“I knew that I wasn’t cis,I knew that,but I didn’t know exactly”: Gender identity development,expression and affirmation in youth who access gender affirming medical care

Abstract

Background: Research about gender identity development is still in its infancy, especially among youth who experience gender dysphoria and are accessing gender-affirming medical care.

Aims: This article contributes to the literature on how gender identity and gender dysphoria is experienced, expressed and addressed by youth who have started, or are just about to start, a gender-affirming medical intervention.

Methods: The project draws from qualitative interviews with 36 trans children and youth of different ages and stages of puberty. The data were collected in three specialized Canadian clinics that offer gender-affirming care and they were analyzed through inductive thematic analysis.

Results: Two interlinked dimensions of the youth’s lives allow meaning-making of their gender identity: 1) internal or personal and 2) interactional or social processes. Careful analysis reveals three gender identity development pathways that may be taken by youth, from early questioning to the affirmation of their gender identity. A discussion of current models of gender identity development and their limitations concludes the article.     

Clinical Management of Gender Dysphoria in Adolescents

SUMMARY

This paper aims to provide professionals working with adolescents with gender-dysphoric feelings practical clinical guidelines for diagnosis and treatment. The different phases of the assessment procedure and treatment process are described. Differential diagnostic considerations and possible psychotherapeutic treatment options are given. Physical interventions, including GnRH analogues to inhibit puberty and cross-sex hormones, are described with consideration of eligibility and readiness issues. We end with discussion of post-treatment evaluation.     

Sex vs. Gender

SUMMARY

This article was first published in D. R. Laub and P. Gandy, (eds), Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome, Stanford University Medical Center, Stanford, California, 1973, pp. 20–24. Prince argues that previous contributors to the symposium in using such terms as “gender conversion surgery” and “anatomic and genetic gender” were failing to grasp the distinction between sex and gender. Genital anatomy is about sex; gender role is about a lifestyle. Out of 100 people applying for a surgery perhaps only 10 percent should have it. The majority confuse sex and gender and fail to appreciate that what they are seeking is a gender change and not a sexual change. Prince likes the word “dysphoria” but argues for distinguishing sexual dysphoria from gender dysphoria. They are different and people should be treated according to which one they happen to be suffering from.     

Clinical Aspects of Transgender Speech Feminization and Masculinization

SUMMARY

Societal norms of speech, voice, and non-verbal communication are often strongly gendered. For transgender individuals who experience a mismatch between existing communication behaviours and felt sense of self, changes to the gendered aspects of communication can help reduce gender dysphoria, improving mental health and quality of life. While peer resources are often beneficial in changing overall appearance and presentation, speech and voice modification is best facilitated by a trans-competent speech professional. In this article we review clinical research relating to transgender speech and voice change and discuss clinical protocols for trans-specific assessment, treatment, and outcome evaluation.     

A Microanalytic Case Study of the Utilization of ‘Solution-Focused Problem Talk’ in Solution-Focused Brief Therapy

Abstract

Solution-focused therapy (SFBT) is a popular therapeutic approach among family therapists. However, disputes about SFBT still arise, especially on problems. This study examines the function of problem talk in SFBT by using a microanalytic case study method. As a result, three categories were found: Eliciting, clarifying, and acknowledging problems. The problem talks initiated by the SF therapist showed a pattern associated with the solution talk and served as preliminary steps to be connected to the following solution talks. The results indicate that solution building is constructed not only through solution talk, but also through ‘solution-focused problem talk.’     

Counseling and Mental Health Care for Transgender Adults and Loved Ones

SUMMARY

Increasingly, transgender individuals and loved ones (partners, family, and friends) are seeking assistance from mental health professionals working in the community rather than in university or hospital-based gender identity clinics. Drawing on published literature specific to transgender mental health, interviews with expert clinicians, the authors' clinical experience, and three key guiding principles (a transgender-affirmative approach, client-centered care, and a commitment to harm reduction), we suggest protocols for the clinician providing mental health services in the community setting. Practice areas discussed include assessment and treatment of gender concerns, trans-specific mental health issues, and trans-specific elements in general counseling of transgender individuals and their loved ones.     

Effectiveness of Cognitive Behavior Therapy for Severe Mood Disorders in an Acute Psychiatric Naturalistic Setting: A Benchmarking Study

The current study examined the effectiveness of brief cognitive behavior therapy (CBT) for severe mood disorders in an acute naturalistic setting. The sample included 951 individuals with either major depressive disorder (n = 857) or bipolar disorder with depressed mood (n = 94). Participants completed a battery of self-report measures assessing depression, overall well-being, and a range of secondary outcomes both before and after treatment. We found significant reductions in depressive symptoms, worry, self-harm, emotional lability, and substance abuse, as well as significant improvements in well-being and interpersonal relationships, post-treatment. Comparable to outpatient studies, 30% of the sample evidenced recovery from depression. Comparison of findings to benchmark studies indicated that, although the current sample started treatment with severe depressive symptoms and were in treatment for average of only 10 days, the overall magnitude of symptom improvement was similar to that of randomized controlled trials. Limitations of the study include a lack of control group, a limitation of most naturalistic studies. These findings indicate that interventions developed in controlled research settings on the efficacy of CBT can be transported to naturalistic, “real world” settings, and that brief CBT delivered in a partial hospital program is effective for many patients with severe depressive symptoms.     

Transsexuals and Pseudotranssexuals

SUMMARY

This article was first published in Archives of Sexual Behavior, vol. 7, no. 4, 1978, pp. 263–272. Prince admits to being attracted by the idea of sex reassignment for herself at the time of the publicity given to the case of Christine Jorgensen. However, the development of her philosophy that the central issues were to do with gender (the psycho-social) and not sex (anatomy and physiology) leads her to the view that it is perfectly possible for a male to be a woman without having sex surgery. She speaks out forcefully against sex reassignment, arguing that it is not appropriate for nine out of ten of those requesting it and writes of “so-called” or pseudo transsexuals. Susceptible transvestites are seduced by the publicity given to the topic into thinking it is the solution to their problems.     

