Book

Born In Your Own Body: Transgender, Children and Young People

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Abstract

This edited collection provides a range of contributions from scholars, activists, parents, transitioners and de-transitioners, all of whom critically reflect on the current medical phenomenon of facilitating sex transition in children and adolescents
... 1 This, together with growing numbers of 'detransitioners' (individuals whose GD has desisted later in adolescence or adulthood), has given rise to fierce debate regarding best practice for the treatment of GD in youth. [4][5][6] Most recently, the UK High Court ruled that endocrine interventions should no longer be prescribed to individuals below the age of 16, and should require a court order for those between 16 and 18 whose healthcare provider (HCP) deems it necessary. 7 Nonetheless, this form of intervention (as we explain in more detail below) is currently established as best practice in a number of countries around the world, and is supported as such by many transgender rights organisations and charities. ...
... 20 Recent research into increasing numbers of (mostly) young people detransitioning, following varying degrees of social and medical transition, highlight uncertainties regarding the capacity of HCPs to distinguish GD that will persist from GD that will desist. 5 15 21 Despite these uncertainties, 'gender affirming' endocrine interventions and surgery have, over the last decade, been recommended as the best course of action by gender-identity specialists and activist organisations. 6 The most commonly used guidelines for the treatment of GD in children and adolescents are based on the 'Dutch protocol', which recommends medical treatment (specifically, puberty suppression through Gonadotropin-Releasing Hormone agonists (GnRHa) or 'puberty blockers') at Tanner stage II-III. ...
... 14 24 All of this serves to suggest that the currently understood 'best practice' (affirmation of self-diagnosis and direction towards physiological interventions) ought to be re-evaluated. This is a view shared by rising numbers of clinicians concerned (some to the point of resigning their posts) by what they perceive as a conflict between 'best practice' and medical ethics at GIDS. 5 This brings us to the second dilemma: the consent dilemma. As noted above, the 'Dutch protocol' recommends commencing endocrine treatment at Tanner stage II-III, which 'almost always precedes the age of consent.' 24 However, it also precedes the age at which many children 'desist' in their experience of incongruence between their sex and gender identity: in one study, both those adolescents whose GD persisted and those whose GD desisted reported that 'they considered the period between 10 and 13 to be crucial'. ...
Article
Both the diagnosis and medical treatment of gender dysphoria (GD)—particularly in children and adolescents—have been the subject of significant controversy in recent years. In this paper, we outline the means by which GD is diagnosed in children and adolescents, the currently available treatment options, and the bioethical issues these currently raise. In particular, we argue that the families and healthcare providers of children presenting with GD currently face two main ethical dilemmas in decision making regarding treatment: the pathway dilemma and the consent dilemma.
... Some psychoanalysts critical to the vision that promotes hormone suppressants in children see the identity problem as requiring a symbolic work, and the body intervention is a mistake, a psychotic solution [51]. According to Bell [52], there are underexplored factors from a social point of view contributing to the current emergence regarding gender dysphoria that includes misogyny internalization, seeing patients as products, and social media influence. ...
Chapter
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Psychoanalysis rose at the end of the nineteenth century as a possibility of reintegrating the mind and body. This came up as proposing a theory that empirically demonstrates that emotions create symptoms in the body. Psychoanalysis introduces a subject moved by desires, governed by the unconscious. Since then, in a dialectic perspective, search and offer to society a counterpoint view of current thought, offering new insights and reflection, bringing enlightenment of what is obscure in individuals’ internal life. The contemporary psychoanalytic crisis comes from conflict avoidance, not worrying in the integrative view, falling into a trap of “politically correct,” that is, accepting what is advocated, without questioning, not putting on the agenda the obscure side effects in human beings, the Unconscious. Therefore, in a psychoanalytic theoretical perspective, this chapter has the aim to reflect about the psychic suffering inside a body identity, without getting into sociological and anthropological meanings about the shaping of social identity. This study seeks to present the psychic suffering of the unidentified body, which not always will find resolution in an aesthetic procedure that might be belonging to a fantasy and identity recognition.
