A cultural shift is occurring in the rapid escalation of teenagers who do not identify with their assigned gender, that is, with the gender they are born with. Even a decade or two ago gender identity issues among teens were rarely discussed at all, so parents may be ill-equipped to handle a teen gender identity crisis should one emerge.
It is estimated that about one-half of one percent of the general population is transgender, meaning individuals struggling with gender identity issues. Among teens aged 16-19, however, that number is about 1.3%, according to a recent study published in Adolescent Health Medicine and Therapeutics. The reason for this uptick in gender identity issues is not yet defined.
We all like to feel like we fit in, that we have a place in this world that is welcoming and supportive. When a teen experiences a disconnect between their the gender they were born with and the one they identify with the teen doesn’t feel they fit in with either gender fully. Their struggle can lead to being bullied, marginalized, and stigmatized, which can result in emotional destabilization and mental health problems.
It has been found that there is a high comorbidity rate between gender dysphoria, the most recent term for a gender identity disorder, and depression, anxiety, self-harming behaviors, and suicidal ideation. Finding the best solutions to treat gender dysphoria in teens is still up for debate. However, addressing the co-occurring mental health issues is of upmost importance.
What is Gender Dysphoria in Teens?
Gender dysphoria refers to a misalignment between between the teen’s physical gender and the gender they identify as. For example, a male teen with gender dysphoria may be anatomically male but feel as if he is a female trapped in a male body. This individual may appear to be a male, but their thoughts, attitudes, preferences, and mannerisms are female. This lack of alignment between the biologically assigned sex and sexual identity sets up a disconnect that can result in severe emotional distress.
The transgender teen will often suffer from psychological problems as a result of the internal discord, as well as the external scorn they may suffer. The teen’s anguish increases if parents and family members are not supportive of them. Parents may be totally surprised at the emergence of the teen gender identity crisis, possibly having no idea that a problem ever existed. This can cause parents to attempt to persuade their teen to ignore the inclinations and to not behave in ways that contradict their biological gender, only complicating the situation.
The causes of gender dysphoria in teens are potentially complex and still not agreed upon within the scientific community. Some of the possible factors include:
- Androgen insensitivity syndrome, caused by the fetus insensitivity to the hormones
- Excess female hormones in utero
- Malfunctioning hormones
- Congenital adrenal hyperplasia
- Chromosomal abnormalities
Because the teen years are a dynamic period for gender development, treatment options are considered with great care, as the condition may resolve on its own. When the symptoms are persistent for an extended period of time, gender reassignment options are available.
Signs and Symptoms of Gender Dysphoria in Teens
Gender dysphoria may actually first appear in childhood. Some children will insist on wearing the clothing styles for the opposite sex, or to participate in non-traditional activities for the biological gender. This may be a boy who desires to wear dresses or to take ballet class, for example, or a girl to never want to wear dresses and wishes to play tag football. In most cases children with the signs of gender identity issues will see these preferences diminish over time.
Gender dysphoria doesn’t have any physical symptoms. The symptoms are primarily behavioral and psychological. These include:
- Insistent that they are the opposite sex, not their biological gender
- Wanting to take part in activities usually associated with the opposite sex
- Pass urine in the way that the opposite sex does (a girl may want to stand, and a boy may want to sit)
- Being very distressed at the physical effects of puberty
- The female wanting to hide developing breasts, a male hiding body hair or muscle definition
- Being disgusted with their genitalia
- Avoiding school
- Self-harming behaviors
- Feeling at easy only when dressed as the gender they identify with
- Taking on a new name and asking family and friends to call him or her by the name
- Asking others to refer to them by the pronoun associated with the gender they identify with
- Low self-esteem
- Eating disorders
- Isolating behaviors
- Suicidal ideation
Comorbid Mental Health Disorders with Gender Dysphoria
Teens with gender dysphoria are considered psychologically vulnerable. They often present with one or more mental health conditions, with ADHD being the most prevalent coexisting mental health issue, according to a study published in Psychiatry and Clinical Psychopharmacology. Other common mental health disorders seen in teens with gender dysphoria include depression, anxiety, eating disorders, and borderline personality disorder.
