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Additionally, the numbers of adolescents seeking care for gender dysphoria has increased dramatically. It is unknown why these changes are occurring. This month, a Brown University researcher published the first studyto empirically describe teens and young adults who did not have symptoms of gender dysphoria during childhood but who were observed by their parents to rapidly develop gender dysphoria symptoms over days, weeks or months during or after puberty.

Descriptive studies aren't randomized controlled trials -- you can't tell cause and effect, and you can't tell prevalence. It's going to take more studies to bring in more information, but this is a start. Littman surveyed more than parents of children who suddenly developed gender dysphoria symptoms during or after puberty.

She said she wanted to better understand the phenomenon, which seems to be on the rise, but had been considered atypical even just a few years ago. Gender dysphoria is defined as the emotional distress a person feels because of the difference between their experienced gender identity and their sex observed at birth.

Gender dysphoria is not the same as gender nonconformity, or not following the stereotypes of one's assigned gender. The children of the parents surveyed were more than 80 percent female at birth and ranged between 11 and 27 years old at the time of survey, with an average age of Additionally, 47 percent of the children were reported as academically gifted, and 41 percent expressed a non-heterosexual sexual orientation prior to their gender dysphoria symptoms.

Most of the parent respondents were female, white and U. In the question survey, Littman asked the parents about each of the eight indicators for gender dysphoria in childhood that are detailed by the American Psychiatric Association. To meet the diagnostic criteria for gender dysphoria in childhood, a child needs to experience at least six of the eight indicators. Most include readily observable signs, such as a strong rejection of typically feminine or masculine toys and games, and strong resistance to wearing typically feminine or masculine clothes.

Eighty percent of the parents reported observing none of these indicators in their children before puberty. Credit Carmen Baskauf. The two wrote about their experiences in a collaborative memoir, At the Broken Places: A Mother and Trans Son Pick Up the Pieces , and say they hope other families can learn from their experience. By transitioning away from being female, Donald was finding himself.

But Mary felt a sense of loss.

And the grief she was experiencing was a type Mary felt almost no one around her fully understood or recognized. Both Donald and Mary emphasized in their interview that emotional and psychological care for the entire family could have helped them maintain and repair their relationship. Having a stable, supportive home environment is a major issue for many young people who are transgender, and is intricately tied to mental health. At the same time, the American Academy of Pediatrics has found alarming rates of suicidal behavior for trans youths that are far higher than among adolescents broadly.

Other studies have found that at least one in two transgender adults experience depression, compared to a little over one in fifteen in the general population, according to the NHCHC.

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"Just Love Your Child"—Parents of Trans Kids on Empowering the Next Generation

Clinicians need to be aware of the myriad of barriers that may stand in the way of making accurate diagnoses when an AYA presents with a desire to transition including: the developmental stage of adolescence; the presence of subcultures coaching AYAs to mislead their doctors; and the exclusion of parents from the evaluation. In this study, An AYA telling their clinician that their parents are transphobic and abusive may indeed mean that the parents are transphobic and abusive. The findings of this study suggest that clinicians need to be cautious before relying solely on self-report when AYAs seek social, medical or surgical transition.

Adolescents and young adults are not trained medical professionals. When AYAs diagnose their own symptoms based on what they read on the internet and hear from their friends, it is quite possible for them to reach incorrect conclusions. It is the duty of the clinician, when seeing a new AYA patient seeking transition, to perform their own evaluation and differential diagnosis to determine if the patient is correct or incorrect in their self-assessment of their symptoms and their conviction that they would benefit from transition.

This is not to say that the convictions of the patient should be dismissed or ignored, some may ultimately benefit from transition. However, careful clinical exploration should not be neglected, either. The findings that the majority of clinicians described in this study did not explore trauma or mental health disorders as possible causes of gender dysphoria or request medical records in patients with atypical presentations of gender dysphoria is alarming.

It is possible that some teens and young adults may have requested that their discussions with the clinicians addressing gender issues be kept confidential from their parents, as is their right except for information that would put themselves or others at harm. However, maintaining confidentiality of the patient does not prevent the clinician from listening to the medical and social history of the patient provided by the parent.

Because adolescents may not be reliable historians and may have limited awareness and insight about their own emotions and behaviors, the inclusion of information from multiple informants is often recommended when working with or evaluating minors. One would expect that if a patient refuses the inclusion of information from parents and physicians prior and current , that the clinician would explore this with the patient and encourage them to reconsider.