... Like most public declarations about being denied a platform on which to speak, this paranoid statement about the silencing effect of trans activism carries its own dissonance. Brunskell-Evans, despite her claim that trans activists immediately shut down any discussion about trans life, has published three books decrying trans childhoods (Brunskell-Evans, 2018, and she made this statement as one of seven key interview subjects for O'Malley's Channel 4 documentary. Paranoia, in this sense, is both a fear that her critique is being shut down and a conviction in her assertion of a new grandiose plot of unregulated experimentation on children. ...
Article
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Some of the most virulent public trans-exclusionary radical feminist (TERF) discourse in the UK follows the grammatical form of the third conditional: if I had grown up now, I would have been persuaded to transition. This articulation of the hypothetical threat of a transition that did not happen but is imagined, in retrospect, to be not just possible but forcibly enacted, plays an important role, both politically and psychically, in a contemporary political landscape that is threatening the livelihoods of trans children. Interrogating this discourse via an analysis of an open letter by J.K. Rowling, and a documentary by Stella O’Malley, this article asks: What might we learn about contemporary transphobia in the UK if we took seriously the grammar of TERF discourse animated by trans childhood? It argues that while the third conditional grammar of TERF discourse could articulate a politics of solidarity between cis and trans positionalities and politics, its potential for a shared political standpoint is routinely interrupted by the defence mechanisms that are oriented by the psychic life of the child. Interrogating these defence mechanisms at the level of the cultural, the article traces out paranoia (as reading practice and psychic state) as well as projection, as two main modes of TERF engagement with trans childhood. The article thus engages with the range of real and fantasmatic impossibilities that haunt the trans child both in the present and the past, and it contributes to the growing body of scholarship on trans childhoods. Doing so, it makes the case that public discourse on trans children desist from hypothetical third conditional claims, and instead find ways of embracing trans childhoods unconditionally.
... As with drug control, some characterisations of childhood (innocent, vulnerable and so on) hold particular explanatory and regulatory power in such debates. However, discourse on transgender rights presents different (and of course unstable) visions of childhood, including the misgendered or rights-bearing child (Gires, 2018), as well as the corrupted child, the child as a vessel for political correctness, or the trans child as a neoliberal construct (see, for example, Brunskell-Evans and Moore, 2020;Brunskell-Evans, 2018). Any or all of these versions might carry political force, serve symbolic functions and shape or materialise the "problems" of gender dysphoria and trans subjectivity, while potentially authorising the subjection of trans communities to continued harm and exclusion. ...
Book
Debates about the regulation of drugs are inseparable from talk of children and the young. Yet how has this association come to be so strong, and why does it have so much explanatory, rhetorical and political force? The premise for this book is that the relationship between drugs and childhood merits more exploration beyond simply pointing out that children and drugs are both ‘things we tend to get worried about’. It asks what is at stake when legislators, lobbyists and decision-makers revert to claims about children in order to sustain a given legal or policy position. Beginning with a genealogy of the relationship between the discursive artefacts of ‘drugs’ and ‘childhood’, the book draws on Foucauldian methodologies to explore how childhood functions as a device in the biopolitical management of drug use(rs) and supply. In addition to analysing decriminalisation initiatives and sentencing measures, it (unusually) reaches beyond the criminal context to consider the significance of the ‘politics of childhood’ for law- and policymaking in the fields of family justice and education. It concludes by arguing that the currency of childhood and ‘youth’ is not reducible to rhetoric; it shapes the discursive entities of drugs and addiction and is one of the ways in which particular substances become socially, culturally and politically intelligible. At the same time, ‘drugs’ serve as a technology of child normalisation.
... As with drug control, some characterisations of childhood (innocent, vulnerable and so on) hold particular explanatory and regulatory power in such debates. However, discourse on transgender rights presents different (and of course unstable) visions of childhood, including the misgendered or rights-bearing child (Gires, 2018), as well as the corrupted child, the child as a vessel for political correctness, or the trans child as a neoliberal construct (see, for example, Brunskell-Evans and Moore, 2020;Brunskell-Evans, 2018). Any or all of these versions might carry political force, serve symbolic functions and shape or materialise the "problems" of gender dysphoria and trans subjectivity, while potentially authorising the subjection of trans communities to continued harm and exclusion. ...
