Gender Identity in Children's Behavioral Health
Child Behavioral Health
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Week 10
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www.genderbread.org
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Cisgender (“Cis”)
•
Anatomical Sex = Gender Identity
Genderqueer
•
Broad term to encompass non-cisgender identities
Binary Trans
•
Trans Male (FtM)
•
Trans Female (MtF)
Non-Binary:
•
Does not fit within two discrete genders
Gender Fluid
:
•
Gender identity is not static, changes
9/14/2024
4
http://www.soc.ucsb.edu/sexinfo/article/gloss
ary-sexual-orientationgender-terminology
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No longer Gender Identity (
Disorder
) in DSM
–
Gender noncomformity ≠ Disorder
•
At least 2 criteria met for at least 6 months w/ Impairment**
–
Noticeable incongruence between the gender that the patient sees
themselves are, and their classified gender assignment
–
An intense need to do away with his or her primary or secondary sex
features (or, in the case of young teenagers, to avert the maturity of the
likely secondary features)
–
An intense desire to have the primary or secondary sex features of the
other gender
–
A deep desire to transform into another gender
–
A profound need for society to treat them as another gender
–
A powerful assurance of having the characteristic feelings and
responses of the other gender
9/14/2024
5
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•
52% of a sample of children with GID met criteria for
comorbid psychiatric condition
–
Depression
–
Anxiety
–
SI (~65%) & Attempts (~26%)
•
Just under 50% attributed SI to stressors related to trans identity
–
High Risk Behaviors
(truancy, risky sex, substance use)
9/14/2024
6
Institute of Medicine, 2011; Wallien,
Swaab, & Cohen-Kettenis, 2007
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Very difficult to determine due to existing research
being plagued by:
–
Small sample sizes
–
Methodological flaws
(e.g., those who drop out as desisting)
–
Differing inclusion criteria, changing terms/definitions,
understanding
•
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–
Younger when identifying
–
Pervasive, consistent, persistent, insistent
–
Less likely to say “I want to be …” more likely to say “I
am…”
9/14/2024
7
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Ask about pronouns/identity/name
and use what they tell you;
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Okay to make mistakes with them, it’s okay if done with compassion
•
Admit when you don’t know, while showing willingness to learn
•
Acceptance/Rejection does not change likelihood of persisting, only
amount of distress and comorbid mental health difficulties
child/person will face
9/14/2024
10
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•
Puberty Suppression
–
Gonadotropin releasing hormone (GnRH)
analogues (ex. Leuprolide)
•
Hormone Therapy
–
FTM
testosterone
–
MTF
estrogen
•
Surgery
–
Chest reconstruction
(“Top surgery”)
–
Genital surgery (typically 18 and older) (
“Bottom
surgery”
)
9/14/2024
11
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•
Oral Contraception for FTM patients
–
Continuous administration of active oral
contraceptive pills
–
Progestogen – only long acting reversible
contraceptives (ex: Depo Provera)
9/14/2024
12
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Center for Excellence for Transgender Health
–
http://transhealth.ucsf.edu/tcoe?page=guidelines-youth
•
WPATH: Trans Healthcare Standards of Care
–
https://wpath.org/
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•
Philadelphia Trans Wellness Conference
–
https://www.mazzonicenter.org/trans-wellness
•
Trans Ohio Symposium (Columbus)
–
http://www.transohio.org/
9/14/2024
13
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9/14/2024
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9/14/2024
17
Explore the nuances of gender identity, gender dysphoria, and associated co-morbidities in children's behavioral health. Learn about the challenges, controversies, and evolving definitions shaping this critical aspect of mental well-being.
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Presentation Transcript
........ Child Behavioral Health
Gender Identity Week 10 .. ..
www.genderbread.org Definitions .. ..