At the very least, if a patient asks that all information from parents and medical sources be disregarded, it should raise the suspicion that what the patient is presenting may be less than forthcoming and the clinician should proceed with caution. The argument to surface from this study is not that the insider perspectives of AYAs presenting with signs of a rapid onset of gender dysphoria should be set aside by clinicians, but that the insights of parents are a pre-requisite for robust triangulation of evidence and fully informed diagnosis.

All parents know their growing children are not always right, particularly in the almost universally tumultuous period of adolescence. Most parents have the awareness and humility to know that even as adults they are not always right themselves. The strengths of this study include that it is the first empirical description of a specific phenomenon that has been observed by parents and clinicians [ 14 ] and that it explores parent observations of the psychosocial context of youth who have recently identified as transgender with a focus on vulnerabilities, co-morbidities, peer group interactions, and social media use.

Additionally, the qualitative analysis of responses about peer group dynamics provides a rich illustration of AYA intra-group and inter-group behaviors as observed and reported by parents. This research also provides a glimpse into parent perceptions of clinician interactions in the evaluation and treatment of AYAs with an adolescent-onset or young adult-onset of gender dysphoria symptoms. The limitations of this study include that it is a descriptive study and thus has the known limitations inherent in all descriptive studies.

This is not a prevalence study and does not attempt to evaluate the prevalence of gender dysphoria in adolescents and young adults who had not exhibited childhood symptoms. Gathering more data on the topics introduced is a key recommendation for further study. It is not uncommon for first, descriptive studies, especially when studying a population or phenomenon where the prevalence is unknown, to use targeted recruiting. To maximize the possibility of finding cases meeting eligibility criteria, recruitment is directed towards communities that are likely to have eligible participants.

For example, in the first descriptive study about children who had been socially transitioned, the authors recruited potential subjects from gender expansive camps and gender conferences where parents who supported social transition for young children might be present and the authors did not seek out communities where parents might be less inclined to find social transition for young children appropriate [ 77 ].

In the same way, for the current study, recruitment was targeted primarily to sites where parents had described the phenomenon of a rapid onset of gender dysphoria because those might be communities where such cases could be found. The generalizability of the study must be carefully delineated based on the recruitment methods, and, like all first descriptive studies, additional studies will be needed to replicate the findings. Three of the sites that posted recruitment information expressed cautious or negative views about medical and surgical interventions for gender dysphoric adolescents and young adults and cautious or negative views about categorizing gender dysphoric youth as transgender.

One of the sites that posted recruitment information is perceived to be pro-gender-affirming. Hence, the populations viewing these websites might hold different views or beliefs from each other. And both populations may differ from a broader general population in their attitudes about transgender-identified individuals. Future studies should explore all these issues. This study cannot speak to those details about the participants.

All self-reported results have the potential limitation of social desirability bias. However, comparing this self-report sample to the national self-report sample [ 78 ], the results show similar rates of support. Therefore, there is no evidence that the study sample is appreciably different in their support of the rights of transgender people than the general American population. It is also important to note that recruitment was not limited to the websites where the information about the study was first posted. Snowball sampling was also used so that any person viewing the recruitment information was encouraged to share the information with any person or community where they thought there could be potentially eligible participants, thus substantially widening the reach of potential respondents.

In follow up studies on this topic, an even wider variety of recruitment sources should be attempted. Another limitation of this study is that it included only parental perspective. Ideally, data would be obtained from both the parent and the child and the absence of either perspective paints an incomplete account of events.

Input from the youth would have yielded additional information. Further research that includes data collection from both parent and child is required to fully understand this condition. However, because this research has been produced in a climate where the input from parents is often neglected in the evaluation and treatment of gender dysphoric AYAs, this research supplies a valuable, previously missing piece to the jigsaw puzzle. If Hypothesis 3 is correct that for some AYAs gender dysphoria represents an ego-syntonic maladaptive coping mechanism, data from parents are especially important because affected AYAs may be so committed to the maladaptive coping mechanism that their ability to assess their own situation may be impaired.

There are, however, obvious limitations to relying solely on parent report. Readers should hold this possibility in mind. Overall, the plus responses appear to have been prepared carefully and were rich in detail, suggesting they were written in good faith and that parents were attentive observers of their children's lives. Although this research adds the necessary component of parent observation to our understanding of gender dysphoric adolescents and young adults, future study in this area should include both parent and child input.

This research does not imply that no AYAs who become transgender-identified during their adolescent or young adult years had earlier symptoms nor does it imply that no AYAs would ultimately benefit from transition. Rather, the findings suggest that not all AYAs presenting at these vulnerable ages are correct in their self-assessment of the cause of their symptoms and some AYAs may be employing a drive to transition as a maladaptive coping mechanism.

