GDA Working Group Support for the AMA

The Gender Dysphoria Affirmative Working Group wants to express support and thanks to the American Medical Association for it’s strong stance affirming the rights and identities of transgender and gender nonbinary individuals.

AMA Affirms Medical Spectrum of Gender

During its interim meeting last week, the American Medical Association adopted a GLMA-sponsored policy stating that it will “oppose efforts to deny an individual’s right to determine their stated sex marker or gender identity.” This policy passed following reports of a Department of Health and Human Services memo that would attempt to narrowly redefine sex as an immutable condition determined at birth.

The adopted policy also states:

The AMA will educate state and federal policymakers and legislators on and advocate policies addressing the medical spectrum of gender identity to ensure access to quality health care.
and the AMA affirms that an individual’s genotypic sex, phenotypic sex, sexual orientation, gender and gender identity are not always aligned or indicative of the other, and that gender for many individuals may differ from the sex assigned at birth.
“It is essential to acknowledge that an individual’s gender identity may not align with the sex assigned to them at birth. A narrow limit on the definition of sex would have public health consequences for the transgender population and individuals born with differences in sexual differentiation, also known as intersex traits,” said AMA Board Member William E. Kobler, MD.

GLMA was proud to have introduced and sponsored this resolution through our seat in the AMA House of Delegates. The AMA’s public stance aligns it with GLMA and 37 other leading health professional associations and community health centers in opposing any action that would seek to erase federal recognition of transgender people as contrary to medical science.

During this interim meeting, GLMA also introduced and sponsored a resolution that advocates for the collection of demographic data in federal and state surveys that is inclusive of sexual and gender identity.

“The AMA will advocate against the removal of demographic data inclusive of sexual and gender identity from public health surveys and registries without plans for updating measures of these data,” said AMA Board Member William A. McDade, MD, PhD.

In addition, the AMA passed other LGBTQ-related resolutions that were also supported by GLMA:

Improving screening and treatment guidelines for domestic violence against lesbian, gay, bisexual, transgender, queer/questioning, and other individuals
Supporting offering HIV Post-Exposure Prophylaxis (PEP) to all survivors of sexual assault
GLMA is the only LGBTQ organization with a seat in the AMA House of Delegates, the policy-making body of the AMA. GLMA is represented in the HOD by Delegate Jeremy Toler, MD, and Alternate Delegate (and GLMA Treasurer) Desiray Bailey, MD.

These policies enable GLMA and other advocates to utilize the expertise of health professionals and their associations to promote fair and equitable treatment for all LGBTQ patients.

“Parenting Is Not a Job... It’s a Relationship”: Recognition and Relational Knowledge Among Parents of Gender Non-conforming Children

 

“Parenting Is Not a Job ... It’s a Relationship”: Recognition and Relational Knowledge Among Parents of Gender Non-conforming Children

A study on how parents understand, make sense of, and then advocate for their children’s needs, and how an affirming approach honors the needs of the individual, the family, and is based in individual and social justice.

 

Published in: Journal of Progressive Human Services.  2016. Author: Jake Pyne.

“A proliferation of social science studies and a burgeoning field of transgender studies have challenged the assumption that gender is the natural and mechanical expression of biological sex, exploring at length the discord between the medicoscientific knowledge of gender versus the historical and social realities of how gender is lived and embodied. Although this distinction may be self-evident to critical theorists, it remains a site of ongoing struggle in the lives of parents of gender non-conforming children.”

“Yet within the past decade, a different response has emerged publically. Supported by a number of mental health clinicians and advocates, some parents are taking an affirmative stance on gender non-conformity, supporting their children to express their felt sense of gender and advocating for their rights and inclusion in social life. In the face of opposition and disbelief, affirming parents support their children to live in non-prescribed gender locations and, at times, facilitate the social or medical transition to a new gender… [in this paper] I explore what participants’ knowledge might make possible, in contrast to the pathology approach to gender non-conformity. The affirming approach is proposed as a justice-based parenting practice.”

“… Proponents of the corrective-treatment approach have cited the prevalence of violence and other potentially painful life experiences as the rationale for conformity’s being best (Green et al., 1972; Zucker, 2006)… We hear concern for the brutal living conditions of gender non-conforming people, but we do not hear proposals for advocacy to challenge these conditions. Instead, what is made possible is the continued subjugation of gender non-conforming people in the name of their own interests. What is foreclosed is the possibility of social change.”