(Some) More Definitions Cisgender ( Cis ) Anatomical Sex = Gender Identity Genderqueer Broad term to encompass non-cisgender identities Binary Trans Trans Male (FtM) Trans Female (MtF) http://www.soc.ucsb.edu/sexinfo/article/gloss ary-sexual-orientationgender-terminology Non-Binary: Does not fit within two discrete genders Gender Fluid: Gender identity is not static, changes .. .. 9/14/2024 4
Gender Dysphoria* No longer Gender Identity (Disorder) in DSM Gender noncomformity Disorder At least 2 criteria met for at least 6 months w/ Impairment** Noticeable incongruence between the gender that the patient sees themselves are, and their classified gender assignment An intense need to do away with his or her primary or secondary sex features (or, in the case of young teenagers, to avert the maturity of the likely secondary features) An intense desire to have the primary or secondary sex features of the other gender A deep desire to transform into another gender A profound need for society to treat them as another gender A powerful assurance of having the characteristic feelings and responses of the other gender .. .. 9/14/2024 5
Co-morbidities 52% of a sample of children with GID met criteria for comorbid psychiatric condition Depression Anxiety SI (~65%) & Attempts (~26%) Just under 50% attributed SI to stressors related to trans identity High Risk Behaviors (truancy, risky sex, substance use) Institute of Medicine, 2011; Wallien, Swaab, & Cohen-Kettenis, 2007 .. .. 9/14/2024 6
Persist/Desist Controversy Very difficult to determine due to existing research being plagued by: Small sample sizes Methodological flaws (e.g., those who drop out as desisting) Differing inclusion criteria, changing terms/definitions, understanding Those who are morelikely to persist: Younger when identifying Pervasive, consistent, persistent, insistent Less likely to say I want to be more likely to say I am .. .. 9/14/2024 7
Barriers to Care Percent who report barriers to medical care 0 10 20 30 40 50 60 70 80 90 100 Health Professionals are not adequately trained to care for people who are transgender Medical personnel will treat me differently because I am transgender I will be refused medical services because I am transgender .. .. Lambda Legal, 2009
Educational Pearls Ask about pronouns/identity/name and use what they tell you; Ask whether caregivers are aware and do not use in front of them if they do not; careful with documentation Okay to make mistakes with them, it s okay if done with compassion Admit when you don t know, while showing willingness to learn Acceptance/Rejection does not change likelihood of persisting, only amount of distress and comorbid mental health difficulties child/person will face .. .. 9/14/2024 10
Medical Interventions Puberty Suppression Gonadotropin releasing hormone (GnRH) analogues (ex. Leuprolide) Hormone Therapy FTM testosterone MTF estrogen Surgery Chest reconstruction ( Top surgery ) Genital surgery (typically 18 and older) ( Bottom surgery ) .. .. 9/14/2024 11
Medical Interventions Oral Contraception for FTM patients Continuous administration of active oral contraceptive pills Progestogen only long acting reversible contraceptives (ex: Depo Provera) .. .. 9/14/2024 12
Want to take a deeper dive? Clinical/Medical Interventions and Guidelines Center for Excellence for Transgender Health http://transhealth.ucsf.edu/tcoe?page=guidelines-youth WPATH: Trans Healthcare Standards of Care https://wpath.org/ Conferences Philadelphia Trans Wellness Conference https://www.mazzonicenter.org/trans-wellness Trans Ohio Symposium (Columbus) http://www.transohio.org/ .. .. 9/14/2024 13
Central Ohio Transgender Resources Kaleidoscope Youth Center http://www.kycohio.org/ Based in Columbus. They also have a GSA (Gay- Straight Alliance groups in schools) and the list is available online at: http://www.kycohio.org/network- directory.html Genderscope. Meets on Tuesdays and Thursdays. Liam Gallagher liam@kycohio.org THRIVE at Nationwide Children s Hospital https://www.nationwidechildrens.org/specialties/thrive- program .. .. 9/14/2024 14
Ohio Transgender Resources TransOhio - www.transohio.org Provides services, education, support, and advocacy, which promotes and improves the health, safety and life experience of the Ohio transgender individual and community. PFLAG Ohio Chapters They publish a book called Our Trans Loved Ones: Questions and answers for parents, families, and friends of people who are transgender and gender expansive. .. ..
Additional Reading Trans Bodies, Trans Selves: A Resource for the Transgender Community by Laura Erickson-Schroth Gender Born Gender Made by Diane Ehrensaft PFLAG has a reading list -- https://pflag.org/resource/transgender-reading-list- adults Welcoming Schools A project of HRC has a reading list as well -- http://www.welcomingschools.org/resources/books/trans gender-youth/ .. .. 9/14/2024 16
National Transgender Resources National Center for Transgender Equality - https://transequality.org/ - amazing organization! For Ohio info directly: https://transequality.org/documents/state/ohio Transgender Law Center https://transgenderlawcenter.org/ - based in California, but have begun to do work across the country PFLAG (Parents, Friends of Lesbian and Gay), now just called PFLAG so that they are inclusive of trans and gender diverse people TransYouth Family Allies (TYFA) -- http://www.imatyfa.org -- They have resources for both kids and parents HRC (Human Rights Campaign) www.hrc.org they also have a section on Faith. .. .. 9/14/2024 17