Article
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O presente artigo possui como tema central os processos que têm sido denominados de ‘destransição de gênero’. Propomos realizar, nesse texto, uma revisão teórica sobre o gênero em seus aspectos identitários ou como estados transitórios, buscando basear nossas discussões sobre a questão da ‘destransição’. Nossos debates giraram em torno de alguns pontos principais, envolvendo certas questões internas aos movimentos trans*, como a disputa pelo sujeito político. Ademais, abordamos outros pontos, como as normas de gênero e os movimentos de subversão delas e buscamos traçar um mapeamento dos estudos sobre a ‘destransição de gênero’ no Brasil. Nossa proposta é a de pensar o gênero como trânsito, entendendo certos processos como movimentos de errância corporal. PALAVRAS-CHAVE: ‘Destransição de gênero’. Sujeito político. Trânsitos de gênero. Errância.
Article
Some Christians are anxious and uncomfortable about gender diversity and transition. Sometimes, they understand these issues as a rejection of God's intention for creation. Gender diversity has also been assumed to entail self-deception, mental ill-health, and dysphoria. Yet, humans are inherently transformative creatures with a vocation to shape their own worlds and traditions. Transformative creaturely theology recognizes the capacity of gender to shape humans even as we also question it. In this book, Susannah Cornwall reframes the issues of gender diversity and transition in constructive Christian theological terms. Resisting deficit-based discourses, she presents gender diversity in a way that is positive and non-oppositional. Her volume explores questions of the licit limits of technological interventions for human bodies, how gender diversity maps onto understandings of health, and the ethics of disclosure of gender diversity. It also brings these topics into critical conversation with constructive Christian theologies of creation, theological anthropology, Christology, and eschatology.
Article
The UK Government's Higher Education (Freedom of Speech) Bill is currently progressing through Parliament. The bill is designed to strengthen free speech and academic freedom in higher education, in response to what former Education Secretary Gavin Williamson describes as ‘the rise of intolerance and cancel culture upon our campuses’. But is there really a crisis of academic freedom in British universities? To see that there is, say Judith Suissa and Alice Sullivan, we need only look at the contemporary reality of suppression of debate on sex and gender. The evidence they catalogue of supression of research, of blacklisting, harassment and smear campaigns, of no‐platforming, disinvitations and shutting down of events, is incontrovertible. The recent experience of scholars and students wishing to discuss the material reality and political salience of sex makes complacency about academic freedom a luxury we cannot afford. Suissa and Sullivan set out a powerful argument for the role of academic freedom in pursuing truth within the academy and developing democracy beyond it. They effectively counter attempts to narrow the scope of academic freedom so as to render it compatible with no‐platforming. And they lay out a series of practical steps administrators can take to ensure that universities are places where an expansive and pluralistic intellectual climate prevails. This is a timely and compelling intervention in a vexed but urgent public debate. For their clear‐sighted diagnosis of where and how academic freedom has been eroded in our universities, and for their judicious account of what must be done to rebuild it, Suissa and Sullivan deserve a wide and attentive hearing.
Article
This paper argues that a conceptual conflation between biology and ontology has had a pervasive influence on psychoanalytic thinking about gender, particularly transgender phenomena. This has made it difficult to think about gender’s relationship to the body outside of essentializing fantasies. The origins of the modern term gender and Freud’s biological emphasis are addressed, followed by a more extensive engagement with contemporary psychoanalytic scholarship on trans. Finally, the paper proposes a framework for attending to gender’s relationship to the body with greater nuance, turning to Freud’s late drive theory to help us think in this complex area.
Article
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Trans, gender diverse and gender questioning adults are highly likely to experience mental health difficulties, for multiple reasons including transphobia or minority stress. However, gender diverse adults often describe having negative experiences accessing mental healthcare in the UK. Concurrently, health professionals have described feeling inadequately skilled, and lacking confidence in their ability to support gender diverse people. There has been limited research exploring the experiences of mental health professionals who provide care for gender diverse people in mainstream mental health services, and even less in the UK. In this study, the accounts of seven mental health professionals from a range of disciplines were analysed with a constructionist narrative analysis, to better understand the nature of stories and positioning of individuals, within the local, social and historical contexts of the narratives’ construction. This paper focuses on participants’ narratives of feeling inadequately skilled when working with gender diverse individuals, which were drawn on and resisted in their stories. Implications for clinical practice and training are suggested.
