Gender dysphoria in childhood

Abstract

Gender dysphoria (GD) in childhood is a complex phenomenon characterized by clinically significant distress due to the incongruence between assigned gender at birth and experienced gender. The clinical presentation of children who present with gender identity issues can be highly variable; the psychosexual development and future psychosexual outcome can be unclear, and consensus about the best clinical practice is currently under debate. In this paper a clinical picture is provided of children who are referred to gender identity clinics. The clinical criteria are described including what is known about the prevalence of childhood GD. In addition, an overview is presented of the literature on the psychological functioning of children with GD, the current knowledge on the psychosexual development and factors associated with the persistence of GD, and explanatory models for psychopathology in children with GD together with other co-existing problems that are characteristic for children referred for their gender. In light of this, currently used treatment and counselling approaches are summarized and discussed, including the integration of the literature detailed above.

Parental perceptions of emotional and behavioral difficulties among prepubertal gender-nonconforming children.

“…However, there is no consensus on a clinical approach to care for prepubertal TGNC children beyond general agreement that attempts to actively steer a child’s gender identity/expression toward conformity with assigned sex at birth is neither clinically sound nor ethical. There is also little understanding of the nature of psychopathology among TGNC children, which tends to be conceptualized in one of two primary ways: (1) Gender nonconformity/GD is unrelated to co-occurring psychiatric symptoms (vs. secondary to co-occurring psychopathology; Ristori & Steensma, 2016); and (2) co-occurring psychiatric symptoms (e.g., depression, anxiety, oppositionality) emerge secondary to gender nonconformity/GD due to invalidating social and cultural responses to the child’s gender identity or expression (e.g., restrictions on gender expression, bullying; Hidalgo et al, 2013). …”

How Should Physicians Help Gender-Transitioning Adolescents Consider Potential Iatrogenic Harms of Hormone Therapy?

“…The primary reason for this recommendation is that GD in childhood does not always persist into adolescence or adulthood. A review focusing on the development of children with GD showed that the gender nonconforming children in the studies were likely to identify as lesbian, gay, or bisexual adolescents or adults at the time of follow-up and that the GD had remitted around or after puberty for the majority of the children (85.2 percent) [11]. In addition, the ability to predict whether gender nonconformity in a child will persist or desist in the future is limited [12][13][14][15].…”

“…In addition, the ability to predict whether gender nonconformity in a child will persist or desist in the future is limited [12][13][14][15]. Therefore, it is generally seen as strongly inadvisable to intervene medically in this period [11].…”

Gender Incongruence of Childhood: Clinical Utility and Stakeholder Agreement with the World Health Organization’s Proposed ICD-11 Criteria

“…While some people propose the removal of this diagnosis from the classification system, others feel that being part of it is important. Proponents for the removal of this diagnosis state that a diagnosis for children is not needed because: 1) no medical treatment for pre-pubertal children with gender incongruence of childhood is available (e.g., [3,6]); 2) it stigmatizes and pathologizes children with normal variations of gender expressions [3,6]; 3) due to the fact that it is not possible to predict which children will have persisting gender incongruence of adolescence or adulthood and which will not [7–10], clinical input will be provided to children when it is not needed thus increasing the risk of iatrogenic harm [6]; and 4) the way gender variance in children is viewed is culture-specific, with many non-Western cultures being more accepting of gender variance than Western cultures [6]. …”