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Clinicians should carefully explore these options and try to clarify areas of disagreement with confirmation from outside sources such as medical records, psychiatrists, psychologists, primary care physicians, and other third party informants where possible. Further study of maladaptive coping mechanisms, psychiatric conditions and family dynamics in the context of gender dysphoria and mental health would be an especially valuable contribution to better understand how to treat youth with gender dysphoria.

Adolescent-onset gender dysphoria is sufficiently different from early-onset of gender dysphoria that persists or worsens at puberty and therefore, the research results from early-onset gender dysphoria should not be considered generalizable to adolescent-onset gender dysphoria.

It is currently unknown whether the gender dysphorias of adolescent-onset gender dysphoria and of late-onset gender dysphoria occurring in young adults are transient, temporary or likely to be long-term. Without the knowledge of whether the gender dysphoria is likely to be temporary, extreme caution should be applied before considering the use of treatments that have permanent effects such as cross-sex hormones and surgery.

Research needs to be done to determine if affirming a newly declared gender identity, social transition, puberty suppression and cross-sex hormones can cause an iatrogenic persistence of gender dysphoria in individuals who would have had their gender dysphoria resolve on its own and whether these interventions prolong the duration of time that an individual feels gender dysphoric before desisting.

There is also a need to discover how to diagnose these conditions, how to treat the AYAs affected, and how best to support AYAs and their families. Additionally, analyses of online content for pro-transition sites and social media should be conducted in the same way that content analysis has been performed for pro-eating disorder websites and social media content [ 44 ]. Finally, further exploration is needed for potential contributors to recent demographic changes including the substantial increase in the number of adolescent natal females with gender dysphoria and the new phenomenon of natal females experiencing late-onset or adolescent-onset gender dysphoria.

Collecting data from parents in this descriptive exploratory study has provided valuable, detailed information that allows for the generation of hypotheses about potential factors contributing to the onset and expression of gender dysphoria among AYAs. Emerging hypotheses include the possibility of a potential new subcategory of gender dysphoria referred to as rapid-onset gender dysphoria that has not yet been clinically validated and the possibility of social influences and maladaptive coping mechanisms contributing to the development of gender dysphoria.

Parent-child conflict may also contribute to the course of the dysphoria. I would like to acknowledge Michael L.


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Littman, PhD, for his assistance in the statistical analysis of quantitative data, Michele Moore, PhD, for her assistance in qualitative data analysis and feedback on an earlier version of the manuscript, Lisa Marchiano, LCSW, for feedback on earlier versions of the manuscript, and four external peer-reviewers, three PLOS ONE staff editors and two Academic Editors for their attention to this research. National Center for Biotechnology Information , U.

When your child comes out as transgender: a Q&A with Sue Chitayi

PLoS One. Published online Aug Daniel Romer, Editor. Author information Article notes Copyright and License information Disclaimer. Received Oct 7; Accepted Aug 1. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

This article has been corrected. See PLoS One. See " Formal comment on: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria " in volume 14, e This article has been cited by other articles in PMC. Abstract Purpose In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria, appearing for the first time during puberty or even after its completion.

Methods For this descriptive, exploratory study, recruitment information with a link to a question survey, consisting of multiple-choice, Likert-type and open-ended questions was placed on three websites where parents had reported sudden or rapid onsets of gender dysphoria occurring in their teen or young adult children. Results There were parent-completed surveys that met study criteria. Background Gender dysphoria in adolescents Gender dysphoria GD is defined as an individual's persistent discomfort with their biological sex or assigned gender [ 11 ].

Demographic and clinical changes for gender dysphoria Although, by , there was research documenting that a significant number of natal males experienced gender dysphoria that began during or after puberty, there was little information about this type of presentation for natal females [ 5 ]. Open in a separate window. Fig 1. Purpose Rapid presentations of adolescent-onset gender dysphoria occurring in clusters of pre-existing friend groups are not consistent with current knowledge about gender dysphoria and have not been described in the scientific literature to date [ 1 — 8 ].

Participants During the recruitment period, parents completed online surveys that met the study criteria. Table 1 Demographic and other baseline characteristics of parent respondents. Table 2 Demographic and other baseline characteristics of AYAs. Procedure A question survey instrument with multiple choice, Likert-type, and open-ended questions was created by the researcher.

