Course Materials
GATHERING RESEARCH EVIDENCE: GENDER DYSPHORIA
An interesting and important topic like gender dysphoria among children and its effects and treatment generates controversy and debate. To understand and make decisions about it, I/we need to see what the research (as we've said, a good though not perfect way of knowing things) says. This is just one example of where/how to find out (searches conducted on Wednesday March 14, 2018).
[First search via Google:]
New York Times
November 9, 2017
Violence Against Transgender People Is on the Rise, Advocates Say
By Maggie Astor
https://www.nytimes.com/2017/11/09/us/transgender-women-killed.html
The full death toll is impossible to determine, but
by rights groups’ estimates, each of the past three years has become the
deadliest on record.
And experts say these numbers almost certainly understate the problem. Local
officials are not required to report such killings to any central database, and
because the police sometimes release incorrect names or genders, it can be
difficult to know that a homicide victim was transgender. So advocacy groups are
left to comb news reports and talk to victims’ friends or family.
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[More searches via
Google Scholar: ]
American Journal of Public Health
2017 Sep;107(9):1441-1447.
Homicide Rates of Transgender Individuals in the United States:
2010-2014
Dinno, A.
https://www.ncbi.nlm.nih.gov/pubmed/28727530
RESULTS: The overall homicide rate of transgender
individuals was likely to be less than that of cisgender individuals, with 8 of
12 RR [relative risk] estimates below 1.0. However, the homicide rates of young
transfeminine Black and Latina residents were almost certainly higher than were
those of cisfeminine comparators
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American Journal of Public Health (AJPH)
February 2014 | Vol. 104 Issue 2
Lesbian, Gay, Bisexual, and Transgender Hate Crimes and Suicidality
Among a Population-Based Sample of Sexual-Minority Adolescents in Boston
Dustin T. Duncan ScD, and Mark L. Hatzenbuehler PhD
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301424
Results. Sexual-minority youths residing in [Boston]
neighborhoods with higher rates of LGBT assault hate crimes were significantly
more likely to report suicidal ideation (P = .013) and suicide attempts
(P = .006), than were those residing in neighborhoods with lower LGBT assault
hate crime rates. We observed no relationships between overall
neighborhood-level violent and property crimes and suicidality among
sexual-minority adolescents (P > .05), providing evidence for specificity of the
results to LGBT assault hate crimes.
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The New Atlantis ["a nonpartisan publication..." vs.
"'the best conservative publication in America...' --Jason Pontin, editor in
chief and publisher, MIT Technology Review"]
Spring 2017
Growing Pains
Problems with Puberty Suppression in Treating Gender Dysphoria
Paul W. Hruz, Lawrence S. Mayer, Paul R. McHugh
https://www.thenewatlantis.com/publications/growing-pains
In light of the growing prominence of gender
identity issues in our society, and the appeal that puberty suppression may have
for parents raising children who identify as the opposite sex, it is worth
examining in detail what puberty suppression is, how it works, and whether it is
as safe and prudent as its advocates maintain. As we shall see, the evidence for
the safety and efficacy of puberty suppression is thin, based more on the
subjective judgments of clinicians than on rigorous empirical evidence. It is,
in this sense, still experimental — yet it is an experiment being conducted in
an uncontrolled and unsystematic manner.
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Pediatrics
February 2016
Mental Health of Transgender Children Who Are Supported in Their
Identities
Kristina R. Olson, Lily Durwood, Madeleine DeMeules, Katie A. McLaughlin
http://pediatrics.aappublications.org/content/early/2016/02/24/peds.2015-3223
What’s Known on This Subject:
Transgender individuals have been found to have highly elevated rates of anxiety
and depression, but little is known about the mental health of transgender
children whose identities are affirmed and supported by their families.
What This Study Adds:
More families are allowing their transgender children to live and present to
others as their gender identity. This is the first study to examine mental
health in these children, finding that they have low levels of anxiety and
depression.
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Pediatrics
December 2014, VOLUME 134 / ISSUE 6
Psychological and Medical Care of Gender Nonconforming Youth
Stanley R. Vance Jr, Diane Ehrensaft, Stephen M. Rosenthal
http://pediatrics.aappublications.org/content/134/6/1184
The objective of this review is to provide an
overview of existing clinical practice guidelines for GN [gender nonconforming]
youth. Such guidelines emphasize a multidisciplinary approach with collaboration
of medical, mental health, and social services/advocacy providers. Appropriate
training needs to be provided to promote comprehensive, culturally competent
care to GN youth, a population that has traditionally been underserved and at
risk for negative psychosocial outcomes.
Gender dysphoria, the psychiatric diagnosis that has replaced the earlier
diagnosis of gender identity disorder (GID) in the most recent edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5), elaborates on the
noted clinical profile of gender dysphoria. With this change in the DSM, a
cross-gender identity itself is no longer considered pathologic, as it had been
with the previous edition’s (DSM-IV) GID diagnosis; instead, the psychiatric
focus is on distress stemming from incongruence between assigned gender and
affirmed gender identity.
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Journal of Adolescent Health
October 2015 Volume 57, Issue 4, Pages 367–373
Early Medical Treatment of Children and Adolescents With Gender
Dysphoria: An Empirical Ethical Study
Lieke Josephina Jeanne Johanna Vrouenraets, M.Sc.
Miranda Fredriks, M.D., Ph.D.,
Sabine E. Hannema, M.D., Ph.D.,
Peggy T. Cohen-Kettenis, Ph.D.,
Martine C. de Vries, M.D., Ph.D.
http://www.jahonline.org/article/S1054-139X(15)00159-7/abstract
[article available via link to pdf]
Purpose
The aim of this study was to explicate the considerations of proponents and
opponents of puberty suppression in GD [gender dysphoria] to move forward the
ethical debate.
Methods
Qualitative study (semi-structured interviews and open-ended questionnaires) to
identify considerations of proponents and opponents of early treatment
(pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17
treatment teams worldwide.
Results
Seven themes give rise to different, and even opposing, views on treatment: (1)
the (non-)availability of an explanatory model for GD; (2) the nature of GD
(normal variation, social construct or [mental] illness); (3) the role of
physiological puberty in developing gender identity; (4) the role of
comorbidity; (5) possible physical or psychological effects of (refraining from)
early medical interventions; (6) child competence and decision making authority;
and (7) the role of social context how GD is perceived. Strikingly, the
guidelines are debated both for being too liberal and for being too limiting.
Nevertheless, many treatment teams using the guidelines are exploring the
possibility of lowering the current age limits.
Conclusions
As long as debate remains on these seven themes and only limited long-term data
are available, there will be no consensus on treatment. Therefore, more
systematic interdisciplinary and (worldwide) multicenter research is required.
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Current Opinion in Endocrinology, Diabetes and Obesity
2016 Apr; 23(2): 172–179.
Research Priorities for Gender Nonconforming/Transgender Youth: Gender
Identity Development and Biopsychosocial Outcomes
J Olson-Kennedy, P. T. Cohen-Kettenis, B.P.C Kreukels, H.F.L Meyer-Bahlburg, R
Garofalo, W Meyer, and S.M. Rosenthal
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807860/
Extensive research is needed to improve
understanding of gender dysphoria, and transgender experience, particularly
among youth. Recommendations include identification of predictors of persistence
of gender dysphoria from childhood into adolescence, and a thorough
investigation into the impact of interventions for transgender youth. Finally,
examining the social environments of transgender youth is critical for the
development of appropriate interventions necessary to improve the lives of
transgender people.