‘Un-certainty’: working therapeutically with a transgender young person and learning to bear the unknown

Abstract

The rate of referrals to mental health services for children and young people for whom gender dysphoria is the identified clinical issue has increased significantly over the last ten years. Debates around the classifications of gender identity disorder, gender dysphoria or gender incongruence, as well as the involvement of child and adolescent mental health services with this group of children and young people seem to be re-enacting the societal gender binary world view where we see acceptance versus rejection, open-mindedness versus conservative, trans-phobic thinking. In this paper the author will attempt to shed some light on the work with these young people in a clinical setting by reflecting on a year of therapeutic work with a female to male young person. Through the therapist’s reflections upon these binary preconceptions, along with the use of developmental and object relations theory, an in-depth account of the work is given. It is suggested that in some cases the therapist’s capacity to bear the unknown, while gradually observing and mirroring the un-integrated inner self of the patient, can gradually bring the fragments together, even if not in a perfect fit, and that this in turn provides a sense of relief.     

大学生性别角色形成研究——双性化与未分化个案的对比

采用刘电芝编制的中国大学生性别角色量表(CSRI-50),甄别出双性化、未分化和单性化被试。在此基础上,对双性化和未分化个案进行深度访谈,以探究影响大学生性别角色形成的主要因素。结果表明父母教养方式、父母个性特点、父母期待、亲子关系、玩伴和自我期待是性别角色的六大影响因素。其中家庭因素最为重要,在家庭因素中父母处于核心地位。通过双性化和未分化个案的比较研究,表明教养者的温柔、鼓励,民主型教养方式,良好的家庭气氛,兄弟姐妹间友好关爱,积极的自我调节有利于双性化的发展;反之,则加剧未分化的形成。     

Care of the Patient Undergoing Sex Reassignment Surgery

SUMMARY

Sex reassignment surgery (SRS) has proven to be an effective intervention for the patient with gender dysphoria. As with any surgery, the quality of care provided before, during, and after SRS has a significant impact on patient outcomes. This article is intended to help primary care providers who are already familiar with routine transgender care to understand the specialized processes involved in SRS. Topics include guidelines for the recommendation of SRS, feminizing and masculinizing surgical procedures, suggested timelines for various interventions, expected course and recovery, risks and complications, and revisional surgery that may be required.     

Views of individuals with gender dysphoria and disorders of sex development on sexism: An Iranian study

ABSTRACT

Background: Ambivalent sexist attitudes have been previously measured regarding several factors such as sex, race and religion.

Aims: In this study, we evaluated the ambivalent sexism among Iranian individuals with gender dysphoria with or without disorders of sex development (DSD).

Methods: Attitudes towards gender stereotypes were investigated using Ambivalent Sexism Inventory (ASI) among three groups of participants with varying psychosexual outcome. These groups were transpeople (N = 152, M = 25.44, SD = 6.52), people with DSD (N = 40, M = 21.2, SD = 2.24) and cisgender people (N = 195, M = 25.9, SD = 5.59).

Results: Significant differences in both types of sexism, benevolent (F (2,383) = 134.217, p < .001) and hostile (F (2,383) = 93.765, p < .001), were found between transpeople, participants with DSD and controls. While scores of transpeople and people with DSD were not significantly different from each other (p = 0.191, Cohen's d = 0.38), both groups were significantly more sexist than controls on hostile sexism (p < 0.001, Cohen's d = 1.4 and 1.1). In benevolent sexism, there were significant differences between the scores of the trans, DSD and control groups, with individuals with DSD being most sexist followed by transgender people (p < 0.001) and controls showing the least degree of sexism (p < 0.001).

Conclusion: Using the Gender Self-Socialization Model (GSSM), we propose that increased scores of ASI among individuals whose gender identity is incongruent with all or some of their physical features are attempts to attain gender typicality. This may lead to a higher degree of sexist beliefs than when all sex and gender characteristics are congruent.     

Transgender women’s experiences and beliefs about hormone therapy through and beyond mid-age: An exploratory UK study

Background: Little is known about transgender women’s beliefs and experiences of hormone therapy (HT), as part of their transition process, and particularly as they grow older. Aims: This study aimed to investigate: (i) transgender women’s experiences and attitudes to HT, and (ii) expectations of what might occur and/or what occurred after they reached “menopausal age.” Methods: Participants were recruited through invitations to an online survey sent to 138 Lesbian, gay, bisexual, transgender plus (LGBT+) support groups across the UK. Sixty-seven transgender women consented and completed the questionnaire; responses were analyzed using a mixed-methods approach. The beliefs about medicines questionnaire (BMQ) was used to assess beliefs about HT, while an inductive thematic qualitative approach was used to explore participants’ personal expectations and experiences of HT and their views about the menopause. Results: Participants were aged on average 49 years ranging from 20 to 79 years old. Most (96%) were taking HT. BMQ scores revealed strong beliefs about the necessity of HT and some concerns. Positive views about HT were expressed, with themes including treatment importance, personal and mental health benefits, but concerns about long-term effects, side effects, and maintaining access to the treatment were also mentioned. Views about menopause included uncertainty and questioning of its relevance; some mentioned changes to HT dosage, but most expected to use HT indefinitely. Discussion: This study provides exploratory qualitative and quantitative information about transgender women’s views about HT and menopause. Practical implications include improving access to HT and provision of evidence-based information about long-term use.