Gender dysphoria in children

Gender dysphoria in children refers to a conflict between the sex assigned to a child at birth and the gender with which that child identifies. The conflict is not fleeting and may cause stress, anxiousness, and overall discomfort. Separate and unique criteria must be met in establishing gender dysphoria in children. Experts have debated how to handle and treat gender dysphoria in children, as well as whether children and adolescents can even experience gender dysphoria. A Cedars-Sinai study involving transgender men and women reported that 78 and 73 percent, respectively, indicated they first experienced gender dysphoria by age seven. Children are able to distinguish gender roles as young as two or three years old, and, by age four, most children have a conclusive idea of their gender identity.

Background

Gender dysphoria is a psychiatric diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Previously, the diagnosis was called “gender identity disorder.” The diagnosis for gender dysphoria was created and included in the DSM-5 so that individuals could access appropriate healthcare and treatment. While gender dysphoria is considered a mental health disorder, being transgender or gender-non-conforming is not. The three terms, though often seen together, are also not interchangeable. The term “transgender” refers to individuals whose biological sex, over time, does not match society’s expected gender identity, while “gender diverse” is a more general term that includes a variety of labels used when one’s gender identity does not adhere to societal constructs or norms. Unlike gender dysphoria, transgender and gender diverse are not diagnoses. They are ways to describe one’s gender. Although some people, including children, may be gender diverse, they do not necessarily experience gender dysphoria.

Gender dysphoria in children is defined as occurring before puberty. To be diagnosed with gender dysphoria, a child must meet at least six of eight criteria listed in the DSM-5. One of the criteria must include a powerful desire to be, or conviction that one is, of a different gender than the assigned one. In addition, the child must experience disconnect between their biological sex and gender identity for at least six months. Other criteria include strong preferences for clothing, playmates, toys, games, and so on that do not conform to societal expectations for their biological sex. Children may also show a strong dislike for their sexual anatomy or societal expectations for their particular sex. Finally, a child must exhibit significant distress that impairs their everyday activities and functioning. The distress may manifest itself as depression, anxiety, or suicidal thoughts.

While a child may be diagnosed with gender dysphoria, it is not typically treated until after puberty, except through therapy and/or social changes. In therapy, a goal is to reduce the negativity and anxiety created because of the conflict between the individual’s sex and gender identity. Therapy that attempts to “treat” or change the gender identification is generally frowned upon by doctors and considered a form of conversion therapy. Conversion therapy is viewed as unethical and considerably harmful by organizations like the American Psychological Association and the World Professional Association for Transgender Health. There are opposing viewpoints that argue going through puberty can be detrimental to someone with gender dysphoria. However, others support the idea that medical and/or surgical procedures should not occur until after puberty. Not every child (or adolescent/adult) who experiences gender dysphoria goes on hormone therapy or surgery. Children who experience gender dysphoria may be encouraged to adopt the normalized behaviors, pronouns, and dress of the gender with which they best identify. For example, an individual born with a vagina, whom society views as a woman, may identify more with society’s established masculine behaviors. As such, they may adopt a masculine name, traditionally male clothes, and use he/him pronouns.

Topic Today

According to the American Academy of Pediatrics, children are typically aware of differences between boys and girls at around the age of two. By age three, most can label themselves as a boy or girl, and by four years old, children have a solid idea of their own gender identity. Also at this time, children learn the stereotypes or norms of what it means to be a boy or a girl. They begin to choose their own clothes, attitudes, friends, and behaviors. When their choices do not align with societal norms, they may become distressed and start to believe they are different in a bad way. However, this is also the time when children like to explore different behaviors, engage in make-believe, and start to establish their own likes and dislikes. In the past, children who expressed gender-diverse feelings were ignored or discredited until they entered adolescence. Further research has shown that being dismissive of a child’s feelings has the potential to increase anxiety and depression, and ultimately encourage gender dysphoria.

Discussion surrounding gender dysphoria in children has become more widespread. So, too, have the debates. Although medical and surgical treatments more commonly occur after puberty, such treatments in children are not unheard of. Hormone blockers can be given to children to delay physical growth development. This treatment also allows more time for children to explore their gender identity without having to deal with pubic hair, periods, and so on. The American Psychological Association issued in 2020 a position statement on transgender and gender-diverse individuals. In that statement, the organization recognizes the important role hormone blockers can play to youth who may otherwise become devastated psychologically by experiencing puberty. Although there are still those individuals—including medical professionals—who support conversion therapies, more practitioners support affirmative care and therapy. As of 2022, at least twenty states had banned conversion therapy for minors.

Bibliography

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“Most Gender Dysphoria Established by Age 7, Study Finds,” Cedars Sinai, 16 June 2020, www.cedars-sinai.org/newsroom/most-gender-dysphoria-established-by-age-7-study-finds/. Accessed 10 Aug. 2022.

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