Quite a good paper from Australia on Gender Dysphoria

[rogdmum]

It feels like the adults are starting to sit up and realise GD is an incredibly complex issue.

From the Abstract:

“ Key challenges faced by the clinicians included the following: the effects of increasingly dominant, polarized discourses on daily clinical practice; issues pertaining to patient and clinician safety (including pressures to abandon the holistic [biopsychosocial] model); the difficulties of untangling gender dysphoria from comorbid factors such as anxiety, depression, and sexual abuse; and the factual uncertainties present in the currently available literature on longitudinal outcomes. Our results suggest the need to bring into play a biopsychosocial, trauma-informed model of mental health care for children presenting with gender dysphoria. Ongoing therapeutic work needs to address unresolved trauma and loss, the maintenance of subjective well-being, and the development of the self.”

Lots on the expectations of children and parents when coming to the gender clinic and complex traumatic background of many young patients.

journals.sagepub.com/doi/full/10.1177/26344041211010777#.YIc_RaJBvsE.twitter

Yes, good article explaining what everyone knows, gender dysphoria is a mental health problem.

Ongoing therapeutic work- yes!
Holistic models of care - yes!
Trauma informed model of care - yes!

Silly old me guessed this years ago! That's why I obtained the above care for my dysphoric minor at significant expense, while receiving significant abuse for not jumping straight to affirmations and transition.

Good to see it validated in the literature.

This paper is significant in that it acknowledges the importance of positioning the child's distress within the context of their development, environment and family etc. As such it indicates the need for a move away from the medical/deficit model focussed solely on 'correcting' the child whose body is the site of the issue/s rather than recognising the contributory /causative factors of distress around the child.

(extract)
"Our study also found that despite the high rates of family conflict, relationship breakdowns, parental mental illness, and maltreatment (see Table 3)—and our own clinical perspective that both individual and family work were indicated for the majority of families—few families rated themselves as being in a clinically severe range on self-report (SCORE-15). Coupled with the dominant sociopolitical discourse—the gender affirmative model that prioritizes the medical treatment pathway—it is not surprising that the large majority of children and families were not motivated to engage in or to remain engaged in ongoing therapy. These data bring three important phenomena into focus. First, when children and families were given the space and structure to tell the child’s developmental story—nested in the story of the family—they were able to identify and provide a detailed narrative of the key issues that had contributed to the child’s presentation and distress. Without this space and structure, the issues remain undeclared and unaddressed. Second, some families—but also some clinicians—function within a non-holistic (non-biopsychosocial) framework where the child’s developmental experiences are disconnected from their clinical presentation. This non-holistic framework is likely to promote a healthcare delivery model that dehumanizes the child (by not examining the child’s and family’s lived experience) and that promotes medical solutions (correcting the identity/body mismatch) for a problem that is much more complex. Third, as noted earlier, our experience suggests that, insofar as the gender affirmative model is taken as equivalent to medical intervention, clinicians (including ourselves) who work in gender services are coming under increasing pressure to put aside their own holistic (biopsychosocial) model of care, and to compromise their own ethical standards, by engaging in a tick-the-box treatment process. Such an approach does not adequately address a broad range of psychological, family, and social issues and puts patients at risk of adverse future outcomes and clinicians at risk of future legal action." (continues)

Thank you for posting this.

Section 5.2 is good as well:

“ 5.2. Conflation of gender affirmation and medical intervention

The second theme concerned the way in which the gender affirmative model—the dominant sociopolitical discourse—shaped the expectations of the children (and families) presenting to the service (see Section 4.2). It appeared to us that a large subgroup of children equated affirmation with medical intervention and appeared to believe that their distress would be completely alleviated if they pursued the pathway of medical treatment. Very often, we the clinicians felt that our efforts to work from a biopsychosocial perspective, along with our therapeutic efforts to discuss different aspects of the medical situation, fell on deaf ears. Lost were our efforts to highlight the many different pathways in which gender variation could be expressed, to explain potential adverse effects of medical treatment, to explore issues pertaining to future fertility and child rearing, and to highlight the importance of ongoing psychotherapy. With regard to the last item, we had a strong commitment to exploring issues of self and to helping the children both to understand the context in which their own distress (and potential mental health comorbidities) had arisen and to reflect, more generally, on their concerns, expectations, and future prospects. This same overall dynamic also put many parents—who were trying to support their children in a more holistic way but who were aware of potential long-term harms—in a difficult and untenable situation. The drivers of this dynamic appeared to include not simply the gender affirmative model itself but information from peers, previously encountered health workers, and the internet; many children arrived at the clinic with strongly entrenched beliefs and with no interest in further exploring their medical, psychological, social, or familial situation. It also became apparent to us that many children did not have the cognitive, psychological, or emotional capacity to understand the decisions they were making (see also Section 7).”

