GENDER DYSPHORIA CARLA KANTYKA PAEDIATRIC SHO ORDER OF

GENDER DYSPHORIA CARLA KANTYKA PAEDIATRIC SHO

ORDER OF THE DAY • Definitions • What we’re looking for • How to manage it • Where can I send my kids?

DEFINITIONS • Gender: Grammatical? • Since around 1950: socio-culturally constructed “role” • Changes depending on setting • E. g. Hijra (east asia), Mahu (Hawaii) , two-spirit community (native American) • Unusual in western cultures late Middle English: from Old French gendre (modern genre ), based on Latin genus ‘birth, family, nation’. The earliest meanings were ‘kind, sort, genus’ and ‘type or class of noun, etc. ’ (which was also a sense of Latin genus )

DEFINITIONS … • Assigned gender: gender at birth • Affirmed Gender: gender you feel yourself to be • sex: biological sex at birth. Aka “natal gender” • Chromosomes • Genitalia

YET MORE DEFINITIONS • Gender Incongruence • Difference between assigned and affirmed gender • Gender dysphoria: • Significant distress and altered function secondary to gender incongruence or transgenderism • Across a variety of settings

CHANGES TO DEFINITIONS RECENTLY • ICD 11 and the DSM are changing (release 2022). • Gender incongruence has been moved out of mental health issues – now in disorders of sexual health • Reducing stigma • Allows formal diagnosis • Lots of places have yet to catch up with this

WHAT CAUSES IT? • We know about sex development: CAH/AIS etc • We don’t really know what causes gender incongruence. • Gender dysphoria: • Societal norms -> (society’s reaction)

HOW IT PRESENTS • Majority adults • Mean age of presentation 42 • 0. 6% of US adults identify as gender nonconforming • 18 -24 more likely to identify as gender nonconforming • Rapidly changing • Earlier recognition can prevent psychosocial fallout • Suicidality, self harm, body dysmorphia

DOES GENDER DYSPHORIA ALWAYS MEAN YOU ARE TRANSGENDER? • No! • 6 -13% (gender incongruence) persist in to adulthood • Higher link to homosexuality and body dysmorphia • Limited size studies • After 16, hormone treatment may be considered • Transition to adult services

WHY IT’S A PROBLEM: • Higher rates of: • Homelessness • HIV infection • Physical violence • Substance abuse • Suicidality (30% MTF, 50% of FTM have attempted suicide)

SO WHAT DO WE ASK THEM? • Nonjudgemental • Questions to ask: • Timescale • Effect on school, home, social, relationships • Health and wellbeing • Future plans/ambitions • Sexuality and relationships • Feelings towards their gender specific features

MANAGEMENT: • Swift referral to appropriate GIDS • Supporting treatment and therapies • Talking therapies/psychotherapy (DBT) • Medical therapies • • Antianxiety/antidepressants • Hormonal therapy Family based therapy • Get the pronouns right • Ask

HORMONE TREATMENT • Overseen in specialist clinics • Tavistock and portman Gender Identity services • Delaying puberty (gnrh analogues) • Stops pituitary making hormones that encourage sex hormone secretion, causing halting of development of secondary sexual characteristics • Used to treat precocious puberty and other adult hormonal problems • Adverse effects are rare (some negative effect on BMD, effects of psychological development unclear) • Regret for reassignment surgery/hormones: • 1. 8%

HOW CAN I HELP MY STUDENTS? • Ask how they wish to be addressed • Be receptive • Gender expression is different for everyone • Be alert for signs like withdrawal, self harm, or struggling • Referral process: • Through a GP is preferable • Self referral to GIDS is possible

IS IT REALLY SO DIFFERENT?

PLACES TO SEND THEM: • https: //gids. nhs. uk/youngpeople – the Tavistock gender identity services website. Lots of FAQ/help, referral pathways, stories • https: //www. tranzwiki. net - has lists of support groups etc by area • https: //mermaidsuk. org. uk – children <19, info and articles, resources for parents • https: //www. youngstonewall. org. uk – LGBTQ+ charity, support, stories • https: //mindedforfamilies. org. uk – general mental health support for parents of children who are suffering • http: //www. pinktherapy. com – UK organisation for finding therapists specialising in gender diverse people of all ages

REFERANCES • http: //www. nhs. uk/conditions/gender-dysphoria/ • shttps: //childmind. org/guide-to-gender-dysphoria/ • https: //patient. info/doctor/gender-dysphoria-pro#ref-17 • https: //patient. info/mental-health/gender-dysphoria-leaflet • https: //youngminds. org. uk/find-help/for-parents/parents-guide-to-support-a-z/parents-guide-to-supportgender-identity-issues/ • https: //adc. bmj. com/content/103/7/631 • https: //www. mentalhealthjournal. org/articles/gender-incongruence-is-no-longer-a-mental-disorder. html • https: //pediatrics. aappublications. org/content/142/4/e 20182162 ** great article **

ANY QUESTIONS?