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Editor's Corner The Gender Affirmative Model: What We Know and What We Aim to Learn



In the summer of 2013, Dr. Jack Drescher published an editorial opinion about gender-nonconforming children in the New York Times in which he stated: ''Cur-rently experts can't tell apart kids who outgrow gender dysphoria (desisters) from those who do not (persisters), and how to treat them is controversial'' [Drescher, 2013, p. 1]. As members of a four-site child gender clinic group, we concur with Dr. Drescher regarding the controversy, but take issue with his assessment of experts and their inability to differentially assess ''persisters'' and ''desisters'' in childhood. We would like to take this opportunity to outline the gender affirmative model from which we practice, dispel myths about this model, and briefly outline the state of knowledge in our field regarding facilitators of healthy psychosocial development in gender-nonconforming children. The major premises informing our modes of prac-tice include: (a) gender variations are not disorders; (b) gender presentations are di-verse and varied across cultures, therefore requiring our cultural sensitivity; (c) to the best of our knowledge at present, gender involves an interweaving of biology, devel-opment and socialization, and culture and context, with all three bearing on any in-dividual's gender self; (d) gender may be fluid, and is not binary, both at a particular time and if and when it changes within an individual across time; (e) if there is pathol-ogy, it more often stems from cultural reactions (e.g., transphobia, homophobia, sex-ism) rather than from within the child. Our goals within this model are to listen to the child and decipher with the help of parents or caregivers what the child is communicating about both gender identity and gender expressions. We define gender identity as the gender the child articulates
Editor’s Corner
Human Development 2013;56:285–290
DOI: 10.1159/000355235
The Gender Affirmative Model: What We
Know and What We Aim to Learn
Marco A. Hidalgo a Diane Ehrensaft b Amy C. Tishelman c
Leslie F. Clark
d Robert Garofalo a Stephen M. Rosenthal b
Norman P. Spack
c Johanna Olson d
a Ann and Robert H. Lurie Children’s Hospital of Chicago/Feinberg School of Medicine,
Northwestern University, Chicago, Ill. ,
b University of California San Francisco Medical
Center, San Francisco, Calif. ,
c Boston Children’s Hospital/Harvard Medical School,
Boston, Mass. , and
d Children’s Hospital Los Angeles/Keck School of Medicine, University of
Southern California, Los Angeles, Calif. , USA
In the summer of 2013, Dr. Jack Drescher published an editorial opinion about
gender-nonconforming children in the New York Times in which he stated: ‘‘Cur-
rently experts can’t tell apart kids who outgrow gender dysphoria (desisters) from
those who do not (persisters), and how to treat them is controversial’’ [Drescher,
2013, p. 1]. As members of a four-site child gender clinic group, we concur with Dr.
Drescher regarding the controversy, but take issue with his assessment of experts and
their inability to differentially assess ‘‘persisters’’ and ‘‘desisters’’ in childhood. We
would like to take this opportunity to outline the gender affirmative model from
which we practice, dispel myths about this model, and briefly outline the state of
knowledge in our field regarding facilitators of healthy psychosocial development in
gender-nonconforming children. The major premises informing our modes of prac-
tice include: (a) gender variations are not disorders; (b) gender presentations are di-
verse and varied across cultures, therefore requiring our cultural sensitivity; (c) to the
best of our knowledge at present, gender involves an interweaving of biology, devel-
opment and socialization, and culture and context, with all three bearing on any in-
dividual’s gender self; (d) gender may be fluid, and is not binary, both at a particular
time and if and when it changes within an individual across time; (e) if there is pathol-
ogy, it more often stems from cultural reactions (e.g., transphobia, homophobia, sex-
ism) rather than from within the child.
