2025 – PAGE 443 – PSYCHIATRY AND SOME SOCIAL ISSUES

CARING FOR TRANSGENDER YOUTH (AKA GENDER DYSPHORIA)

Gender dysphoria is a term that seems to be used for children when a child or adolescent feels distressed because their gender identity is not aligning with their biological sex. Try to identify gender dysphoria prior to puberty as delayed diagnosis and the irreversible changes of puberty increase the risk of depression, anxiety, self-destructive behaviors, and suicide. Plus, if deemed appropriate by a multidisciplinary team (including mental health professionals), treatment with endocrine therapy to suppress puberty may be needed. This would then be followed by hormone replacement therapy (HRT, or “cross-sex hormones”) during adolescence and possible gender reassignment surgery in adulthood. “Cross-sex hormones” may include feminizing hormones for natal males, and androgens for natal females. Reparative psychotherapy (trying to change someone’s gender identity) does not work and is psychologically harmful. Promote supportive family and social environments and connect the patient to resources and support groups in the transgender community.

• PEARL: Gender and sexuality terms:
  • SEX: The biological status (male, female, or intersex) as determined by chromosomes and gonads.
  • GENDER: An individual’s psychological status (feelings, attitudes and behaviors) associated with being male or female in a given culture.
  • GENDER IDENTITY: An individual verbal expression of identifying themselves as male or female.
  • CISGENDER: When an individual’s gender identity is congruent with the individual’s biological sex.
  • TRANSSEXUAL/TRANSGENDER: When an individual’s gender identity is not congruent with the individual’s biological sex. This term seems to be used for older adolescents and adults.
  • GENDERQUEER: When an individual does not identify with a male or female gender identity.
  • GENDER EXPRESSION: The manner in which one expresses a gender. Best thought of in terms of external appearance, mannerisms, intonations, clothing, etc. It’s important to note that this expression might not be congruent with the patient’s own gender identity.
  • GENDER VARIANT/GENDER NONCONFORMING: Terms used to identify those whose gender expression is different from their biological sex. May be used in specific situations, such as play with toys.
  • SEXUAL ORIENTATION: Used to help identify the sex of those to whom an individual is sexually attracted to (e.g. someone attracted to the opposite sex is considered heterosexual, someone attracted to the same sex is considered gay or lesbian, and someone attracted to both sexes is considered bisexual).
• PEARL: Gonadotropin-releasing hormone analogs are used to suppresses puberty.