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 He had become sad and withdrawn at school, and ceased joining activities that he used to enjoy with his friends.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