Our goals within this model are to listen to the child and decipher with the help
of parents or caregivers what the child is communicating about both gender identity
and gender expressions. We define gender identity as the gender the child articulates
Diane Ehrensaft
445 Bellevue Avenue, Suite 302
Oakland, CA 94610 (USA)
E-Mail dehrensaft @
© 2013 S. Karger AG, Basel
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DOI: 10.1159/000355235
286 Hidalgo /Ehrensaft /Tishelman /Clark /Garofalo /
/Spack /Olson
as being – male, female, or something else. Research and our clinical experience sug-
gest that many children develop a strong sense of gender identity at a young age. In
most children, that identification will match the sex assigned on the child’s birth
certificate, but in a small minority the affirmed gender will be other than that assign-
ment. Learning from the work of Milton Diamond [2000], we understand gender
identity, both in its match and mismatch with assigned natal sex, as primarily in-
formed by a child’s cognitions and emotions, rather than by genitalia and observable
external sex characteristics. Gender identity is then to be differentiated from gender
expressions: the manner in which a child presents gender to the world – physical ap-
pearance, toys chosen, preferred playmates and activities. The category ‘‘gender-
nonconforming children’’ embraces all children exploring, questioning, or asserting
their gender identities and/or their gender expressions outside of cultural expecta-
tions. By differentiating gender expressions from gender identities, we have a tool
for sorting out the children who are insistent, persistent, and consistent in their af-
firmation of a cross-gender identity from those children who are either asserting or
exploring gender-nonconforming expressions within acceptance of their natal gen-
der assignment.
We have worked to dispel the myth that gender identity formation is synony-
mous with sexual identity formation (i.e., sexual orientation). Simply put, sexual
identity refers to the gender(s) one is romantically and/or sexually attracted to, while
gender identity has to do with what gender you are. These are two separate lines of
development, albeit ones with crossovers for certain children. For example, many
young boys explore the margins of gender identity on the way to later discovering
their gay sexual identities; these boys will often fall within the category of desisters,
shedding either their earlier gender nonconformity or dysphoria and developing into
males who identify as gay [Ehrensaft, 2011].
In this model, gender health is defined as a child’s opportunity to live in the
gender that feels most real or comfortable to that child and to express that gender
with freedom from restriction, aspersion, or rejection. Children not allowed these
freedoms by agents within their developmental systems (e.g., family, peers, school)
are at later risk for developing a downward cascade of psychosocial adversities in-
cluding depressive symptoms, low life satisfaction, self-harm, isolation, homeless-
ness, incarceration, posttraumatic stress, and suicide ideation and attempts [D’Au-
gelli, Grossman, & Starks, 2006; Garofalo, Deleon, Osmer, Doll, & Harper, 2006;
Roberts, Rosario, Corliss, Koenen, & Bryn Austin, 2012; Skidmore, Linsenmeier, &
Bailey, 2006; Toomey, Ryan, Díaz, Card, & Russell, 2010; Travers et al., 2012]. While
the developmental impact of our approach has yet to be rigorously studied, some
evidence suggests that gender-nonconforming children are negatively impacted
when given the message by therapists, doctors, or families that their gender expres-
sion must conform to traditional gender roles associated with their birth-assigned
gender [Hill, Menvielle, Sica, & Johnson, 2010]. Psychotherapies attempting to
tweak a child’s gender identity or expressions have been shown to suppress authen-
tic gender expression and create psychological symptoms [Bryant, 2006; Green,
Newman, & Stoller, 1972]. What we can deduce is that these psychotherapies are
unsuccessful because they aim to alter a child’s emerging gender identity (i.e., an in-
ternal sense of self) by attempting to change the child’s nonconforming gender ex-
pression (i.e., a behavior). Similar behavioral efforts to change aspects of sexual iden-
tity (i.e., reparative psychotherapies for homosexuality) have also proven unsuccess-
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Human Development 2013;56:285–290
DOI: 10.1159/000355235
ful, deleterious, and lacking in efficacy [for a review, see Anton, 2010]. Professional
health organizations, including the American Academy of Pediatrics (AAP), the
American Psychiatric Association (APA), and the American Psychological Associa-
tion, recommend against implementing such change efforts in clinical care [AAP,
1993; Anton, 2010; APA, 2000].