Thesis
My thesis asks how psychoanalysis can understand gender identity; I consider this socially, culturally, and psychoanalytically, exploring the conscious and unconscious aspects of the motivation or drive to realign gender. I consider how early awareness of difference between the sexes and contrast between phantasy and reality can trigger depression, denial and conflict. When this is unmanageable it can instigate a protest, and a schism between body and mind. I have developed theoretical ideas, conducted Psychoanalytic Research Interviews to bring in lived experience, and formulated hypotheses that I discuss as a psychoanalytic psychotherapist and as a researcher. My theory chapters work through central concepts of gender and sexual identity, underpinned by Freud’s ideas, British Object Relations, the American Relational School of Psychoanalysis, Second Wave Feminist clinical and theoretical contributions including Queer theory and aspects of Lacan and Laplanche. My methodology provides a rationale for using Psychoanalytic Research Interviews specifically for this thesis, and also in the broader debate about psychoanalytic research. In my findings and discussion chapter I introduce hypotheses and interpret the interviews in relation to the theory chapters. My ideas develop from a description and exploration of sex, sexuality and gender to more distinctive propositions about the reversal of temporality into ‘I am therefore I was’ and unconscious matricidal wishes that might propel the drive to undo femaleness and femininity. Early development, Oedipal conflict, puberty, matricidal wishes, manifestations of masculinity, concreteness, fluidity, temporality and representation inform my investigation into sexual and gender identity and identification. The proliferation of young women who wish to be, or feel themselves already to be male has been seen by some as a psychic epidemic1 ; this might include the flight from womanhood and a move away from female homosexuality. By analysing the ways in which sexuality, identity, subjectivity and co-morbidity contribute to this phenomenon, I address how psychoanalysis as a discipline can better understand gender identity.
Article
This paper introduces the topic and unique format of the section that follows, on psychoanalytic work with transgender children. We first review the apparent impasse that characterizes our field regarding clinical work with gender diverse kids, as well as the reasons we pursued a live dialog to push thinking forward. Then, we outline the structure of the entire section, in which four contributors offer short essays, followed by a transcribed and edited version of the dialog we facilitated, which uses these essays as a starting point. We conclude with reflections on some of the themes that arise in the dialog, and implications for all of us who work in the arena of gender and young people.
Article
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The 2014 article "Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment" by de Vries, McGuire, Steensma, Wagenaar, Doreleijers and Co-hen-Kettenis is the one and only positive evaluation of the gender-affirming model to cure gender dysphoria in minors and restore their well-being. After critically presenting the scarce foundations of 'gender dysphoria' as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this contribution examines the article's methodology. The 2014 article does not show scientific evidence for the effectiveness of the "Dutch model", due to subjects who left the sample group and the failure to include data subject who died. While this three-staged model with drugs for puberty suppression during ages 12-14, cross-sex hormones at 16 and sex-reassignment surgery at 18 is still not proven, it is being applied in a growing number of countries, and is even officially recommended. 224
Article
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This article questions how we might continue to envision an open and inviting engagement between the terrains of childhood studies and queer theory. Matters of childhood innocence in particular are problematised throughout. The paper builds on the offerings of queer of colour scholarship and women of colour feminism, endeavouring to contribute to an emergent childhood studies that is informed by queer and feminist understandings that uphold the materiality and lived experience of the child, both in theory and in practice.