Second the request to @blackwave to describe how and what she did to obtain help pls.

I truly hope the authors agave support when the inevitable backlash is unleashed.

Brilliant paper - congratulations to the authors for their work and their courage.

Wow. This is fantastic to read.

Another chink in affirmation model's armour.

Another chink in affirmation model's armour

It’s all right in front of us, isn’t it? It just needs people willing to write it up.

Its more than a chink. The two sections quoted identify the serious risks and harms done to children by this iatrogenic medical/deficit model of 'gender identity' treatment.

The developmental stories told by the children and their families highlighted high rates of adverse childhood experiences, with family conflict (65.8%), parental mental illness (63.3%), loss of important figures via separation (59.5%), and bullying (54.4%) being most common.

I've never seen statistics on family background before.

Unfortunately from the start those who chose to specialise in children's 'gender identity' appeared unskilled/disinterested in recognising and assessing the influence of family and environment, preferring instead to be 'fascinated' by the child and the expression of their distress whilst ignoring established child development knowledge.

1. Find an adolescent psychiatrist who practises psychotherapy.

1. Find out if they are open to psychotherapeutic exploration of gender and any other issues. You can do this through an initial interview.

1. Does the practitioner take a full developmental history? Do they speak alone to you, and alone to the child? Are they open to hearing your concerns? The child's concerns? Again, are they prepared to engage with the child in psychotherapy? Do they treat a diagnosis of dysphoria as the beginning of the therapeutic exploration, rather than the end? Most importantly, is the fit between therapist and child such that child will go to therapy!

1. Borrow $ to pay for the weekly therapy. Get your own therapy. Find a GC therapist you can trust. You are likely part of your child's underlying distress, and you also need support for yourself. Explicitly encourage child to share whatever pieces of family history they need to.

1. Continue to engage in therapy (both of you). At home, allow child to dress, have hair etc as they wish. Use reality based language. Connect with child on non-gender interests. Do not hyper-focus on gender in any direction, for or against.

1. Let therapy take its course. Allow/encourage treatment of co-morbidities. Borrow more $ to pay for it all.

1. All along, assess the role of your child's psychotherapist. Are they truly allowing exploration of issues? Is your child's distress improving or more tolerable? Are they functioning better? Ruminating on gender less? Engaging in offline life in fulfilling ways? Change psych if need be.

1. Hope it's going to be ok, one way or the other.

BlackWaveComing and all best wishes for you and your family's recovery.

@Ritasueandbobtoo9

Yes, good article explaining what everyone knows, gender dysphoria is a mental health problem.

Lols - you mean all the "armchair" experts.

Those who actually have a medical and mental health background, the WPATH, have clearly stated that gender dysphoria is not a mental illness.

I think I will accept their informed judgement.

Those who actually have a medical and mental health background, the WPATH, have clearly stated that gender dysphoria is not a mental illness.

I think I will accept their informed judgement.

WPATH (and US Endocrine Society) will be proven not to be a reliable evidence-based source.

Medscape (long read article)
April 26, 2021
'Transgender Teens: Is the Tide Starting to Turn?'
Becky McCall and Lisa Nainggolan
(extract)
Endocrine Society Guidelines Based on One Study
"Safer serves on the Standards of Care revision committee for the World Professional Association for Transgender Health (WPATH). WPATH's most recent standards of care, issued in 2012, state: "Adolescents may be eligible to begin feminizing/masculinizing hormone therapy, preferably with parental consent. In many countries, 16-year-olds are legal adults for medical decision-making and do not require parental consent." They add: "Hormone therapy should be provided only to those who are legally able to provide informed consent. This includes people who have been declared by a court to be emancipated minors."