Newly emerging evidence indicating the positive influence of family acceptance
on the psychosocial well-being of gender-nonconforming and transgender youth
supports our gender-affirming model of care [Ryan, Russell, Huebner, Díaz, & Sán-
chez, 2010; Travers et al., 2012]. In a study of lesbian, gay, bisexual, and transgender
young adults, reports of family acceptance related to sexual and gender identity/
expression during adolescence were associated with positive self-esteem, increased
social support, and overall health in early adulthood [Ryan et al., 2010]. Family ac-
ceptance was also found to protect youth against negative psychosocial health vulner-
abilities commonly faced by gender-nonconforming and transgender youth (includ-
ing depression, substance abuse, and suicidality). More recently, in a sample com-
prised exclusively of gender-nonconforming and transgender youth, those who
reported their families as being strongly supportive of their gender identity and ex-
pression in childhood endorsed more positive mental health, less depressive symp-
toms, high self-esteem and life satisfaction in later adolescence compared with those
whose families were non-supportive [Travers et al., 2012]. As concluded by the au-
thors: ‘‘… anything less than strong support may have deleterious effects on a child’s
well-being’’ (p. 3). If that is so, we need to dispel the myths that confuse families and
prevent that support from occurring.
Myths about the Gender Affirmative Model
Two myths regarding a gender-affirming approach misrepresent its underlying
beliefs and assumptions. We outline these myths here.
Myth No. 1: Gender-affirming approaches conflate gender identity and gender ex-
pression; therefore, any child who exhibits gender nonconformity is believed to be trans-
Nothing could be further from the truth. Given that the gender affirmative mod-
el purports that gender presentations are diverse and varied, gender identity itself is
multiple in its possibilities, and can be paired with infinitely varied presentations. We
recognize that non-transgender individuals express their identities in manifold ways,
and embrace the welcome diversity that this facilitates. We also acknowledge that the
majority of gender-nonconforming children presenting for clinical care related to
gender dysphoria are desisters unlikely to mature into transgender individuals [de
Vries, Steensma, Doreleijers, & Cohen-Kettenis, 2011; Drummond, Bradley, Peter-
son-Badali, & Zucker, 2008; Green, 1987; Steensma, McGuire, Kreukels, Beekman, &
Cohen-Kettenis, 2013; Wallien & Cohen-Kettenis, 2008; Zucker & Bradley, 1995].
Thus, we dispute the notion that any child who exhibits nonconforming gender ex-
pression be considered transgender. Our stance, as gender-affirming practitioners, is
that children should be helped to live as they are most comfortable. For a gender-
nonconforming child, determining what is most comfortable is often a fluid process,
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288 Hidalgo /Ehrensaft /Tishelman /Clark /Garofalo /
/Spack /Olson
and can modify over time. Therefore, in a gender affirmative model, gender identity
and expression are enabled to unfold over time, as a child matures, acknowledging
and allowing for fluidity and change. Support, problem-solving, communication and
acceptance can facilitate a child’s self-understanding and choices, and allow time and
space for exploration and self-acceptance within an infinite variety of authentic gen-
der selves, whether it be in identity, expression, or both. To the extent possible, par-
ents and others should be supported to endure what can be a confusing and socially
challenging period.
Myth No. 2: The gender affirmative model asserts that gender identity and gender
expression are immutable and removed from social context or influence.
This myth of ‘‘essentialism’’ suggests that our approach endorses gender iden-
tity as fixed at or before birth and that no outside forces help shape or influence a
child’s identity or expression. To the contrary, we recognize that all elements of a
child’s sense of self – their self-beliefs, emotional responses, cognitions, perceptions,
expressions and assertions – develop and are informed by a complex interplay of cul-
tural, social, geographic, and interpersonal factors [Bronfenbrenner, 1979]. The gen-
der affirmative model holds central an awareness of prevailing societal norms per-
taining to gender identity and gender expression. These norms, present even in lan-
guage and pronoun structures, support a binary interpretation of gender (e.g., male
vs. female). Children with nonconforming gender expression (whether or not they
exhibit gender dysphoria) are at odds with prevailing gender norms. Those whose
behaviors (and/or dysphoria) ‘‘persist’’ do so even while vulnerable to facing consid-
erable isolation and disdain from family, peers and others, and often without many
media models or others with whom to identify. This suggests a strong constitutional
component for gender-nonconforming children, albeit one never exempt from envi-
ronmental forces. Our objective is to support gender-nonconforming children in
what may be fundamental to all elements of their sense of self. This understanding
informs our model’s premises that gender presentations are fluid and changing over
time as well as our orientation that, to the extent possible, children should be com-
fortable to freely explore a range of gender identities and expressions without external
and rejecting forces impinging upon them.