“… participants in this study responded to their children’s genders as subjective experiences of the childrens’, recognizing and learning this experience through relationship. By refusing to problematize their children, parents demanded places of belonging for their children, refocusing the gaze on the policies and practices of institutions. By searching out affirming communities and language, parents sought contexts in which their children’s differences could be valued. By “desacralizing” professional knowledge, they expanded ourways of knowing gender outside of medicalized discourse. By conceptualizing gender transition as a process of sense making and embodiment, they made possible a destigmatized reading of transgender subjectivity. By relinquishing authority over who their children could be, they challenged the framework of parenting-as-job and child-as-product. In responding to otherness without aggression, they opened the possibility of doing justice to difference.”

“… In closing, parents of gender non-conforming children encounter substantial conflict as they negotiate their children’s otherness. For decades, a pathologizing service model has advocated clinical correction (Zucker & Bradley, 1995; Zucker et al., 2012). In opposition, some parents adopt an affirming stance toward their children. This study explored the knowledge underneath this stance, asking parents of gender non-conforming children how they know what they know. Analysis revealed a process of recognition and a knowledge of the children’s needs acquired through relationship. Drawing on political philosophy and psychoanalytic theory, I argue that the affirming approach to gender non-conforming children is a non-aggressive response to the other and a justice-based parenting practice.”

https://www.academia.edu/20203759/_Parenting_is_not_a_Job..._its_a_Relationship_Recognition_and_Relational_Knowledge_among_Parents_of_Gender_Non_Conforming_Children

 

 

Impacts of Strong Parental Support for Trans Youth

Yet another study making clear the connection between strong parental support and improved outcomes for trans and gender nonbinary youth.

October 2, 2012. Authors: Robb Travers, PhD; Greta Bauer, PhD, MPH; Jake Pyne, MSW; Kaitlin Bradley, MSc; LorraineGale, MSW; Maria Papadimitriou, MSc, MPH.

“First and foremost, our findings show clear associations between the support that trans youth experience from their parents and numerous health outcomes. The most significant differences show that trans youth who have strong parental support for their gender identity and expression report higher life satisfaction, higher self-esteem, better mental health including less depression and fewer suicide attempts, and adequate housing compared to those without strong parental support.”

“For parents and caregivers, our data have many implications. Our earlier results (not shown) revealed that having a “somewhat supportive” parent did not have a significantly more positive effect on youth than if their parents were not at all supportive of their gender expression and identity. This indicates that anything less than strong support may have deleterious effects on a child’s well-being…”

“…Some parents feel shame or grief because their child is different than they expected and many worry that their child will be bullied or will lead an unhappy life. For some families, a non-judgemental counsellor can help to process these fears. For others, peer support from other parents of trans youth, either on-line or in person, where available, is their greatest resource. Wherever parents seek support, it is important that they express and process these complex feelings with other adults and not with their child. While some parents worry that being trans will cause their child to be unhappy, ultimately our data indicate that it is parents and caregivers themselves who provide the foundation for their children’s health and well-being with their support.”

“Those working professionally in school settings, child welfare, residential and other services should be aware of the risks facing trans youth whose parents are unsupportive of their gender expression and identity....The presence of an active Gay-Straight Alliance (GSA) in a school is an important and crucial resource for trans youth…”

“Trans-inclusive youth programs that provide trans youth with a safe and confidential space to access professional and peer supports are crucial in helping to decrease feelings of depression and the despair that precedes suicidal ideation and attempts.”

“Finally, our data point to an urgent need for policy-makers to make themselves familiar with the needs of this very vulnerable group of youth, and to respond accordingly with resources that will help to ameliorate a very desperate situation. For example, providers in a range of settings, including schools, mental health, child welfare, residential, and social and health care services, require appropriate policies, practices, training and resources to ensure that service provision to trans youth is delivered with dignity and respect…”

http://transpulseproject.ca/wp-content/uploads/2012/10/Impacts-of-Strong-Parental-Support-for-Trans-Youth-vFINAL.pdf?fbclid=IwAR2m69IR3NcLblk1VZaPsjjaYiOSn_pDj9BHfq_B4UIku6do2GMFy7A7f_c

Childhood Gender Nonconformity: A Risk Indicator for Childhood Abuse and Posttraumatic Stress in Youth

Published in: Pediatrics.  2012.  Authors: Andrea L. Roberts, PhD,Margaret Rosario, PhD,Heather L. Corliss, PhD,Karestan C. Koenen, PhD, and S. Bryn Austin, ScD

A study discussing the associations between gender nonconformity and negative outcomes… making clear that lack of acceptance is a significant cause of poorer physical and mental health, poorer school performance, unemployment, substance abuse, and suicide.