Safe is also a co-author of the Endocrine Society's 2017 guidelines for treating youth confused about their gender. These guidelines were formally presented at the annual meeting of the Endocrine Society in March 2018.

Malone was there.

"At this conference, the Endocrine Society — a highly respected organization — rolled out a set of guidelines for kids that essentially said, 'Your job as endocrinologists is to medically affirm [gender dysphoric] adolescents with puberty blockers and cross-sex hormones,'" he tells Medscape.

Malone says he was astounded when he first heard the guidelines, but immediately assumed, "There must have been a massive change in the landscape, some landmark study that I missed somehow, some stunning piece of evidence that says, 'Psychotherapy is out and affirmation is in.' " But the evidence simply wasn't there, he says.

The recommendations are based on a single uncontrolled study out of the Netherlands (the so-called 'Dutch' study, published in 2014 ), which Malone says was of low quality." (continues)
www.medscape.com/viewarticle/949842?src=soc_tw_share#vp_6

Those who actually have a medical and mental health background, the WPATH, have clearly stated that gender dysphoria is not a mental illness.

I wonder how many WPATH members actually have this sort of background? Membership is open to people from quite a wide range of disciplines. I think you'll find that many people here would also qualify.

Full professional membership is available to professionals working in disciplines such as medicine, psychology, law, social work, counseling, psychotherapy, nursing, family studies, sociology, anthropology, speech and voice therapy and sexology. Full membership costs $225 (US) per year, and carries voting privileges within the Association.

wpath.org/MembershipInfo

Thanks @blackwavecoming. Very helpful. Can i ask what the outcome for you was?

Wow this is a really important article, thank you for posting. Will keep it in my pocket for whenever I may become brave enough to put my head above the parapet at work.

It will be interesting to see the in-depth analysis of the evidence base informing WPATH's judgements when it emerges (as not doubt it shall eventually).

Michael Biggs Dept of Sociology, University of Oxford
Published by Transgender Trend
(22 July 2019)
'Tavistock’s Experiment with Puberty Blockers: an Update'
(extract)
Five years ago, in 2014, Carmichael told the Mail on Sunday that the study demonstrated favourable outcomes: ‘Now we’ve done the study and the results thus far have been positive we’ve decided to continue with it’ (italics added). She even appeared in a BBC television programme – ‘I Am Leo’, aimed at audiences aged 6 to 12 – to promote the benefits of GnRHa drugs. (See our analysis of the programme here).

The Tavistock’s statement says remarkably little about the experiment’s outcomes. It cites Carmichael and Viner’s presentation to the 2014 World Professional Association for Transgender Health (WPATH) conference showing ‘there was no overall improvement in mood or psychological wellbeing using standardized psychological measures’ (italics added). This finding was presented in February 2014, but just four months later Carmichael claimed ‘the results thus far have been positive’. I cannot find slides from this 2014 presentation, but Carmichael’s presentation to the 2016 WPATH conference apparently recycles the same finding. It also acknowledges that ‘Natal girls showed an increase in internalising problems from t0 to t1 [after 12 months on GnRHa] as reported by their parents’ (italics added). This negative outcome is omitted from the Tavistock’s statement." (continues)

www.transgendertrend.com/tavistock-experiment-puberty-blockers-update/

Lols - you mean all the "armchair" experts.

I know I am on the right side when I look at the two groups of "armchair" experts. It's a generalisation but..

On the one hand you have mature women who understand kids having their spent their lives caring or working with children and watching them develop as a mother/grandmother/teacher/nurse etc etc

On the other you have young men in their 20s with blue hair who went to uni and read some queer theory.

Which of the groups do you think is more informed and which is most likely to care passionately about the welfare of children?

@whoshouldItalkto

Thanks *@blackwavecoming*. Very helpful. Can i ask what the outcome for you was?

Reduction in dysphoria symptoms, including cessation of self-harm, improved functioning, reintegration in offline friendships and employment, significant co-morbidities treated, improvement in mood, establishment of non-gender life goals. Child has almost reached adulthood without having foreclosed on their identity through premature social, hormonal or surgical treatment, has progressed through and benefited from puberty (particularly in terms of cognitive and social development). Child currently presents as birth sex and there is currently no significant child-parent friction. On track developmentally. Still seen by psychiatrist at 4 monthly intervals to monitor meds.