From Shattering Myths to Taking Action
The fields of medicine and psychology are only beginning to uncover the devel-
opmental trajectory of gender identity and expression in gender-nonconforming
children. We have much to learn about the healthy development of these children
and their families. For example, what are the comparative developmental outcomes
of the various approaches for treating gender-nonconforming children and youth?
Can we provide a fuller, accurate developmental picture distinguishing gender-non-
conforming children who are transgender from gender-nonconforming children
who may not be transgender? Is there any psychological harm done if a child transi-
tions from one gender to another and then transitions back? What are the outcomes
of receiving (or not receiving) psychosocial or medical interventions characteristic
of gender-affirming support, which may include reversible pubertal suppression
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therapy and irreversible cross-sex hormone therapy? Can we identify resilience fac-
tors and psychosocial risk factors in gender-nonconforming children and their fam-
ilies? What are the effects, both positive and negative, of the family, peer, socio-eco-
nomic, and socio-cultural systems in which gender-nonconforming children devel-
op? Are there instances in which a child’s beliefs about gender identity can become
confused by family and social forces, and how can we help to account for and coun-
ter such forces?
We invite other theoreticians and practitioners to consider the premises we have
laid forth for the gender affirmative model, and the rationale supporting them. We
also encourage the development of informal, multidisciplinary networks, such as our
own, comprised of providers who abide by a gender-affirming model of care, are cu-
rious about finding answers to the questions about the gender-nonconforming chil-
dren and youth we serve, and are eminently guided by the oath of our professions: to
‘‘do no harm.’’ Together, we hope to make a positive difference in the lives of these
children and families and in society at large so that gender in all its iterations can
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... 14 In addition, a needs assessment in South Florida identified routine and quality health care, including HIV, among top five health concerns of TGNC people living with HIV. 15 Another needs assessment of TGNC people living with HIV in New Orleans, Louisiana found trans-affirming health care and access to different HIV treatments among top health concerns. 16 In Bradford et al. 15 and Chung et al., 16 and Chung et al. 17 stigma and discrimination were cited as barriers to general and HIV health care. ...
... As a set of tenets, the gender affirmative model (GAM) guides practice with people of transgender, non-binary, gender diverse, expansive, and nonconforming lived experience. 17 It asserts: a) gender variations of identities and presentations are not disorders (i.e., depathologizing and destigmatizing); b) differences across cultures, requiring cultural sensitivity; c) involvement of biology, development and socialization, and culture and context; d) fluid or non-binary possibilities; and e) recognition of pathology (e.g., trauma-related symptoms or mental health challenges) as stemming from experiences of anti-transgender societal reactions. Gender-affirmative model approaches encompass the recognition and respect of an individual's gender identity and expression, with consideration of social and cultural contexts. ...
... In the contemporary U.S. South, GAM training is particularly important, given the region's socio-cultural realities (which strongly affect HSOs and HIV-affected TGNC groups). [8][9][10][11][12][13][14][15][16][17][18]48 This study aims 1) to summarize survey data from September 2018-August 2019 on GAM training and service provision at HSOs in Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas; and 2) to examine barriers to implementing GAM training and service provision. ...
Research on gender affirmative models (GAM) of training and service provision is emerging. This study aims 1) to summarize 2018–2019 survey data on GAM training and service provision at Southern HIV Service Organizations (HSOs) in the U.S. South and 2) identify barriers in the region. Methods. Data were collected from Southern HSOs ( n =207). Relations between GAM training and service provision were examined through frequency distributions and logistic regressions. Results. Few (46.6%) received training. Most (73%) used clients' asserted names and pronouns. Only 62% engaged with transgender, nonbinary, and gender nonconforming (TGNC) communities and 55% provided a gender autonomous (i.e., based on self-determination) facility. Gender affirmative model-trained HSOs had at least twice the odds of implementing GAM elements compared with non-trained HSOs. Barriers included funding (61%), expertise/knowledge (59%), capacity/staff-ing (52%), and political climate (23%). Discussion . This study identifies gaps and highlights the urgent need for funding, training, and meaningful TGNC community partnerships.
