One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria

D’Angelo, Roberto; Syrulnik, Ema; Ayad, Sasha; Marchiano, Lisa; Kenny, Dianna T.; Clarke, Patrick

doi:10.1007/s10508-020-01844-2

Cited by 32 publications

(29 citation statements)

References 52 publications

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“…Concerns have been raised that this new cohort of gender dysphoric individuals is unlike previous cohorts. Professionals have started to call for caution before treating this cohort with interventions with permanent effects because the etiologies, desistance and persistence rates, expected duration of symptoms, and whether this new population is helped or harmed by gender transition is still unknown (D'Angelo et al, 2021;Kaltiala-Heino et al, 2018). The natal females and natal males in this sample differed on several dimensions, including that natal females were younger than natal males when they sought transition, when they decided to detransition, and at the time of survey completion.…”

Section: Discussionmentioning

confidence: 98%

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners

Littman¹

2021

Arch Sex Behav

147

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The study’s purpose was to describe a population of individuals who experienced gender dysphoria, chose to undergo medical and/or surgical transition and then detransitioned by discontinuing medications, having surgery to reverse the effects of transition, or both. Recruitment information with a link to an anonymous survey was shared on social media, professional listservs, and via snowball sampling. Sixty-nine percent of the 100 participants were natal female and 31.0% were natal male. Reasons for detransitioning were varied and included: experiencing discrimination (23.0%); becoming more comfortable identifying as their natal sex (60.0%); having concerns about potential medical complications from transitioning (49.0%); and coming to the view that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition (38.0%). Homophobia or difficulty accepting themselves as lesbian, gay, or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition. The majority (55.0%) felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition and only 24.0% of respondents informed their clinicians that they had detransitioned. There are many different reasons and experiences leading to detransition. More research is needed to understand this population, determine the prevalence of detransition as an outcome of transition, meet the medical and psychological needs of this population, and better inform the process of evaluation and counseling prior to transition.

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Section: Discussionmentioning

confidence: 98%

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners

Littman¹

2021

Arch Sex Behav

147

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“…For instance, many detransitioners in Yoo's (2018) study "wished their providers [ … ] had initiated a discussion about other ways to address, treat, or live with gender dysphoria" (p. 184). Thus, developmentally informed, ethical, exploratory psychotherapy should be equally available for individuals-along with biomedical interventions-as a first-line treatment to ameliorate their feelings of GD (D'Angelo et al, 2020). This is especially significant insofar as considerable gaps in knowledge still exist regarding the impact and safety of gender-affirmative medical interventions for youth with GD (Olson-Kennedy et al, 2016), a circumstance that requires clinicians to be open about different therapeutic approaches instead of fostering a single view, for doing so "is worse than admitting uncertainty" (Lenzer, Hoffman, Furberg, & Ioannidis, 2013, p. 2).…”

Section: Implications For Healthcare Providersmentioning

confidence: 99%

“…Several studies have found GAT to improve gender dysphoric individuals' mental health and psychosocial functioning (e.g., Cohen-Kettenis, Schagen, Steensma, de Vries, & Delemarre-van de Waal, 2011;Costa & Colizzi, 2016;de Vries et al, 2014), but others have reported no significant differences (see Costa & Colizzi, 2016). In this regard, it is crucial to bear in mind that one size does not fit all (D'Angelo et al, 2020), meaning that GAT may not be a panacea for every individual with GD. Moreover, GAT do not necessarily bring benefits to other domains of the individual's life, so clinicians must address any potential issue in these areas in addition to GD.…”

Section: Implications For Healthcare Providersmentioning

confidence: 99%

A Typology of Gender Detransition and Its Implications for Healthcare Providers

Expósito-Campos

2021

Journal of Sex & Marital Therapy

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Gender detransition is an emerging yet poorly understood phenomenon in our society. In the absence of research, clinicians and researchers have applied the concept of detransition differently, leading to inconsistencies in its use. The article suggests a typology of gender detransition based on the cessation or the continuation of a transgender identity to address this issue. Implications of this typology for healthcare providers are discussed, emphasizing the increasing necessity of developing clinical guidelines for detransitioners. Finally, the article reflects on the possibilities of preventing detransition, which underlines the challenges that clinicians face when treating individuals with gender dysphoria.

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“…The study found that 88% had desisted at a mean age of 20.5 years (range, 13-39 years) (Singh et al, 2021). In 2020, three critiques of trans supportive interventions demonstrated that published scientific papers were flawed (Biggs, 2020;D'Angelo et al, 2021;Kalin, 2020). In 2020, a UK court put a halt to puberty blocking hormones and the use of cross-sex hormones for those under age of 16 and required 16-and 17-yearolds to individually have court approval before beginning hormones.…”

Section: Transgender Phenomena Evoke Intense Countertransferencesmentioning

confidence: 99%

Reflections on the Clinician’s Role with Individuals Who Self-identify as Transgender

Levine

2021

Arch Sex Behav

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The fact that modern patterns of the treatment of trans individuals are not based on controlled or long-term comprehensive follow-up studies has allowed many ethical tensions to persist. These have been intensifying as the numbers of adolescent girls declare themselves to be trans, have gender dysphoria, or are “boys.” This essay aims to assist clinicians in their initial approach to trans patients of any age. Gender identity is only one aspect of an individual’s multifaceted identity. The contributions to the passionate positions in the trans culture debate are discussed along with the controversy over the official, not falsifiable, position that all gender identities are inherently normal. The essay posits that it is relevant and ethical to investigate the forces that may have propelled an individual to create and announce a new identity. Some of these biological, social, and psychological forces are enumerated. Using the adolescent patient as an example, a model for a comprehensive evaluation process and its goals are provided. The essay is framed within a developmental perspective.

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One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria

Cited by 32 publications

References 52 publications

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners

Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners

A Typology of Gender Detransition and Its Implications for Healthcare Providers

Reflections on the Clinician’s Role with Individuals Who Self-identify as Transgender

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