should be chosen with consideration of its validity, and whether the measure adds value over and above self-identification and talking together about gender. There is a need for the development, and validation in pediatric populations, of measures that ensure the inclusivity of non-binary genders, language tailored to target ages and timepoints in gender transition, and updated, culturally appropriate language and examples.