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Vincent Iannelli, M.D.

Children with Gender Identity Disorder

By February 20, 2012

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Children and teens with gender identity disorder (GID) have been getting more attention in recent years.

This has been helped by some media attention and articles that describe what the children and their parents are going through in getting diagnosed and treated, such as:

These articles also highlight many of the challenges they face.

A new study, "Characteristics of Children and Adolescents with Gender Identity Disorder Referred to a Pediatric Medical Center," which will be published in the March issue of Pediatrics, "highlights the importance of educating pediatricians about care guidelines for children and adolescents with Gender Identity Disorder."

And since early treatment can "minimize acute distress from endogenous pubertal development and maximize appropriate 'gender attribution' (society's perception of one's gender)," it would likely be a good idea to educate the parents of children and adolescents who may have gender identity disorder too.

This is especially important as another new study, "Childhood Gender Nonconformity: A Risk Indicator for Childhood Abuse and Posttraumatic Stress in Youth," found that these children were at risk for "childhood sexual, physical, and psychological abuse and PTSD."

Many of these children also present with serious psychological symptoms, including anxiety, depression, or suicidal ideation. Many also engage in self-harm behaviors. It is important that this study notes that these symptoms do not seem to be primarily psychiatric. Instead, they found that their "psychological functioning improves with medical intervention and suggests that the patients' psychiatric symptoms might be secondary to a medical incongruence between mind and body."

Ideally, it would seem like treatment with reversible gonadotropin-releasing hormone (GnRH) analogs to suppress puberty should occur before secondary sexual characteristics have fully developed.

The authors of the study "advocate for early evaluation of these children by experienced professionals."

They also provide some clues that might indicate a child has gender identity disorder, including:

  • preference for female clothing and underwear (boys)
  • always sitting to void (boys)
  • exclusive play with female toys when given a choice (boys)
  • desire for long hair (boys)
  • preference for male underwear (girls)
  • breast binding (girls)
  • refusal to wear female swimsuits (girls)
  • psychiatric decompensation at the onset of menstruation (girls)

If symptoms of gender dysphoria persist or intensify as the child starts puberty, then they should be referred to a specialist who treats teens with gender identity disorder and medical treatment should be considered.

Unfortunately, there aren't that many clinics that specialize in this type of treatment. Among those that do are the Gender Management Service (GeMS) Clinic at Children's Hospital Boston and the Disorders of Sexual Development Clinic at UCSF Benioff Children's Hospital.

Keep in mind that some gender questioning and gender role exploration can be normal. The prevalence of true gender identity disorder is much lower than rates of of reported cross-gender behavior. That may indicate that "a lot of children seem to be experimenting with cross-gender behavior, but very few are following through to request gender change as they mature." At least that is the conclusion of a commentary in the same issue of Pediatrics, "Gender Identity Disorder: An Emerging Problem for Pediatricians."

Still, the bottom line, according to the American Academy of Pediatrics, is that "Study authors advocate for early evaluation of children exhibiting GID, but treatment with medications should not be started until they reach puberty. Pediatricians and parents should consult with experienced mental health professionals for children and adolescents experiencing gender-related issues. When patients are sufficiently physically mature to receive medical treatment, they should be referred to a medical specialist or program treating GID."

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World Professional Association for Transgender Health
TransYouth Family Allies
Intersex Society of North America
Consortium on the Management of Disorders of Sex Development

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