“…childhood gender nonconformity has also been associated with a lower sense of well-being in adolescence and mental health problems in adulthood, including depression and anxiety symptoms, distress, body dissatisfaction, attachment anxiety, and suicidality. Thus, gender nonconformity in childhood may be an important health risk indicator.”

 “…Thus, if gender nonconforming children are at higher risk of abuse, they may also be at greater risk for developing PTSD compared with gender-conforming children. PTSD has severe sequelae with particular relevance to youth, including substance abuse, school dropout, teen pregnancy, suicide, mood disorders, relationship instability, and unemployment.”

 “…We identify gender nonconformity as an important indicator of children at increased risk of sexual, physical, and psychological abuse and of lifetime probable PTSD in early adulthood, both among children who will be heterosexual and children who will have a minority sexual orientation. PTSD is associated with serious sequelae, including health risk behaviors, such as unprotected sex and involvement with interpersonal violence, and physical sequelae, including dysregulated immune function, cardiovascular risk indicators, metabolic syndrome, and chronic pain.”

“…Prior research describes possible pathways linking gender nonconformity to abuse. Some parents may be uncomfortable with gender nonconformity in their children, possibly increasing their likelihood of being abusive toward gender-nonconforming children. Parents may also see gender nonconformity as an indicator of same sex sexual orientation or think others will assume their child will be gay or lesbian. If parents are uncomfortable with homosexuality, nonconformity may lead to the child being targeted for abuse. Some parents also believe their own parenting can shape their child’s gender nonconformity and future sexual orientation; thus, their parenting may become more physically or psychologically abusive in an attempt to discourage their child’s gender nonconformity or same-sex orientation…Sexual predators may similarly target gender nonconforming children.”

http://pediatrics.aappublications.org/content/129/3/410

‘More than boy, girl, male, female’: exploring young people’s views on gender diversity within and beyond school contexts

Published in: Sex Esudation.  March 1, 2018.  Authors: Sara Bragg, Emma Renold, Jessica Ringrose & Carolyn Jackson.

 

An interesting study on the ways in which youth interact with and address issues of gender diversity within schools, largely demonstrating that youth ‘get it’, and that, despite the fears or even homophobia/transphobia of their elders, youth are quite able to integrate gender and sexual diversity in their communities without difficulty, and without being influenced to adopt those identities themselves.  This also directly counters the notions of “social contagion.”  It also provides valuable insights to assist educators.

 

“…the contemporary context, with its increasing global awareness of gender diversity, offers young people significant new ways of learning about and doing gender. Findings reveal that many young people have expanded vocabularies of gender identity/expression; critical reflexivity about their own positions; and principled commitments to gender equality, gender diversity and the rights of gender and sexual minorities. We also show how young people are negotiating wider cultures of gendered and sexual violence. Schools are providing some spaces and learning opportunities to support gender and sexual diversity. However, overall, it appears that young people’s immediate social cultural worlds are constructed in such a way that gender binary choices are frequently inevitable, from school uniforms and toilets to sports cultures and friendships.”

 

“For Carlita, ‘old-fashioned’ anti-gay attitudes were seen to be caused by lack of information and education. The Internet, she suggested, is now addressing this:

“People are much more accepting now … 50 years ago if you were gay or anything like that, you would have been heavily judged for that … people would beat you up on the street. But now I think there are people who I know [are gay] here and they don’t get beaten up every day, they don’t get severely bullied, some of them just get on with it and they’re accepted. I think it is slowly getting better … because before we couldn’t spread information as quickly as we can now. Now in a click of a button we can spread information to the whole world in less than a second, but before that was impossible. People are being educated in a different way rather than just (in their) household.”

 

“Sometimes young people’s experiences of racism and their understandings of racial diversity seemed to prompt them to support sex, gender and sexual diversity, underpinned by a desire that differences of any kind should not be a barrier to self-identity and self-expression. Sometimes it was part of a general morality about ‘live and let live’, letting others make choices that are different from your own:

“If you’re born a female, I think that’s the way you were supposed to be … that’s just what I think … [but] that’s their life, that’s their business … they have made the choice so what can I do about it?”

“If he (Conchita, a trans celebrity) wants, if he wants to be like, wants to do that, I don’t really mind. It’s his life so if he wants to live it.”

“I respect what they’ve chosen. But it’s just something I wouldn’t choose.”

