Gender dysphoria: what is it and can it be treated?

With an increase in awareness of Gender Dysphoria (GD), Dr Michelle Telfer, Clinical Leader at the RCH Centre for Adolescent Health, explains the finer points of GD and the benefits of treatment for gender variant young people.

GenderDys - BLOG TILEOne of the first patients I looked after when I began working in the RCH Gender Clinic was Henry, an 11-year-old. Henry told me that on every birthday since he’d turned four, he’d blown out the candles on his cake and wished that his body became that of a girl. He had become sad and withdrawn at school, and ceased joining activities that he used to enjoy with his friends. Henry told me that he didn’t want anyone to call him Henry or use “he” anymore. He’d decided that the name Holly fitted better. Just using the name Holly brought the biggest smile to her face and, as we talked about how our team at RCH could help her to be who she really was, I realised how lucky I am to have such a wonderful job.

Henry’s story helps to illustrate the difference between ‘sex’ and ‘gender’, words that are often used interchangeably.

‘Sex’ refers to a person’s physical appearance, determined by their chromosomes and hormones. In contrast, ‘gender’ refers to a person’s inner sense of whether they are male, female or somewhere in between. A person is ‘transgender’ when their sex and gender do not match; when this mismatch causes severe distress, it is referred to as Gender Dysphoria (GD).

It is common for children to display gender variant behaviour. For example, some girls like to play with trucks rather than dolls, and some boys like playing dress-ups with typically female clothing. This is not always a sign of GD; only 20% will continue to display gender variant behaviour after the onset of puberty, identifying as transgender during adolescence. Over 99% of transgender adolescents continue to identify as being transgender throughout adulthood.

The health risks associated with inadequate care and support of transgender adolescents are well known. For example, Australia’s third national survey about the health and wellbeing of transgender young people (2010) found that almost half of gender questioning young people had self-harmed. 28% had attempted suicide. There are also increased rates of bullying and physical assaults perpetrated against transgender young people, with discrimination experienced in accessing medical care, educational and employment opportunities.

Throughout the Western world, the number of people coming forward for medical intervention for Gender Dysphoria is increasing. This is likely due to increasing social acceptance of gender variance and public awareness of the treatment options through positive media coverage and the internet. At RCH we have seen an increase from one new referral in 2003 to 40 new referrals during 2013, and we expect that the numbers of young people coming forward for support and assistance will continue to increase over time.

When medical treatment commences at the optimal time (during early puberty), physical and mental health outcomes are better for transgender individuals. International treatment guidelines for children and adolescents with gender dysphoria recommend a series of medical interventions that are initially fully reversible (Stage 1 treatment using medication to suspend puberty), through to partially reversible interventions (Stage 2 treatment using oestrogen or testosterone hormones) and finally irreversible surgical interventions in adulthood (after the age of 18 years).

At RCH, the Gender Dysphoria Service consists of a team of Child and Adolescent Psychiatrists, Adolescent Physicians, Endocrinologists and Gynaecologists. We work together to ensure that all young people presenting to RCH with gender concerns receive a comprehensive assessment and ongoing support.

Psychological support may include education and counselling for the child or adolescent, their family members and involvement of the school community. For those young people who decide to commence hormonal treatment, this ongoing support is considered a necessary component of their care.

If you, or your child or adolescent wishes to be seen by the RCH Gender Dysphoria Service, a referral is required from a general practitioner. Parents can also access support through Transcend, a parent support group for families with transgender children or adolescents.

Other resources can be accessed via:

Beyond Blue: www.beyondblue.org.au
Kids Help Line: www.kidshelp.com.au
The Safe Schools Coalition: www.safeschoolscoalitionvictoria.org.au
Transgender Victoria: www.transgendervictoria.com
Transcend: 
www.transcendsupport.com.au

5 comments for “Gender dysphoria: what is it and can it be treated?”

  1. Dani

    None of the links work.

    Reply
  2. Dani

    None of the links listed are in order. I cannot access the information they are meant to connect me to.

    Reply
  3. Georgina Whitby

    This article is very misleading. Your definition of gender difference as an inner sense of biological sex, is very problematic and has little relationship to the criteria used to identify “gender dysphoria”. Setting aside that basic concern, the misleading description of statistics relation to GD diagnosis and Transgender and transsex identities is apaling:

    You say; “It is common for children to display gender variant behaviour. For example, some girls like to play with trucks rather than dolls, and some boys like playing dress-ups with typically female clothing. This is not always a sign of GD; only 20% will continue to display gender variant behaviour after the onset of puberty, identifying as transgender during adolescence. Over 99% of transgender adolescents continue to identify as being transgender throughout adulthood.”

    This paragraph make is sound like 20% of children who express gender variant behavior go on to be transgender! As you very well know, cross gender behaviour is healthy and near universal in young children. Of the small minority who meet Gender Dysphoria Diagnosis, between 2-20% (of the diagnosed kids) go on to be transgender after puberty. Where you got your 99% figure is a mystery.

    You mention puberty , and all the research agrees that active puberty is (with emerging sexuality and increasing complexity) what usually facilitates children integrating their bodies, sexuality, and gender aspects into more nuanced identity. Something not possible with intervention at the first blood test detection of impending tanner stage 2.

    You talk about transgender treatments, but really what you are talking is transsex treatments. Being transgender doesn’t typically require treatment. Being transsex may, but it is impossible before puberty to identify which children would grow up transgender, let alone transsex. Your clinic only offers screening and treatment for transsex treatments, not support for gender non-conformity or transgender identities outside that model.

    Your descriptions re the reversibility of treatments are also misleading. If children are given cross-hormones following early blockers, the combination of these treatments leads to irreversible infertility. This is unlike more mature bodies receiving cross hormones.

    The level of misinformation on this page needs investigation.

    Reply
  4. Colin J Ely

    Firstly I am reminded of the most important (unwritten) part of the Hippocratic Oath
    “First do no harm!”

    I wonder why your hospital includes references to the ‘Safe Schools Coalition’ and the film, ‘The Gender Fairy’. particularly after the current scandal of grossly innapropriate material for minors contained therin??!!

    Reply
  5. Michele

    To all the people who have commented above. With your negative so called ” educated responses” do you even have a child with gender dysphoria? I’m assuming you don’t. Because if you did you would be grateful for any support that you were given. So instead of babbling on about how wrong the information you think is stated above, how about being gratefull for the amazing service that the RCH offers our children in this situation. As a mother trying to navigate through gender dysphoria for my child all I am wanting to do is get my child through this alive and healthy at the end of it. So how about you show some support and gratitude to the people who are trying to help us parents raise our kids to be happy kids and comment your crap somewhere else!

    Reply

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