Article
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The medical “transition” of children with “gender dysphoria” is increasingly normalized in North America, Western Europe, Australia, New Zealand, and the United Kingdom. Although each country has specific national gender identity development services, the rationale for prescribing hormone treatment is broadly similar. A minority rights paradigm underpinned by postmodern theory has gained traction in the past 10 years and has been successful in influencing public policy, the education of pediatricians, endocrinologists, and mental health professionals. In this view, any response other than an affirmation of the child’s claim to be the opposite sex or “born in the wrong body” is understood as a denial of their human rights to have their “outer” body match their authentic “inner” self. The postmodern paradigm has brought about a concomitant shift in the classification of the patient from a child who suffers “gender dysphoria” to a child who is “transgender”. Yet the practice of putting children on a medical pathway brings severe, life-long consequences including bone/skeletal impairment, cardiovascular and surgical complications, reduced sexual functioning, and infertility. Examination of postmodern “transgender” health care reveals it is rarely expert, evidenced-based or objective but on the contrary, is highly politicized and controversial. Although the High Court in the United Kingdom has ruled those children 16 years and under cannot consent to hormone treatment, several lobby groups, as well as the NHS Tavistock and Portman Hospital Trust Gender Identity Development Service (GIDS), have been granted legal permission to challenge the ruling. With the example of the United Kingdom, I demonstrate that if the appeal is successful, children’s rights to protection from bodily and psychological harm will continue to be abused by the postmodern social justice paradigm which, in the very name of upholding children’s rights, violates them.
Article
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Philosophical arguments regarding academic freedom can sometimes appear removed from the real conflicts playing out in contemporary universities. This paper focusses on a set of issues at the front line of these conflicts, namely, questions regarding sex, gender and gender identity. We document the ways in which the work of academics has been affected by political activism around these questions and, drawing on our respective disciplinary expertise as a sociologist and a philosopher, elucidate the costs of curtailing discussion on fundamental demographic and conceptual categories. We discuss some philosophical work that addresses the conceptual distinction between academic freedom and free speech and explore how these notions are intertwined in significant ways in universities. Our discussion elucidates and emphasises the educational costs of curtailing academic freedom.
Thesis
La disforia de género ha sido definida en los ámbitos psicológico y psiquiátrico como el malestar clínicamente significativo que puede acompañar a la incongruencia entre el género sentido o expresado por una persona y su sexo biológico. Muchas de las personas que experimentan este malestar se identifican como transgénero—o simplemente trans—y buscan atención médica especializada para alinear su cuerpo con su género sentido, un proceso habitualmente conocido como transición de género. En los últimos años, no obstante, han comenzado a surgir diversos testimonios de personas que, después de un período más o menos extenso de tiempo, detienen sus procesos de transición de género y deciden volver a vivir conforme a su sexo natal. Las experiencias de estas personas, conocidas como “destrans,” apenas han sido objeto de atención en la literatura académica hasta tiempos muy recientes. En consecuencia, nuestro conocimiento acerca de los motivos o vivencias que conducen a estas personas a destransicionar es aún muy limitado, y está basado fundamentalmente en evidencia de carácter anecdótico. Por consiguiente, el objetivo principal de este trabajo consiste en explorar, analizar y visibilizar una realidad aún muy desconocida en el contexto español, haciendo hincapié sobre cómo una mejor comprensión de este fenómeno puede contribuir a mejorar los servicios sanitarios de atención para las personas con disforia de género. Para ello, después de un recorrido por la literatura más relevante sobre identidad y disforia de género, presentaré el relato de vida de M., una mujer destrans española, el cual irá acompañado por su respectiva línea de vida. Ambas herramientas permiten comprender el proceso de destransición desde una perspectiva subjetiva e íntima, así como las redes de significados culturales, sociales y políticos que se encuentran encarnados en los cuerpos destrans.
Article
This paper presents findings from a UK mixed-method study that aimed to understand parents/carers' views and experiences of support received from health services for primary school age (4–11) gender diverse children and their families. Data was collected via an e-survey including 10 open-ended questions with 75 parents/carers addressing experiences with (i) primary health services, including general practice (GP) clinics and child and adolescent mental health services (CAMHS) (ii) specialist gender identity development services (GIDS) (iii) non-health related support including transgender groups and online resources. Findings are organised into four themes: ‘journey to health service provision', ‘view on health services used', ‘waiting' and ‘isolation’. Discourses about gender diversity, childhood and the validity of trans healthcare shape parental experiences, including their desire for better information, more certainty in healthcare pathways and more expedient access to support services to reduce anxiety, distress and isolation. The emotional costs of waiting are compounded by the material costs of accessing the limited number of specialist services. Experiences could be improved through ensuring GPs and CAMHS are better prepared, expanding access to trans-specific support groups for those caring for children and young people, and exploring the provision of school-based support for gender diverse primary-age children.