 

“In some cases, religious beliefs conflicted with young people’s sense of themselves as modern (more accepting or pro-gay):

“I know for a fact, my religion, the most wrongest thing you can do is either be gay or be something that God didn’t choose for you, because God doesn’t make mistakes … Honestly, I think it’s wrong, I’m not going to say that I think it’s right: because you were born like that you should embrace it and everything. But if they don’t feel that way then I’m not going to question it. It’s not up to me.”

“I’m a Muslim but I feel like some of the things are wrong, like … a person should be allowed to marry the person that’s the same gender as them … and, in my religion, that’s really wrong … but I believe in it … and I usually go with my head, rather than my heart … my religion’s in my heart … so head-wise, my mindset is that’s gay … it should be allowed … that’s what I personally believe.”

 

“…young people were reflexive about conflicting sets of beliefs or values, or why they struggled with particular gender issues. Kushtim, Marek and Lyndal  discussed how they might feel if Conchita [a fictional trans celebrity] walked into their classroom and sat at their table. They shared their fears of feeling ‘uncomfortable’ and why they might feel this way, suggesting that perhaps it related to transgenderism being ‘common’ on television, but more unusual in their communities. Kushtim commented that ‘I think the first time I saw a gay person, like, kissing was in Year 6 [aged 10–11]. I was shocked because I’ve never seen it in my life. Now when I see them it’s just Oh, OK. Like I’ve seen it a few times now’. They agreed that one day transgenderism might be more acceptable, less ‘shocking and new’, less ‘weird’, even if ‘it’s not something they would choose’.”

 

“However, despite strong support amongst many young people for gender fluidity and for challenging gender norms, from their perspective, schools were generally structured and operated in ways that reinforced the notion of gender identity and expression as binary, especially in regards to school uniforms, toilets and sports. There were some exceptions. For example, the coastal school, which was recently built, had gender-neutral toilets. Yet students expressed ambivalence about sharing such ‘private’ space across genders, as well as about the staffsurveillance it allowed. Indeed, as we have shown here, the contextual contingency of gender r/evolutions continuously rubbed up against sedimented sexist, homophobic and transphobic sentiments, discrimination and violence.”

“Our findings offer many ways forward for educators. They show that adults who want to make changes towards practices which create and support inclusive gender cultures and address gender equity and gender justice can expect to find allies amongst the young people with whom they work. In fact, the challenge maybe in keeping pace with young people’s new modes of expression and sites for learning. Indeed, never has there been a more urgent need for teacher training on critical gender sensitive pedagogies in the context of the historical and contemporary social, cultural, biological and political sex/gender/sexuality landscape…  It also follows that if educators are supported to create conducive contexts through which young people are encouraged to lead the way in some of this work, then potentially rich pedagogical encounters of why, how, where and when gender matters might be formed.”

https://doi.org/10.1080/14681811.2018.1439373

 

The Future of Sex and Gender in Psychology: Five Challenges to the Gender Binary

Published in: American Psychologist. July 19, 2018. Authors: Janet Shibley Hyde, Rebecca S. Bigler, Daphna Joel, Charlotte Chucky Tate, and Sari M. van Anders.

“Over the past two decades, however, a confluence of forces has challenged psychology’s assumption of the gender binary. These forces range from the transgender activist movement… and the intersex activist movement… to research in neuroscience and psychological science. This article synthesizes research that challenges the gender binary from multiple perspectives, focusing especially on neuroscience, behavioral neuroendocrinology, research on gender similarities and differences, research on the experiences of transgender individuals, and the developmental psychology underlying the psychological process of categorizing by gender.”

“For centuries, the treatment of individuals seeking assistance for mental health problems has been shaped by physicians’ and therapists’ belief in the gender binary (Brabender & Mihura, 2016). Treatment practices that are rooted in the gender binary persist, but they are under increasing scrutiny…”

“In 2015, the APA issued guidelines for psychological practice with transgender and gender-nonconforming people (APA, 2015). The overarching goal is practices that are affirming for transgender, nonbinary, and gender-nonconforming individuals... For example, one of the guidelines asserts that gender is a nonbinary construct and another recognizes fluidity in gender identity over development.”