Why Transgender Kids Should Wait to Transition - Pacific Standard

Recruitment sites There were four sites known to post recruitment information about the research study. Transgendertrend Transgendertrend was founded in November Parents of transgender children Parents of Transgender Children is a private Facebook group with more than 8, members [ 52 ]. Measures Basic demographic and baseline characteristics Basic demographic and baseline characteristic questions, including parental attitudes about LGBT rights, were included. DSM-5 diagnostic criteria for gender dysphoria in children The DSM 5 criteria for gender dysphoria in children consist of eight indicators of gender dysphoria [ 57 ].

DSM-5 diagnostic criteria for gender dysphoria in adolescents and adults The DSM-5 criteria for gender dysphoria in adolescents and adults consist of six indicators of gender dysphoria [ 57 ]. Behaviors, outcomes, clinical interactions Survey questions were developed to specifically quantify adolescent behaviors that had been described by parents in online discussions and observed elsewhere.

Data analysis Statistical analyses of quantitative data were performed using Excel and custom shell scripts Unix. Table 3 DSM 5 Indicators for gender dysphoria. Table 4 AYA baseline comorbidities and vulnerabilities predating the onset of gender dysphoria. Friend-group exposure The adolescent and young adult children were, on average, Table 6 Friend group exposure. Theme: Behaviors occurred both in person and in online settings Parents observed the behaviors both in-person and in online settings, and specifically mentioned seeing posts and conversations on Tumblr, Twitter, Facebook, and Instagram.


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Theme: Examples of behaviors Participants gave many examples of the observed behaviors that were mocking towards non-transgender people and non-LGB people. Theme: Emphasizing victimhood Participants described that their children and friend group seemed to focus on feeling as though they were victims. Table 8 Outcomes and behaviors. Table 9 AYA Cumulative mental disorder and neurodevelopmental disability diagnoses. Table 10 Additional behaviors. Clinical encounters Parents were asked if their child had seen a gender therapist, gone to a gender clinic, or seen a physician for the purpose of beginning transition and 92 respondents Table 11 Interactions with clinicians.

Qualitative analysis The open-ended comments from the question about whether the clinician explored mental health, trauma or alternative causes of gender dysphoria before proceeding were selected for qualitative analysis. Theme: Insufficient evaluation Another theme was insufficient evaluation where parents described evaluations that were too limited or too superficial to explore mental health, trauma or alternative causes of gender dysphoria.

Theme: Unwillingness or disinterest in exploring mental health, trauma or alternative causes of GD Parents described that clinicians did not seem interested or willing to explore alternative causes. Theme: Mental health was explored A few parents had the experience where the clinician either made an appropriate referral for further evaluation or the issues had been addressed previously.

Theme: Transition steps were pushed by the clinician Some parents described clinicians who seemed to push the process of transition before the patient asked for it. Theme: Parent views were discounted or ignored Parents describe that the clinicians did not take their concerns seriously. Table 12 Transition steps and disposition.

Table 13 chi-squared comparisons for exposure to social influence SI vs not exposure to social influence NSI. Discussion This research describes parental reports about a sample of AYAs who would not have met diagnostic criteria for gender dysphoria during their childhood but developed signs of gender dysphoria during adolescence or young adulthood.

Emerging hypotheses Hypothesis 1: Social influences can contribute to the development of gender dysphoria It is unlikely that friends and the internet can make people transgender. Hypothesis 3: Maladaptive coping mechanisms may underlie the development of gender dysphoria for some AYAs For some individuals, the drive to transition may represent an ego-syntonic but maladaptive coping mechanism to avoid feeling strong or negative emotions similar to how the drive to extreme weight loss can serve as an ego-syntonic but maladaptive coping mechanism in anorexia nervosa [ 68 — 69 ].

How to Be An Ally to Gender-Expansive and Transgender Children

Reflections Clinicians need to be aware of the myriad of barriers that may stand in the way of making accurate diagnoses when an AYA presents with a desire to transition including: the developmental stage of adolescence; the presence of subcultures coaching AYAs to mislead their doctors; and the exclusion of parents from the evaluation. Conclusion Collecting data from parents in this descriptive exploratory study has provided valuable, detailed information that allows for the generation of hypotheses about potential factors contributing to the onset and expression of gender dysphoria among AYAs.

Supporting information S1 Appendix Survey instrument. PDF Click here for additional data file. Acknowledgments I would like to acknowledge Michael L. Funding Statement The author received no specific funding for this work. Data Availability The data cannot be made available due to ethical and regulatory restrictions. References 1. Do no harm: an interview with the founder of youth trans critical professionals.

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