... We also use the gender affirmative model as our lens by which to view gendered implications of sexuality, SRH, and SRH education, whose underlying premises are (a) gender variations are not disorders; (b) gender presentations are diverse and varied across cultures, therefore requiring our cultural sensitivity; (c) to the best of our knowledge at present, gender involves an interweaving of biology, development and socialization, and culture and context, with all three bearing on any individual's gender self; (d) gender may be fluid, and is not binary, both at a particular time and if and when it changes within an individual across time; and (e) if there is pathology, it more often stems from cultural reactions (e.g., transphobia, homophobia, sexism) rather than from within the child (Hidalgo et al., 2013). ...
... We used an inductive approach using CCA and the gender affirmative model by which to explore gendered implications of sexuality, SRH, and SRH education from male-identified perspectives (Dutta, 2008;Hidalgo et al., 2013). We used a multi-phase analysis of multiple sources of data, including Photovoice and YPAR discussion sessions, youth interviews, CAB member meetings, and CAB member interviews. ...
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Adolescent sexual and reproductive health (ASRH) inequities are well documented for historically excluded youth (i.e., youth of color, LGBTQIA+ youth, youth with disabilities, recently im/migrated youth) living in the U.S. Northeast. However, the lived experience of male-identifying young people from historically excluded backgrounds in ASRH remains largely unexamined. The purpose of this paper is to present findings related to male-identified perspectives on social constructions of sexuality, sexual and reproductive health, and sexuality education. A research team composed of two local youth-serving organizations, eight youth researchers, and university researchers, used Youth Participatory Action Research (YPAR) methods to examine how structural violence contributes to inequitable ASRH outcomes for historically excluded youth. Photovoice and community mapping were used as YPAR methods. We also completed individual interviews on the same topic with the youth and with 17 key stakeholders that either provide services to youth or are emerging adult service recipients. Community-driven data reveal two major themes around the silencing of male-identified voices in ASRH: lack of culture-centered and gender-expansive approaches for ASRH, and the subsequent toll of sexism and (cis)gendered social and educational norms on young people. Our findings highlight that sexuality education, cisgender hetero culture, and social norms have put the onus of responsibility on people identifying as women for sexual and reproductive health. An unintended consequence of that is that young people identifying as men may feel powerless and uninformed around their own SRH. Our findings illustrate the importance of using culture-centered and gender-transformative approaches to ASRH to address inequity.
... GALA counters gatekeeping models of transgender care through a trans-affirmative approach that centers transgender voices and experiences, and asserts that being transgender is an identity, not a disorder (Carroll & Mizock, 2017;Hidalgo et al., 2013). The value of intersectionality requires that, when addressing an individual's gender, clinicians recognize and acknowledge that the cultural contexts of race, class, sexual orientation, ability status, and other important identities are inextricably linked and interwoven into a person's lived experience (Crenshaw, 1991;Nadal, 2013). ...
Full-text available
Background: The limited research on nonbinary individuals suggests that this community 10 experiences significant health disparities. Compared to binary transgender individuals, research suggests that nonbinary individuals are at elevated risk for discrimination and negative mental health outcomes, including depression, anxiety, traumatic stress, and suici-dality. Even mental health providers who work with binary transgender individuals often lack knowledge of and training to work competently with nonbinary individuals. Methods: The authors of this conceptual article present the Gender Affirmative Lifespan Approach (GALA), a psychotherapy framework based in health disparities theory and research, which asserts that therapeutic interventions combating internalized oppression have the potential to improve mental health symptomatology resulting in improved overall health and well-being for gender diverse clients. GALA's therapeutic interventions are designed to promote positive gender identity 20 development through five core components: (1) building resiliency; (2) developing gender literacy; (3) moving beyond the binary; 4) promoting positive sexuality; and (5) facilitating empowering connections to medical interventions (if desired). Results: The core components of the GALA model are individualized to each client's unique needs, while taking into consideration age and acknowledging developmental shifts in, or fluidity of, 25 gender across the lifespan. This model represents an inclusive, trans-affirmative approach to competent clinical care with nonbinary individuals. Discussion: Application of the GALA model with nonbinary clients is discussed, including one clinical case vignette.