Article
Ethical concerns have been raised about routine practice in paediatric gender clinics. We discuss informed consent and the risk of iatrogenesis in the prescribing of gonadotropin-releasing hormone analogues (GnRHas) and cross sex hormones to children and adolescents respectively. We place those clinical concerns in a wider societal context and invite consideration of two further relevant ethical domains: competing rights-based claims about male and female personhood; and freedom of expression about those claims. When reflecting on the assessment and medicalization of children and adolescents presenting at gender clinics, the matters of informed consent and iatrogenic risk should be the most pressing for clinicians. However, this is not just a matter of medical ethics, it also implies the need for a full ethical debate on competing notions of personhood and the defence of freedom of expression about transgender and its implications within contemporary democracies.
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In this study we examine the life story of Gray, an individual who identifies as having both a non-binary gender identity and autism spectrum disorder (ASD). We argue that Gray’s story of transitioning from female to male and then detransitioning to a non-binary identity is unique and presents a counter to the more typical stories of transitioning individuals. We utilized a life story narrative protocol with an intersectional theoretical framework in order to examine how Gray’s different identities have intersected, evolved, and entangled throughout their life. We found that Gray’s story is a complex web from which they have made decisions concerning their gender identity and plans to transition and detransition, which we argue can inform the way researchers examine gender identity and how it interacts with ASD and other identity markers. We further wish to acknowledge that this topic is rife with tension, and we do not wish to portray a trans-exclusionary study or say that gender dysphoria is related to mental illness or disability. • Points of Interest • The gender binary of man and woman does not work for all individuals. • Gray spoke openly about their experiences with various aspects of disability. This theme is comprised of three sub themes which each act as a piece of Gray’s puzzle. These sub themes are autism, medical issues, and mental health. • For Gray, ASD is an imperative aspect of their individual responses to various situations throughout their life story. The connection between their identity as a person with ASD and with a non-binary identity is powerful. • Gray's story is complex. It helps us understand how gender identity and autistic identity can affect each other.
Article
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The trend towards desegregated women’s and men’s toilets, including installing Gender Neutral Toilets (GNTs), and the implications of revisions to the Gender Recognition Act for women-only spaces, have brought into focus the pre-existing lack of female toilet provision in the UK. Looking at the problem from a town planning perspective, I argue that austerity-driven cuts are coming together with GNT provision to reshape the public toilet landscape in ways that continue to be detrimental to women. Typically women are only provided with half as many facilities as men, resulting in queues for the Ladies, and GNT provision based on relabelling rather than redesigned or additional provision can, in fact, increase competition for the cubicles in the Ladies. The historical, legislative and cultural reasons for this inequality are explored, along with the different types of public toilet and the different requirements of male and female users. The article draws on previous research project findings, many of which foreshadow the problems currently coming to the fore as a result of toilet desegregation. In conclusion, recommendations are made as to how to deal with the conundrum of providing adequate facilities for all women and men, whilst providing all sorts of individuals with choice and privacy to create inclusive, accessible cities for all.
The purpose of this article is to encourage reflection about children and adolescents who are expanding gender expression in this contemporary cultural moment. More specifically, to consider how relational rupture and its affective counterpart, grief, may become encrypted in gender. Attachment theory’s articulation of the intricacies of loss, in combination with psychoanalytic and systems theories, will serve to parse out the complex and paradoxical communications within this potentiality. Toward this end, my clinical process with five gender nonconforming children and adolescents will be discussed. The clinical section forms a tapestry weaving between similarities and differences in the expression of gender within the fabric of an attachment relationship. To link the clinical process to a larger cultural discourse, this article brings literary voices into the conversation, including Carson McCullers’s in Member of the Wedding and Jennifer Boylan’s memoirs of life in two genders and other writings. These sources crisscross/queer developmental time lines, disciplinary mediums, culture, and family dynamics to open up an inclusive conversation about gender subjectivity. The therapeutic process, with particular emphasis on the importance of play, is linked to advances in developmental science. Thinking with the children who vary the expression of gender can potentially inform our conceptualization of gender development, more generally.