“The gender binary may have especially serious consequences for the diagnosis and treatment of individuals who seek assistance for mental health issues related to gender/sex. Belief in the gender binary dictates that children should be encouraged to develop identities that fall into one of the two gender/sex categories: male or female. The matter is a highly contentious one in the United States; the last 10 years have seen divisive, protracted debates over diagnoses such as gender identity disorder and gender dysphoria, and their treatment…”

“Following from the expansive view of gender/sex, everyone, including children, should be able to express their felt gender identity. Furthermore, this approach should apply to individuals, including children, whose identities and behavior combine elements traditionally associated with masculinity and femininity as well as those who completely reject gender/sex as an organizing self-construct. For this to occur, it is important to view all individuals as belonging to a common human group that varies in quantitative ways along various gender-related dimensions (rather than as dichotomous groups that vary qualitatively from each other) and to advocate for societal changes aimed at expanding our views of gender/sex, to make space for all identities, expressions, and behaviors.”

http://www.academia.edu/37634758/The_Future_of_Sex_and_Gender_in_Psychology_Five_Challenges_to_the_Gender_Binary

Affirmative Practice With Transgender and Gender Nonconforming Youth: Expanding the Model

Affirmative care - in which the individual’s self-reported gender is respected, and in which they are given the safety and opportunity to explore their identity and expression - has been clearly demonstrated to show dramatic reductions in depression, anxiety, substance use, self-harm, as well as suicidal ideation and gestures. Research shows clear improvements in school/work performance, mental health, and positive outcomes.

Published in: Psychology of Sexual Orientation and Gender Diversity. 2016. Authors: Laura Edwards-Leeper, Scott Leibowitz, Varunee Faii Sangganjanavanich.

“Affirmative care with transgender and gender nonconforming (TGNC) children and adolescents… rests on a premise that appreciates diverse gender expressions and identities within society, and encourages the highest potential for individuals to follow their own paths to positive emotional well-being… Given the current deficits in scientific understanding of gender identity development in youth, the affirmative provider often faces decisions that are challenging, complex, and unclear. This paper describes the theoretical approaches to TGNC youth across development, provides a brief overview of the current research, and offers providers a way to conceptualize and provide care that can be both supportive and scientifically driven when done in a thoughtful, balanced way.”

“Providing affirmative care is important in offering these youngsters a sense of hope, an element that is all too often missing in their lives. Balancing the provision of such care with the complexities and challenges that exist need not be impossible, yet requires providers to be aware of their assumptions and biases, recognize the developmental considerations involved, advocate creatively in the face of many logistical barriers, work within the multiple perspectives of an interdisciplinary environment, and stay current with the evolving science of gender.”

https://www.apa.org/pubs/journals/features/sgd-sgd0000167.pdf

List of professional organisations opposing conversion or reparative therapy targeting transgender and gender non-conforming individuals

Published in: Medium.com. October 4, 2018. Author: Florence Ashley.

“The following list is a compilation of professional organisations which oppose conversion or reparative therapy targeting transgender and gender non-conforming individuals. The list does not include statements which do not clearly and explicitly prohibit practices targeting gender identity. As such, statements which only mention sexual orientation change efforts are not included. “

https://medium.com/@florence.ashley/list-of-professional-organisations-opposing-conversion-or-reparative-therapy-targeting-transgender-f700b4e02c4e

Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth

Even something as “simple” as using a trans youth’s chosen/preferred/self-identified name can be a very powerful intervention with clear positive outcomes. And don’t we want our youth to have less depression, anxiety, and suicidal ideation?

Published in: Journal of Adolescent Health. October, 2018. Authors: Stephen T. Russell, Amanda M. Pollitt, Gu Li, Arnold H. Grossman.

“Transgender youth whose gender expression and names do not appear to match may be vulnerable to unintended disclosure or “outing,” and to discrimination or victimization, factors that could lead to mental health problems [1]. The purpose of the current study was to examine the relation between chosen name use, as a proxy for youths' gender affirmation in various contexts, and mental health among transgender youth.”

“We asked transgender youth whether they had a preferred name different from the name they were given at birth, and, if yes, asked, ‘are you able to go by your preferred name’ at home (n = 54), at school (n = 57), at work (n = 50), or with friends (n=69).”

“…chosen name use in more contexts predicted fewer depressive symptoms and less suicidal ideation and suicidal behavior. An increase by one context in which a chosen name could be used predicted a 5.37-unit decrease in depressive symptoms, a 29% decrease in suicidal ideation, and a 56% decrease in suicidal behavior. We observed similar results when we individually tested specific contexts for chosen name use (except that chosen name use with friends did not significantly predict mental health after adjusting for demographics and close friend support). Depressive symptoms, suicidal ideation, and suicidal behavior were at the lowest levels when chosen names could be used in all four contexts.”

https://www.jahonline.org/article/S1054-139X(18)30085-5/fulltext



Helping Pediatricians Care for Transgender Children

Not pure research, but an interesting article in the The New York Times on caring for trans youth.