In addition to the mental health disorders that can co-occur with gender dysphoria, it has been found that a high number of adolescents with gender dysphoria also are on the autism spectrum. An article by Kathleen Louden reported that among normally developing kids, those who fall in the autism spectrum are eight times more likely to show the symptoms of gender dysphoria.
Suicide Risk Among Individuals with Gender Dysphoria
There is a significantly higher risk of suicidal ideation and suicide attempts among individuals with gender dysphoria. The American Pediatric Association released disturbing statistics in 2018, stating that more than half the transgender males and 30% of transgender females had attempted suicide at some point.
Additionally, a study published in the Spanish Journal Psicothema followed 151 individuals who had sought help at the Gender Identity Treatment Unit from 2007-2017. Nearly half of the participants reported suicidal ideation, and over this ten-year period 23.8% had attempted suicide.
Teens in gender identity crisis often experience family rejection and bullying, and do not feel they are safe in society. Co-occurring depression can contribute to the suicidal thoughts, as well as disappointing effects of the transitioning process.
How to Help a Teen with Gender Dysphoria
Parents with a trans teen may not know what to do to help their child. A good starting point is to become educated, to learn about gender dysphoria and the issues that impact affected teens. This helps the parent to become more compassionate when dealing with their teen and this challenging condition. The home environment should remain a safe, secure, and accepting place for the teen experiencing gender dysphoria. Higher levels of parental support are associated with less risk-taking behavior, including suicide attempts.
Parents should approach their teen without judgment when they begin to notice the persistent signs of gender dysphoria. Even if the teen initially denies he or she has a problem, the parent should offer to be available anytime they want to discuss any issues at all, including feelings associated with depression or anxiety.
If the symptoms persist, parents should plan to have the teen evaluated by a pediatrician and a mental health professional. This provides an opportunity for the teen to share their struggle with an objective professional who might be able to offer helpful guidance.
There are protocols in place for when or if gender reassignment efforts will be provided. Some of the potential treatment options for gender dysphoria include:
- Puberty suppression. Medications are available that can block or delay the effects of puberty, thereby suppressing the outward physical signs of secondary sex characteristics.
- Cross-sex hormone therapy. Hormones are accessed to alter the teen’s secondary sex characteristics, such as allowing males to develop breasts.
- Gender reassignment surgery. Gender reassignment, or sex reassignment surgery is not typically available as an option until the teen has reached the age of 18. This involves reconstructive surgeries to permanently change the appearance of the genitals and to provide breast augmentation.
Mental Health Treatment for Teens
Because of the high incidence of co-occurring psychiatric conditions among teens with gender dysphoria, it is important for the teen to obtain treatment from a mental health practitioner. The teen may benefit from therapy, both individual and group, and/or medication to help manage the symptoms of the co-occurring disorder. The psychological counseling provides the teen with an opportunity to open up about his or her struggle with gender identity issues. The therapist can refer the teen to a peer support group where they can share with others going through the same thing.
If a teen in crisis has attempted suicide, or is discussing their desire to die, it is important that they receive a higher standard of psychiatric care, especially if the teen has clinical depression. A residential treatment environment offers continual support and supervision while providing a more personalized and intensive approach to treatment. Being away from the stressors of the home community for a period of time can allow the teen to focus entirely on his or her mental health needs. Treatment at a residential program involves a multidisciplinary program, including:
- Group therapy
- Family therapy
- Experiential activities
- Holistic therapy
Teens in residential treatment will be assisted with their studies through the help of a tutor, allowing the teen to keep up with classmates while in treatment for the mental health condition.
BNI Treatment Centers Provides Residential Mental Health Services for Teens
BNI Treatment Centers is a residential mental health treatment program for teens in Los Angeles, CA. BNI Treatment is owned and operated by two psychiatrists who specialize in providing multidisciplinary mental health treatment for adolescents age 12-17. For more information about treatment for gender dysphoria and co-occurring mental health disorders, please contact BNI Treatment Centers today at (888) 522-1504.