121b - Gender Development

Question 1

By what age do most children have a stable gender identity?

Answer 1

Age 6

But many children expriment with gender identity - shoud be encouraged and supported!!

Question 2

How is gender dysphoria diagnosed?

Answer 2

1. Marked incongruence between one’s experienced/expressed gener and natal gender of at least 6 mo in duration, manifested by 6/8 symptoms in children, 2/6 in adolescents and adults
2. Condition is associated with clinically significant distress or impairment in functioning

Remember - the goal for the treatment of dysphoria is to minimize the distress! Gender incongruence is not a pathology!

Question 3

How does treatment with gender-affirming hormones affect the mental health of the individual?

Answer 3

• Alleviated gender dysphoria
• Improved body image, self-esteem
• Improved psychological fx
• Similar well-being to age-matched control
• Decreased anxiety, depression, suicidal ideation
• Improved QOL

Gender affirmation is important!!

Question 4

What develops first?

1. Gender identity
2. Sexual orientation
3. Gender expression
4. Sexual behavior

Answer 4

d. Sexual behavior

Question 5

What are the results of treatment of people with gender dysphoria with GnRH before the onset of puberty?

Answer 5

GnRH = puberty blocker

Buys time for the individual to explore gener before dysphoria increases with the onset of puberty

• Decreased behavioral/emotional problems
• Decreased depressive symptoms
• Increased gen functioning
• NO change in anxiety, gender dysphoria, body satisfaction
• Decreased rates of lifetime suicidal ideation

Outcomes are good!

Question 6

What is the role of puberty blockers in medical gender transition?

Answer 6

Pausing puberty buys time for the individual to explore gender before dypshoria intensifies with puberty

Puberty blocker = GnRH agonist