"But the research shows, he said, that if the children are accepted, they do much better. Dr. Breuner agreed: It’s the environment that endangers the child, she said, not the gender issues; if the child’s family and school and health care system are supportive, she said, the child should not be at higher risk than the general population."

https://www.nytimes.com/2018/10/15/well/family/helping-pediatricians-care-for-transgender-children.html

Suicide risk in the UK Trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt

Published in: Mental Health Review Journal. · December 2014.  Authors: Louis Bailey, Jay McNeil, Sonja J. Ellis.

“The findings reported here indicate that there are extremely high rates of suicidal ideation and suicide attempt within this non-random sample of the UK trans population. However, gender transition – for those that wanted it – was shown to drastically reduce instances of suicidal ideation and suicide attempt, highlighting the important role played by social transition and gender reassignment in improving quality of life and overall well-being amongst respondents…”

“A key finding to emerge from the study was the importance of timely access to gender reassignment treatment for those who required it. Transition was shown to have a positive impact on trans people’s mental health and well-being; the processes of gender reassignment and social transition serving to significantly reduce rates of suicidal ideation and suicide attempt. The majority of participants cited the significant benefits of gender reassignment in terms of aligning their physical body with their internal sense of self, and the knock-on effects of being recognised as the gender that they felt themselves to be…”

“Despite the clear advantages of gender reassignment, some respondents reported significant issues whilst trying to obtain treatment. As has been reported elsewhere, funding delays or refusals were common within this sample and respondents alluded to having gender reassignment treatment stopped or postponed altogether. These issues may, in some cases, contribute to suicide risk within this population…”

“It is crucial that those experiencing gender dysphoria have access to gender reassignment treatment with minimal delays or disruption and that they receive relevant information and support both from medical professionals as well as more informal sources – such as family, friends and support organisations – in order to build resilience and bolster health and well-being during this particularly difficult time.”

https://www.researchgate.net/publication/281441727

Recognising the needs of gender variant children and their parents

Recognising the needs of gender variant children and their parents

Published in: Sex Education: Sexuality, Society and Learning.  2013.  Authors: Elizabeth A. Riley, Gomathi Sitharthan, Lindy Clemson & Milton Diamond

“The data in the present study suggest that even when gender-variant children actively endeavour to conform, their efforts are often thwarted by individuals who seek to marginalise and victimise them for their difference. Children therefore suffer from an invisibility and lack of recognition of their needs, on the one hand, and (in some cases) a violation of their personal boundaries that can foster a general anxiety, on the other. The well-documented need of all children for acceptance and affirmation places even more responsibility on adults to be compassionate and make provisions for gender-variant children.” 

http://dx.doi.org/10.1080/14681811.2013.796287

The role of gender affirmation in psychological well-being among transgender women

No surprise that validating someone’s sense of self decreases depression and improves self esteem.

Published in: Psychology of Sexual Orientation and Gender Diversity. September 2016. Authors Tiffany R. Glynn, Kristi E. Gamarel, Christopher W. Kahler, Mariko Iwamoto, Don Operario, Tooru Nemoto.

“… we found that social, psychological, and medical gender affirmation were significant predictors of lower depression and higher self-esteem... Findings support the need for accessible and affordable transitioning resources for transgender women in order to promote better quality of life among an already vulnerable population.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061456/

Suicide risk in the UK trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt

It is well known that trans and gender nonbinary people have high rates of suicidality… studies consistently show that affirming treatments decrease risk.

Published in: Mental Health Review Journal.  December 2014.  Authors: Louis Bailey, Sonja J. Ellis, Jay McNeil.

“A supportive environment for social transition and timely access to gender reassignment, for those who required it, emerged as key protective factors… The paper highlights the devastating impact that delaying or denying gender reassignment treatment can have and urges commissioners and practitioners to prioritisetimely intervention and support.”

“The findings reported here indicate that there are extremely high rates of suicidal ideation and suicide attempt within this non-random sample of the UK trans population. However, gender transition – for those that wanted it – was shown to drastically reduce instances of suicidal ideation and suicide attempt, highlighting the important role played by social transition and gender reassignment in improving quality of life and overall well-being amongst respondents…”

“A key finding to emerge from the study was the importance of timely access to gender reassignment treatment for those who required it. Transition was shown to have a positive impact on trans people’s mental health and well-being; the processes of gender reassignment and social transition serving to significantly reduce rates of suicidal ideation and suicide attempt. The majority of participants cited the significant benefits of gender reassignment in terms of aligning their physical body with their internal sense of self, and the knock-on effects of being recognised as the gender that they felt themselves to be…”

