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Gender Dysphoria

Created on August 5, 2017. Last updated on October 26th, 2018 at 11:30 am

Some children and adolescents identify as transgender or gender nonconforming. The term transgender is used as a broad umbrella term to describe people whose gender identity—their internal sense of being female, male, or some other gender—does not line up with their sex assigned at birth. The term gender nonconforming is similarly used to describe gender identities or gender expressions that do not fit in with societal expectations for the child’s sex assigned at birth. Being transgender or gender nonconforming is not a psychological disorder.

 

What is Gender Dysphoria?

Gender dysphoria is a diagnosis that is included in the DSM-5. This diagnosis is used to describe the persistent clinically-significant distress and impairment that some transgender or gender nonconforming youth may experience due to the incongruence between their gender identity/expression and their sex assigned at birth. Children and adolescents who experience gender dysphoria may be particularly distressed by certain parts of their body, typically primary or secondary sex characteristics.

 

Effective Therapies for Gender Dysphoria

Currently, there are no psychological interventions that have been shown to reduce gender dysphoria. Therapies that aim to change a child or adolescent’s gender identity are considered unethical. However, transgender and gender nonconforming youth may benefit from seeing a therapist, who can help them cope with stressful experiences that they may face. Transgender and gender nonconforming youth may encounter family rejection, stigma, discrimination, or even interpersonal violence due to their gender identity or expression. These negative experiences may lead to anxiety, depression, or suicidal thoughts and behaviors. It is very important that parents and families of transgender and gender nonconforming youth support and affirm their identity—for example, by using their preferred name and pronouns—as family acceptance is a strong protective factor against negative mental health outcomes.

 

The World Professional Association for Transgender Health has published standards of care (WPATH SOC version 7) that all physical and mental health care providers should use when treating transgender and gender nonconforming youth. The WPATH SOC-7 outlines several gender-affirmative interventions that can help reduce youth’s gender dysphoria. Children and adolescents may choose to socially transition to live in their affirmed gender by changing their name, the pronouns they use, or their appearance (e.g., clothing, hairstyle). Secondly, some young adolescents may decide with their parents and doctors to take medications to suppress their pubertal development. This reversible medical intervention halts the development of physical characteristics that may be distressing for transgender and gender nonconforming youth (e.g., facial hair, breasts, deepening voice). Lastly, older adolescents—typically around age 16—may be eligible for gender-affirmative hormone therapy. Hormone therapy involves taking either estrogen or testosterone, which leads to significant physical changes that help transgender and gender nonconforming youths’ body match their gender identity. Some of these physical changes are permanent, though others may revert if youth stop hormone therapy. Surgical interventions are generally not recommended until age 18, except under certain circumstances.

 

Citations

Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., & Zucker, K. (2012). Standards of care for the health of transsexual, transgender and gender-nonconforming people, version 7. International Journal of Transgenderism, 13, 165-232. doi:10.1080/15532739.2011.700873

Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., … & T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism102(11), 3869-3903.

American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70, 832-864. doi:10.1037/a0039906

Edwards-Leeper, L, Leibowitz, S., & Sangganjanavanich, V. F. (2016) Affirmative practice with transgender and gender nonconforming youth: Expanding the model. Psychology of Sexual Orientation and Gender Diversity, 3,165-172. doi:10.1037/sgd0000167

 

Online Resources

www.genderspectrum.org

https://www.wpath.org/

http://www.imatyfa.org/

https://www.thetrevorproject.org/trvr_support_center/trans-gender-identity/#sm.00000dopvq72f9f7csksgc9ece7du

Supporting Caring for Transgender Children

Books

The Transgender Teen: A Handbook for Parents and Professionals Supporting Transgender and Non-Binary Teens By Stephanie Brill & Lisa Kenney

Helping Your Transgender Teen: A Guide for Parents By Irwin Krieger

“Our Trans Loved Ones” by PFLAG helpful. It is available for free download here: https://www.pflag.org/ourtranslovedones

The Trevor Project is also a great crisis and suicide prevention resource for LGBTQ youth with an associated crisis hotline: 1-866-488-7386

Trans Lifeline also has crisis resources: https://www.translifeline.org/  US: 877-565-8860; Canada: 877-330-6366

The Transgender Child: A Handbook for Families and Professionals https://www.amazon.com/Transgender-Child-Handbook-Families-Professionals-ebook/dp/B0097D7CPM

The Gender Quest Workbook: https://www.newharbinger.com/gender-quest-workbook

From the Family Acceptance Project, the following resource is very informative for parents and takes the stance that parents of any background share the goal of wanting to love and protect their children and being supportive of LGBTQ youth is consistent with that message: Supportive Families, Healthy Children Helping Families with Lesbian, Gay, Bisexual & Transgender Children https://familyproject.sfsu.edu/sites/default/files/FAP_English%20Booklet_pst.pdf

If religion is a barrier to acceptance for families, two other recommended books are “Unfair: Christians and the LGBT Question” by John Shore https://www.amazon.com/UNFAIR-Christians-Question-John-Shore/dp/1490365885 and “Transforming: The Bible and the Lives of Transgender Christians” by Austin Hartke https://www.amazon.com/Transforming-Bible-Lives-Transgender-Christians/dp/0664263100

Partner Sites:

Evidence-based Services Committee of Hawaii