... Estas tendencias han sido observadas también en España, según los datos procedentes de las Unidades de Identidad de Género (UIG) de Andalucía 21 , Asturias 22,23 , Cataluña 24 , Madrid 25 y Valencia 26 . Por otro lado, se está implantando un nuevo modelo de tratamiento, conocido como modelo afirmativo del género (gende affirmative model) 27 , que se basa únicamente en el principio del consentimiento informado 28 y elimina el requerimiento de evaluación y acompañamiento psicológico 29 . Así, este modelo se distancia del modelo biopsicosocial tradicional, que enfatiza la importancia de realizar evaluaciones psicosociales exhaustivas antes de recomendar cualquier tipo de intervención social o médica 30,31 . ...
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Introducción. La destransición de género es el acto de detener o revertir los cambios sociales, médicos y/o administrativos con- seguidos durante un proceso de transición de género. Se trata de un fenómeno emergente de gran interés a nivel clínico y social. Método. Se condujo una búsqueda sistemática en siete bases de datos entre 2010 y 2022, se rastrearon manualmente las referencias de los artículos y se consultaron libros especializados. Se realizó un análisis cuantitativo y de contenido. Resultados. Se incluyeron 138 registros, 37% correspondientes a estudios empíricos y 38,4% publicados en 2021. Se identifican al menos ocho términos para hacer referencia a la destransición, con diferencias en sus definiciones. La prevalencia difiere en función del criterio utilizado, siendo menor para la destransición/arrepentimiento (0-13,1%) que para la descontinuación de la asistencia/tratamiento médico (1,9%-29,8%), y menor para la destransición/arrepentimiento tras cirugía (0-2,4%) que para la destransición/arrepentimiento tras tratamiento hormonal (0-9,8%). Se describen más de 50 factores psicológicos, médicos y socioculturales que influyen en la decisión de destransicionar, así como 16 factores predictores/asociados a la destransición. No se encuentran guías de abordaje sanitario ni legislativo. Los debates actuales se centran en los interrogantes sobre la naturaleza de la disforia de género y el desarrollo de la identidad, el papel de los profesionales con respecto al acceso a los tratamientos médicos y el impacto de las destransiciones sobre la futura accesibilidad a dichos tratamientos. Conclusiones. La destransición de género es una realidad compleja, heterogénea, poco estudiada y escasamente comprendida. Se requiere un abordaje y estudio sistemático que permita comprender su prevalencia real, implicaciones y manejo a nivel sanitario.
... These include, for example, anti-bullying policies, support groups such as gay-straight alliances, professional development for faculty that relates to LGBTQA + student issues, and the inclusion of LGBTQA + identities in the curriculum [7][8][9][10]. While these policies and practices are designed to create inclusive and safe environments for LGBTQA + youth and may lead to experiences of affirmation [9], an affirmative approach goes beyond inclusivity and safety to create an environment that recognises, validates and supports the identity stated or expressed by LGBTQA + youth [11,12]. ...
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Background: Affirming socio-cultural settings are essential for protecting the mental health and wellbeing of lesbian, bisexual or pansexual, trans and gender diverse, asexual and queer (LGBTQA +) youth. However, limited research has explored the role of affirming educational and workplace settings, as reported by LGBTQA + youth themselves, with respect to their mental health and wellbeing. Moreover, existing research maintains a focus on mitigating poor mental health outcomes, with little attention to positive wellbeing outcomes among LGBTQA + youth. Methods: Using data from the largest national survey of LGBTQA + youth aged 14-21 in Australia, multivariable regression analyses were conducted to explore associations between affirming educational and workplace settings and psychological distress and subjective wellbeing among 4,331 cisgender and 1,537 trans and gender diverse youth. Additionally, a series of multivariable regression analyses were conducted to explore individual sociodemographic traits that are associated with reporting affirming educational or workplace settings. Results: Both cisgender and trans or gender diverse participants who reported that their education institution or workplace were affirming of their LGBTQA + identity reported lower levels of psychological distress as well as higher levels of subjective happiness. Additionally, affirming environments were not experienced equally across all subsections of LGBTQA + youth, with reporting of an affirming educational or workplace setting differing most noticeably across gender, type of educational institution and residential location. Conclusion: The findings demonstrate that affirming educational and workplace settings can result not only in better mental health, but also greater levels of subjective happiness among LGBTQA + youth. The outcomes illustrate the importance of ensuring all LGBTQA + youth are afforded the opportunity to thrive in environments where they feel validated and confident to express their identities. The findings further highlight a need to target education institutions and workplaces to ensure the implementation of policies and practices that promote not just inclusion of LGBTQA + youth but affirmation of their identities.
