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 He had become sad and withdrawn at school, and ceased joining activities that he used to enjoy with his friends.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. 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
    • Mirjana

      Thank you Michele,
      I agree, just having had my 15 year tell me he is a she only weeks ago, I cannot begin to address the concerns we as parents are dealing with, just like being caught in a giant washing machine not knowing which way is up, we are searching for help and guidance, I just hope we can trust the RCH to guide us is correctly.

  3. Jodie

    @Colin

    I am so glad people like you get NO SAY in the matter of Safe Schools Australia. I am also extremely pleased that the RCH supports this absolutely necessary program that teaches students that it’s NOT OK to bully anyone based on any kind of diversity, but particularly focused on LGBTIQ kids. Great work, keep it up!

    Reply
  4. CW

    “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” The problem I have with this comment is the ‘gender variant behaviour’. Who has decided that trucks are for boys? Dolls are for girls? I work in early childhood education, and I have never thought of the many boys who play with dolls as displaying gender variant behaviour. They are becoming well balanced individuals who are able to just be themselves. Giving children the idea that there are ‘girl toys’ and ‘boy toys’ is where problems start. If a boy likes sparkly, pretty things and is told that’s for girls, and he is a vulnerable child, he may well think he is supposed to be a girl. I know it’s not that simple, and there are genuine cases of gender dysphoria, but we need to be aware of giving gender labels to toys. Unless the toy is operated by genitals, then it is for either sex. Let the kids be who they are. Some girls have short hair, some boys have long hair. Teach our children that this is ok. Some boys like sport and some don’t, some girls like to paint and so do some boys, some girls like climbing trees while some boys would prefer to stay in with a book, etc. If we start saying ‘some people like…’ that’s a start. They are not experiencing gender fluidity, they are being who they are. ‘Some people like horror movies, some people like romantic comedies’ I could definitely fit my male and female friends into each category.

    Reply

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