How do gender diverse young people who have accessed puberty suppressant treatment speak about their understanding and experiences of their sexuality? A narrative analysis of qualitative interviews with young people aged 16+ who have accessed puberty suppressant treatment

Care provision for transgender and gender diverse (TGD) youth is undergoing significant change within the UK. The service position regarding the use of puberty suppressant treatment (PST) using Gonadotropin releasing hormone analogues (GnRHa) has changed, and this treatment will now only be provided in the context of clinical research. PST has been subject to controversy, with some holding the view that accessing PST may negatively impact sexual development, functioning, and enjoyment. Elucidating the potential contribution of PST with respect to sexuality is an identified research priority. Research with adults indicates that gender affirming interventions exert some influence over their sexual lives. However, no equivalent research has examined the influence, if any, of PST in this respect. Adopting a Narrative Inquiry methodology, the present study examines the narrative accounts of four TGD young people speaking about their experience and understanding of their sexualities in the context of accessing PST. Through using the Listening Guide method (Gilligan et al., 2003), and Hammack and Cohler’s (2009) Master Narrative Engagement approach, the young people’s narratives were contextualised and interpreted with respect to the historical, discursive, and cultural context of their production. The findings are presented for each individual narrator, outlining the content and plot of their account before turning to the relationships between the polyphonic voices in their accounts, understanding this as representative of narrative engagement with wider discourse. The narrators indicated various relationships to PST with respect to sexuality, with some regarding it as specifically facilitative of their sexual engagement, and others attributing little influence to the treatment, positive or negative. In storying their accounts, the young people demonstrated agentic, dynamic, engagement with three main master narratives, cisnormativity, heteronormativity, and transnormativity, both reproducing and countering aspects of these. The clinical implications of the findings, limitations of the study, and future research are discussed.