... These trends have also been observed in Spain, according to data from the Gender Identity Units (GIUs) of Andalusia 21 , Asturias 22,23 , Catalonia 24 , Madrid 25 , and Valencia 26 . On the other hand, a new treatment model, known as gender affirmative 27 , is being implemented, which is based solely on the principle of informed consent 28 and eliminates the requirement for psychological assessment and counseling 29 . This model thus departs from the traditional biopsychosocial model, which emphasizes the importance of conducting comprehensive psychosocial assessments before recommending any social or medical intervention 30,31 . ...
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Introduction. Gender detransition is the act of stopping or reversing the social, medical, and/or administrative changes achieved during a gender transition process. It is an emerging phenomenon of significant clinical and social interest. Methods. We systematically searched seven databases between 2010 and 2022, manually traced article references, and consulted specialized books. Quantitative and content analyses were carried out. Results. We included 138 registers, 37% of which were empirical studies and 38.4% of which were published in 2021. At least eight terms related to detransition were identified, with differences in their definitions. Prevalence estimates differ according to the criteria used, being lower for detransition/regret (0-13.1%) than for discontinuation of care/medical treatment (1.9%-29.8%), and for detransition/ regret after surgery (0-2.4%) than for detransition/ regret after hormonal treatment (0-9.8%). More than 50 psychological, medical, and sociocultural factors influencing the decision to detransition and 16 predictors/associated factors are described. No health or legal guidelines are found. Current debates focus on the nature of gender dysphoria and identity development, the role of professionals in accessing medical treatments, and the impact of detransition on future access to these treatments. Conclusions. Gender detransition is a complex, heterogeneous, under-researched, and poorly understood reality. A systematic study and approach to the topic is needed to understand its prevalence, implications, and management from a healthcare perspective.
... Ter-se-á em conta o seguinte: a maior parte das crianças que apresentam uma expressão de género não-conforme não desenvolvem uma identidade Trans ao longo do processo de crescimento [28]. Contudo, isto não deverá invalidar a existência de crianças de género diverso, que deve ser celebrado e afirmado o mais possível em diferentes contextos de vida, de modo a prevenir o impacto negativo do estigma e discriminação transfóbica no seu desenvolvimento. ...
Past research documents that both adolescent gender nonconformity and the experience of school victimization are associated with high rates of negative psychosocial adjustment. Using data from the Family Acceptance Project’s young adult survey, we examined associations among retrospective reports of adolescent gender nonconformity and adolescent school victimization due to perceived or actual lesbian, gay, bisexual, or transgender (LGBT) status, along with current reports of life satisfaction and depression. The participants included 245 LGBT young adults ranging in age from 21 to 25 years. Using structural equation modeling, we found that victimization due to perceived or actual LGBT status fully mediates the association between adolescent gender nonconformity and young adult psychosocial adjustment (i.e., life satisfaction and depression). Implications are addressed, including specific strategies that schools can implement to provide safer environments for gender-nonconforming LGBT students.
Based on retrospective reports of adult males who want to change sex, we have identified preadolescent boys at high risk for the development of adult transsexualism. These boys prefer the dress, toys, activities, and companionship of girls, and state their wish to be girls. During the past four years we have treated five very feminine boys and their parents. Treatment consists of developing a close relationship between a male therapist and the boy, stopping parental encouragement of feminine behavior, interrupting the excessively close relationship between mother and son, enhancing the role of father and son, and generally promoting the father's role within the family. Results indicate the capacity for gender role preference in the preadolescent male to undergo considerable modification toward masculinity.
