June 17, 2020
Introduction to Health for Transgender Youth:
What is Gender Identity?
Gender identity is a person’s intrinsic sense of being male, female, a combination of male and female, or neither male or female. Gender identity can be the same as one’s assigned sex at birth (“cis-gender”), or may vary. Transgender is umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth. A transgender male refers to a person assigned a female sex at birth who identifies as transgender, and whose gender expression leans towards the masculine. A transgender female refers to a person assigned a male sex at birth who identifies as transgender, and whose gender expression leans towards the feminine. A non-binary gender identity refers to an individual who does not solely identify as male or female. There are numerous other terms for gender identities that may be more specific to an individual. Gender identity is not the same as gender expression, the physical and behavioral expression of one’s gender (i.e. clothing) nor sexual orientation, whom one is romantically or sexually attracted to.
What Causes Variability in Gender Identity?
In most individuals, there is no identifiable cause. Research is ongoing to identify possible contributing genetic, hormonal, environmental or psychological factors. Varying gender identities can occur in individuals with differences of sexual development (reproductive or sexual anatomy that is different than typical male or female types); however, this is not a factor in most people with transgender gender identities.
What is Gender Dysphoria?
Gender dysphoria refers to the discomfort or distress resulting from a difference between a person’s gender identity and the person’s assigned sex, including the associated gender role and gender-specific body characteristics. Gender explorative behavior is common among young children and may be part of normal development. Children who meet the criteria for gender dysphoria may or may not continue to experience it into adolescence and adulthood. Some research shows that children who were more persistent, insistent and consistent in their transgender gender identity and had more intense symptoms and distress, were more likely to be transgender adults. Some transgender children may not experience gender dysphoria in childhood but may begin to do so with the occurrence of the natal puberty leading to more physical changes associated with the sex assigned at birth.
How is Gender Dysphoria Diagnosed?
A qualified physician or mental health professional can help confirm the diagnosis of gender dysphoria. Gender dysphoria is currently a psychological diagnosis, although this is controversial as having any gender identity, including a transgender identity, is not a disorder. Many individuals with gender dysphoria may have symptoms of depression, anxiety, or trauma-related difficulties which may be related to the underlying gender dysphoria or not. Transgender individuals have an increased risk of self-harming behaviors, suicidal thoughts and suicide attempts emphasizing the importance of mental health support. Importantly, family support has been shown to be a significant protective factor against these negative psychological sequelae.
What Kinds of Treatment Options Are Available to Reduce Gender Dysphoria?
The goal of treatment options for transgender individuals involves supporting their affirmed gender identity and helping to reduce gender dysphoria. Unsupportive treatment approaches, such as conversion therapy, to attempt to change individuals from being transgender is harmful and illegal in some states. Some transgender individuals desire to transition, a change in gender role, while others do not. The ability to transition, if desired, is based on individual preference, access to care, and may be limited by insurance coverage and cost.
There are different types of transition including social, medical and surgical. Transitioning has been associated with positive health outcomes by reducing gender dysphoria. Social transition refers making others aware of one’s gender identity such as through the use of a name and pronouns and using clothing or cutting one’s hair in line with the affirmed gender identity. Social transition is completely reversible. Medical transition involves the use of medications such as to prevent progression of an unwanted natal puberty and/or gender-affirming hormones such as estrogen or testosterone. Surgical transition involves altering breasts, genitalia and other body parts. Some medical and surgical interventions are reversible while others have changes that are irreversible. There is no “right” path for transgender youth, but all require support from family, community, and their health care professionals.
Pediatric Endocrine Society/American Academy of Pediatrics Section on Endocrinology Patient Education Committee
Copyright © 2018 American Academy of Pediatrics and Pediatric Endocrine Society. All rights reserved. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Additional English Resources:
- Feminizing Therapy for Transgender Females
- Gender Terminology and Gender Dysphoria
- Masculinizing Treatment for Transgender Males
- Parental Support
- Pubertal Suppression
- Working with your Child’s School