“Despite the clear advantages of gender reassignment, some respondents reported significant issues whilst trying to obtain treatment. As has been reported elsewhere, funding delays or refusals were common within this sample and respondents alluded to having gender reassignment treatment stopped or postponed altogether. These issues may, in some cases, contribute to suicide risk within this population…”

“It is crucial that those experiencing gender dysphoria have access to gender reassignment treatment with minimal delays or disruption and that they receive relevant information and support both from medical professionals as well as more informal sources – such as family, friends and support organisations – in order to build resilience and bolster health and well-being during this particularly difficult time.”

https://www.researchgate.net/publication/281441727_Suicide_risk_in_the_UK_Trans_population_and_the_role_of_gender_transition_in_decreasing_suicidal_ideation_and_suicide_attempt

The Needs of Gender-Variant Children and Their Parents According to Health Professionals

Another article outlining that more supportive, nurturing, and affirming perspectives on a youth’s self-reported gender identity are needed to support both the youth and their parents.

 

Published in: International Journal of Transgenderism.  March 4, 2013.  Authors: Elizabeth Anne Riley, Gomathi Sitharthan, Lindy Clemson & Milton Diamond

“The issues that gender-variant children face highlight consistent deficits and negativity in the children’s lives and focus our attention to the extraordinary burden placed on gender-variant children in their formative years. A report by Grant et al. (2010) describes in detail the extraordinary levels of harassment, physical assault, and sexual violence experienced by transgender children in years during primary and high school. These issues, if unable to be alleviated, are likely to present ongoing and accumulative difficulties that then impact their lives as adults.”

“… The needs of parents overwhelmingly feature the various types of support that would help parents become informed, be able to cope, and make the best decisions for their child. Societal and community support appear to be crucial factors for parents to comfortably engage with the tasks required of them to support their child.”

“… The needs of gender-variant children identified from the professionals’ responses revealed a lack of respect for the rights of children who experience gender variance. The most frequently mentioned needs were to be accepted and supported; to be heard, respected, and loved; to have professional support and recognition; to be allowed to express their gender; to feel safe and protected; to live a normal life; to have peer contact; to have school support and; to have access to puberty-delaying hormones. The needs of the parents focused primarily on areas of support and professional assistance, namely, the need for emotional support and guidance; education and information; support from society, local community, friends, and family; competent knowledgeable professionals; diagnosis, treatment, and beneficial outcomes for their children; peer support; support, understanding, and acceptance from schools; and research.”

“Together, these findings call for education programs to provide knowledge and exposure to the issues that transgender people face, across such sectors as medicine, mental health, and teaching in schools. The targeted education of medical and counseling professionals, the inclusion of printed materials in doctors’ surgeries, and the distribution of best practice guidelines and training in schools would signal a major change across the professional and community sectors that the needs of transgender children are being taken seriously.”

http://www.hawaii.edu/PCSS/biblio/articles/2010to2014/2011-needs-of-gender-variant-children.html

Social Support Networks for LGBT Young Adults: Low Cost Strategies for Positive Adjustment

A study demonstrating that family support is essential in the wellbeing of LGBTQ+ youth.

Published in: Family Relations.  July, 2015.  Authors: Shannon D. Snapp, Ryan J. Watson, Stephen T. Russell, Rafael M. Diaz, Caitlin Ryan.

“Our study adds to the growing body of evidence that family support, both general and sexuality specific, is a crucial factor in LGBT youth’s health and well-being…”

“Two variables were most relevant in predicting adjustment: (a) the percentage of friends who knew about participants’ sexual or gender identity and (b) support related to being LGBT from friends. The presence of a network of friends to whom youth can be out has been linked to measures of health and well-being…”

“Although friendship support is clearly associated with positive well-being in young adulthood, it appears that family acceptance has a stronger overall influence when other forms of support are considered jointly.”

 

https://www.tandfonline.com/doi/full/10.1080/01612840.2017.1398283

Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population

Family and peer support, key components of affirmative approaches for gender variant youth, are all protective factors. This study also clearly refutes the notion among some proponents of "Rapid Onset Gender Dysphoria" that disaffirming approaches and limiting access to peers is beneficial. 

Published in: American Journal of Public Health.  May, 2013. Authors: Walter O. Bockting, PhD, Michael H. Miner, PhD, Rebecca E. Swinburne Romine, PhD, Autumn Hamilton, HSD, and Eli Coleman, PhD.