To understand the way children develop, Bronfenbrenner believes that it is necessary to observe their behavior in natural settings, while they are interacting with familiar adults over prolonged periods of time. His book offers an important blueprint for constructing a new and ecologically valid psychology of development.
These minutes are the official record of the actions of the Association taken during the year by both the Board of Directors (the Board) and the Council of Representatives (Council). The roll of representatives was called at each Council meeting, and more than a quorum answered to their names. Reference is made in these minutes to various reports, some of which will be published elsewhere. Copies of these reports were distributed to Council and are on file in the Central Office. As long as the supply lasts, extra copies of many of the reports are available from the Central Office. These minutes are arranged in topical rather than chronological order, and subheadings are used when appropriate. The main topical headings are I. Minutes of Meetings; II. Elections, Awards, Membership, and Human Resources; III. Ethics; IV. Board of Directors; V. Divisions and State, Provincial, and Territorial Associations; VI. Organization of the APA; VII. Publications and Communications; VIII. Convention Affairs; IX. Educational Affairs; X. Professional Affairs; XI. Scientific Affairs; XII. Public Interest; XIII. Ethnic Minority Affairs; XIV. International Affairs; XV. Central Office; and XVI. Financial Affairs. Changes to the language of the American Psychological Association (APA) Bylaws, Association Rules, or motions of the items are noted as follows throughout these proceedings: Bracketed material is to be deleted; underlined material is to be added. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Objective: To examine the factors associated with the persistence of childhood gender dysphoria (GD), and to assess the feelings of GD, body image, and sexual orientation in adolescence. Method: The sample consisted of 127 adolescents (79 boys, 48 girls), who were referred for GD in childhood (<12 years of age) and followed up in adolescence. We examined childhood differences among persisters and desisters in demographics, psychological functioning, quality of peer relations and childhood GD, and adolescent reports of GD, body image, and sexual orientation. We examined contributions of childhood factors on the probability of persistence of GD into adolescence. Results: We found a link between the intensity of GD in childhood and persistence of GD, as well as a higher probability of persistence among natal girls. Psychological functioning and the quality of peer relations did not predict the persistence of childhood GD. Formerly nonsignificant (age at childhood assessment) and unstudied factors (a cognitive and/or affective cross-gender identification and a social role transition) were associated with the persistence of childhood GD, and varied among natal boys and girls. Conclusion: Intensity of early GD appears to be an important predictor of persistence of GD. Clinical recommendations for the support of children with GD may need to be developed independently for natal boys and for girls, as the presentation of boys and girls with GD is different, and different factors are predictive for the persistence of GD.
This landmark work reports the extensive research findings that address the questions: What is the role of the parents in the development of a son's sexuality? Why do some boys become "feminine"? Which "feminine" boys become homosexual? Why is there a link between being a "sissy boy" and a "gay man"? Parents, teachers, mental health professionals, social scientists, and anyone curious about the development of his or her sexual identity will find this book unusually informative and provocative. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the problems of teenagers with sexual confusion concerning gender identity and sexual orientation. Indications for therapy are described and the case histories of a 19-yr-old girl and an 18-yr-old male with sexual confusion are reviewed. Psychodynamic and biological factors that may be responsible for homosexual behavior are discussed. Therapy can help confused adolescents understand their personal feelings and mitigate against feelings of isolation and inferiority that can cause serious psychological problems. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Gender Identity Disorder of Childhood (GIDC)—a psychiatric diagnosis given to gendervariant children—has been controversial since its creation. Critics inside and outside of the mental health professions have called for the removal or revision of GIDC, arguing that it has served to pathologize homosexuality, to enforce normative notions of masculinity and femininity, and to recast a social problem as individual pathology. Drawing on published clinical and research papers, archival materials, and interviews with clinicians, researchers, and advocates, this article analyzes early studies of gendervariant boys from the 1960s and 1970s and describes the process through which the GIDC diagnosis was created. The article examines some of the limitations of current debates over GIDC and points out new trends that hold the most promise for providing support to gender-variant children.