Transgender youth- current theory and practice

Recently, under the presidency of Obama, same sex marriage has become legal in a number of states in America. President Obama also became the first United States president to use the word transgender as he called for respect and protections for socially marginalized people during the State of the Union address. Transgender is an umbrella term for people whose gender identity and/ or gender expression differs from the gender assigned to them at birth. As a result, through social media and the press, a lot of attention is paid to people whose gender identity and/ or expression does not correspond to traditional norms. Famous transgender adult figures include Caitlyn Jenner, Laverne Cox (from the hit TV series Orange Is The New Black) etc. Even in Hong Kong parents consult with educational or clinical psychologists about transgender issues. In my own practice I do get these sort of referrals and thus it is important for professionals to upgrade their knowledge of transgender issues to help parents and individual adolescents understanding.

 

After some research, I found that there is some evidence that hormone blocker treatment improve a number of mental health outcomes for gender variant/ gender nonconforming adolescents. At the same time, some scholars and clinicians see the need to study this treatment’s long- term effects and argue that this treatment may make it difficult for children who change their mind and want to go back to the gender assigned at birth. We need more research to answer many questions surrounding hormone blockers and cross- hormonal treatment in young people, including the treatment’s effect on the developing brain, bone health, and the related risks for diabetes, hypertension and other chronic mental illnesses. However, one of the biggest obstacles in investigating the effect of hormone treatment is that we don’t fully understand exactly how gender identity develops. Although evidence suggests that children who persistently and strongly present with gender variant/ gender nonconforming at a very young age are more likely to maintain transgender identity into adulthood, clinicians are presently unable to make reliable predictions about which of the young gender variant/ gender nonconforming children will grow up to be transgender adults. And there is no official epidemiological research that exists to provide us with the prevalence of gender variant and gender nonconforming children and youth.

 

Clinical practice with gender variant/ gender nonconforming children can be divided into two main groups. One approach, which can be understood as corrective, is built around promotion of normative/ traditional gender identifications and expressions, and uses behavioral; methods and family training to help children identify with gender assigned to them at birth, in order to reduce stigma and transgender identity. The other approach, which is conceptualized as supportive/ affirming, focuses on supporting and building family and child resilience, counteracting stigma and other environmentally invalidating events, and allowing children to express gender in a way that feels authentic to them. No empirical studies supporting the efficacy of one type of treatment over the other treatment are available and treatment recommendations are based mostly on expert opinion rather than on any scientific outcome data. Most clinicians would support the latter approach especially with an older child. This is the official view of many organizations such as the National Association of School Psychologists.

 

It may be medically and therapeutically indicated for some transgender and other gender diverse children and adolescents to transition from one gender to another using any of the following: change of name, pronoun, hairstyle, clothing, pubertal suppression, cross- sex hormone treatment, and surgical treatment. Engaging in any of these methods is a big step for both the individual child or adolescent as well as for the family. Helping children and families through this process is also a huge challenge for professionals in this emerging area of mental health treatments. All clinicians that work with children and adolescents should seek to increase their knowledge of transgender issues.