 “… family support, peer support, and identity pride all were negatively associated with psychological distress, confirming that these assets are protective factors. Moreover, peer support significantly moderated the relationship between enacted stigma and psychological distress, thus emerging as a demonstrated factor of resilience in the face of actual experiences of discrimination. Only at high (but not low or medium) levels of peer support was enacted stigma not associated with psychological distress, which suggests that the negative impact of enacted stigma on mental health is pervasive and that regular contact with peers is necessary to ameliorate it.”

“Together, these results offer support for the value of transgender individuals connecting with similar others, possibly providing the opportunity to question stigma from the majority culture and reappraise their experiences in a self-affirmative way, which is consistent with what has been postulated and observed among gay and lesbian individuals. This finding is particularly pertinent because previous research found that transgender people have higher levels of depression and lower levels of peer and family support than their gay, lesbian, and bisexual counterparts. These results support a need to promote resilience by facilitating ample peer support.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698807/

Surviving a Gender Variant Childhood: The Views of Transgender Adults on the Needs of Gender Variant Children and Their Parents

Published in: Journal of Sex & Marital Therapy. 2012. Authors: Elizabeth Anne Riley, Lindy Clemson, Gomathi Sitharthan, Milton Diamond.

“… the needs of children that emerged were most notably, for parents, school staff and other authority figures to be educated so that children do not need to ‘hide’ themselves and their gender expression for fear of adversity. The participants also expressed their need as children to be able to speak about their feelings, to have their gender expression accepted, to be recognised, to be protected, to be given the opportunity to know others with similar feelings and for their parents to be open-minded, able and willing to accept their gender variant children. This study identified that the participants’ parents primarily needed access to information and educated professionals, particularly in schools, counselling and medical contexts. Exposure to successful transgender people and access to parent support groups was also seen as a need to help parents become more accepting of their children's diversity. The need for family and wider support was mentioned as a need for both the gender variant children and the parents as some participants felt that even though support of their parents was necessary, it was not enough for them to live happily and safely within the broader society.”

“The need for ‘health literacy’ was highlighted as tool to empower individuals, in this case, parents, to respond effectively in addressing the issues with regard to their gender variant children. In particular, allowing confidence to approach professionals for support with their own and their child's emotional, physical and social well-being….”

“… it appears that living in a society where punishment is customary for lack of conformity to gender stereotypes creates a lifelong struggle and sometimes ‘withdrawal’ that caused some participants great distress and impacts on their self-esteem and ability to thrive.”

https://www.semanticscholar.org/paper/Surviving-a-gender-variant-childhood%3A-the-views-of-Riley-Clemson/20d1168cecafe4aa6c633e4691b60e88ed31c901

The Needs of Gender-Variant Children and Their Parents: A Parent Survey

The Needs of Gender-Variant Children and Their Parents: A Parent Survey

Published in: International Journal of Sexual Health. 2011. Authors: Elizabeth Anne Riley, Gomathi Sitharthan, Lindy Clemson, Milton Diamond.

“The results of this study support the development of affirmative approaches in supporting gender-variant children and their parents. This is particularly evidenced by the parents’ own approaches to supporting their children where parents experimented with different ways of responding to various scenarios and realized that acceptance of their child was the only option as they learned that their child’s need for expression was not changed by their attitude or management of the behavior.”

http://www.hawaii.edu/PCSS/biblio/articles/2010to2014/2011-gender-variant-children.html

Mental Health and Self-Worth in Socially Transitioned Transgender Youth

Socially transitioned youth do better than those who do not transition, and do not show higher level of depression or anxiety than their peers or siblings.

Published in the Journal of the American Academy of Child and Adolescent Psychiatry. February 10, 2017. Authors: Lily Durwood, Katie A. McLaughlin, Kristina R. Olson.

“We found remarkably good mental health outcomes in socially transitioned transgender children in the present study. Transgender children reported normative rates of depression and slightly increased rates of anxiety. Rates of depression in transgender children did not differ significantly from those in siblings of transgender children or from those in age- and gender-matched controls, although rates of anxiety were marginally higher. Parents’ reports of their children’s depression and anxiety largely mirrored the children’s reports, although parents of transgender children reported slightly higher anxiety in their children than the children did…”

“Our findings of normative levels of depression, slightly higher rates of anxiety, and high self-worth in socially transitioned transgender children stand in marked contrast with previous work with gender-nonconforming children who had not socially transitioned. Those studies overwhelmingly reported markedly higher rates of anxiety and depression and lower self-worth, with disproportionate numbers of children in the clinical range.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5302003/