Article
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In recent decades, two interrelated major controversies have been unfolding in the area of sex/gender research. (1) Are gender-identity variants to be understood as psychopathology or natural variation? (2) Is gender (and perhaps even sex) better conceptualized as binary or non-binary? The answer depends on the conceptual context and related considerations of utility. In the context of evolutionary biology, marked variants of sex and gender decrease reproductive success and are, thereby, deemed pathologic. In the present era of the anthropocene, however, the material conditions underlying the traditional division of labor between the sexes and the role of reproductive success have dramatically changed. These changes decrease the psychosocial importance of the binary gender distinction, provide more freedom for non-binary gender expression and identity formation, and render the distinction of pathologic and non-pathologic less useful, unless gender dysphoria develops secondary to a psychiatric condition. Although most people state their gender identity in the form of a nominal category, most self-report or interview-based ratings and multi-item scales of gender expression and/or identity show continuous distributions, either unimodal-asymmetric or bimodal, depending on whether they are designed for one or both of the traditional genders. Similarly, the rating scales of androgen-influenced variants of the genitalia—usually designed for one of the traditional sexes—typically represent a unipolar-asymmetric continuum. However, the binary gender system remains the primary framework against which individuals evaluate themselves. For those who develop gender dysphoria, assistance by mental-health service providers continues to be important.
Article
Gender is a fast-evolving and topical field which is often the centre of attention in the media and in public policy debates. The current cultural and social climate provides possibilities for young people to express themselves. Gender diverse young people are not only developing new ways of describing gender, but they are also shaping what is required of clinical interventions. Emerging cultural, social and clinical trends, such as increases in referrals, shifts in sex ratio and diversification in gender identification, illustrate that gender diverse individuals are not a homogeneous group. How do evolving concepts of gender impact the clinical care of gender diverse young people presenting to specialist gender clinics today?
Article
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Purpose In on-line forums, parents have been reporting that their children are experiencing what is described here as “rapid-onset gender dysphoria,” appearing for the first time during puberty or even after its completion. The onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity. The purpose of this study was to document and explore these observations and describe the resulting presentation of gender dysphoria, which is inconsistent with existing research literature. Methods Recruitment information with a link to a 90-question survey, consisting of multiple-choice, Likert-type and open-ended questions, was placed on three websites where parents had reported rapid onsets of gender dysphoria. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques. Data were collected anonymously via SurveyMonkey. Quantitative findings are presented as frequencies, percentages, ranges, means and/or medians. Open-ended responses from two questions were targeted for qualitative analysis of themes. Results There were 256 parent-completed surveys that met study criteria. The adolescent and young adult (AYA) children described were predominantly female sex at birth (82.8%) with a mean age of 16.4 years. Forty-one percent of the AYAs had expressed a non-heterosexual sexual orientation before identifying as transgender. Many (62.5%) of the AYAs had been diagnosed with at least one mental health disorder or neurodevelopmental disability prior to the onset of their gender dysphoria (range of the number of pre-existing diagnoses 0–7). In 36.8% of the friendship groups described, the majority of the members became transgender-identified. The most likely outcomes were that AYA mental well-being and parent-child relationships became worse since AYAs “came out”. AYAs expressed a range of behaviors that included: expressing distrust of non-transgender people (22.7%); stopping spending time with non-transgender friends (25.0%); trying to isolate themselves from their families (49.4%), and only trusting information about gender dysphoria from transgender sources (46.6%). Conclusion Rapid-onset gender dysphoria (ROGD) describes a phenomenon where the development of gender dysphoria is observed to begin suddenly during or after puberty in an adolescent or young adult who would not have met criteria for gender dysphoria in childhood. ROGD appears to represent an entity that is distinct from the gender dysphoria observed in individuals who have previously been described as transgender. The worsening of mental well-being and parent-child relationships and behaviors that isolate AYAs from their parents, families, non-transgender friends and mainstream sources of information are particularly concerning. More research is needed to better understand this phenomenon, its implications and scope.
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