Gender Dysphoria in children. Options that are available to transgender persons. Terminology. Is being transgender a "disorder?"

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Additional information on transgender
individuals, transsexuals, & gender identity

Part 4:
Transgender children.
Options that
are available to transgender persons.
Is being transgender a
or mental illness?

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This is continued here from a previous essay

Detecting transgender children:

The term "transgender" refers to a person's belief that their gender is different from their birth-identified sex, a.k.a. their biological sex.

There is no test to detect this in newborns or infants. However transgender children generally become aware of their gender conflict early in life, often at about three years of age -- before reaching school age -- and often communicate it to parents.

The Gender Management Clinic (a.k.a. GeMS) at Children's Hospital Boston was founded as the first clinic in the Western Hemisphere to evaluate and treat transgender pubescent children. It was founded by Normal Spack, an endocrinologist who specialized in gender disorders. 1

Stephanie A. Brill and Rachel Pepper, authors of "The Transgender Child: A Handbook for Families and Professionals" wrote:

"Dr. Norman Spack, an expert in this field and founder of the GeMS clinic ... for children with disorders of sexual differentiation or who are transgender, notes that there are several important and clear ways young children typically reveal their transgender identity. He says to watch for:

bullet Bathroom behavior: does your little girl insist on peeing while standing up?

bullet Swimsuit aversion: most trans kids absolutely will not wear the bathing suit of their anatomical sex.

bullet What type and style of underpants kids select: does your son want the girl-cut panties with flowers on them?

bullet A strong desire to play with toys typically assigned to the opposite sex." 2

These are indications of gender-variance in children. However, Brill and Pepper write:

"... the vast majority of gender-variant children are not transgender; they are just gender-nonconforming." 2

Also, playing with toys of the opposite sex is much more likely to be a indicator of future homosexuality rather than a transgender identity. Since adult homosexuals are perhaps 8 times more common (5% compared to 0.6%) than transgender adults, the toy symptom by itself is probably not a good indicator of being transgender.

Finally, many children who exhibit transgender symptoms outgrow them naturally later in life. There is a great deal of controversy over what percentage does this.

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Options available to transgender persons:

Various forms of counseling have had a zero success rate at converting youth and adult transgender individuals into cisgender persons. A transgender person's mind apparently cannot be changed to harmonize with their genetic gender through therapy. The only successful treatment found to date to harmonize the mind and body of transgender older youths and adults is the gender confirmation process. The full process may involve:

bullet Extensive evaluation and counseling, typically by two psychologists or psychiatrists.
bullet The "Real Life Test" (RLT): Living as a person of their perceived gender for a year or more.
bullet Taking hormones to transform the appearance of parts of their body to resemble the other gender.
bullet Perhaps undergoing gender confirmation surgery (formerly called gender reassignment surgery). This final step is generally restricted to adults.

For children approaching puberty who are not sufficiently mature to make decisions about surgery, hormones, etc., puberty blocking medication is sometimes suggested. It delays the onset of puberty and allows children more time to mature and become able to make sound decisions.

The American Psychiatric Association considers such a mismatch between gender perception and genetic gender to be a normal sexual variant, and not a disease or mental illness.

The term Gender Dysphoria, the distress and anxiety generally caused by gender incongruence, can be overwhelming; it leads to an unusually high attempted suicide rate. Some have suggested that about half of all transsexuals die by the age of 30, usually by their own hand." 3 This may have been true in the past. However, with advances in gender confirmation surgery and growing public acceptance of transsexuals, this number is probably significantly lower today, and in decline. Recently, it has been estimated that 41% of transgender individuals attempt suicide at sometime during their life. Fortunately, most do not succeed.

The essays in this section will deal mainly with conflicts between genetic gender and gender identity, as well as the protection of transsexual people from discrimination and abuse.

About terminology:

Discussing gender identity, and transgender topics is a bit of a minefield. There are many conflicting definitions for each term. We will try to use definitions that are in common use by the LGBT community. However, there is no real consensus on definitions. So we are bound to alienate some people.

We have assembled a glossary of terms related to these terms.

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Differentiating transsexuals from transgender persons:

  • Some define a transgender person as one who experiences a mismatch between their birth-assigned sex and their current gender identity, but has not undergone gender confirmation surgery.

  • After such surgery, they are sometimes defined as transsexuals.

  • Others define transgender very broadly, to also include everyone who doesn't fit into conventional gender norms: Included are: transsexuals, cross dressers, drag queens, etc.

  • Some transsexuals are proud to be referred to by that term. Some transsexuals are offended by the term and wish to be referred to by name or simply by "he" or "him" or "male," "she" or "her" or "female" according to their own perceived gender identity.

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What term(s) should be used to refer to transgender persons?

  • Some suggest "cross-gender identification" as a more neutral and acceptable term.

  • Religious and social conservatives often use the term "gender confusion." They may have chosen this term to support their belief that transgender persons can be cured of their gender identity problems by prayer or therapy. It does not seem like a particularly useful term, because transgender persons are generally not confused about their identity; they are quite certain of what their gender identity is. Most are troubled simply because the gender that they know they are does not match their genetic gender and often does not match their appearance.

  • The American Psychiatric Association (APA) once used the term "Gender Identity Disorder" (a.k.a. GID) in section 302.85 of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4 Many people viewed this term as stigmatizing. Some in the transgender community urged that GID be removed from the book just as homosexuality was deleted in 1973. 

    In the case of homosexuality, although homosexuality itself is not listed in DSM-IV. A situation in which a person cannot accept their homosexual orientation is still included.

  • The APA's updated manual, called DSM-5, was released in 2013. It replaced the term "Gender identity Disorder" with "Gender Dysphoria;" the latter refers to the anxiety depression and distress that many transgender persons experience. They also introduced the term "Gender Incongruence," which they feel is clearer and less stigmatizing." 6 A transgender person who does not experience Gender Dysphoria is regarded as being a normal sexual variant. However, those who do experience Gender Dysphoria are usually in great need of support.

This topic continues in the next essay

References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

  1. "Gender Management Service (GeMS)," Children's Hospital Boston, at:
  2. Stephanie A. Brill & Rachel Pepper, "The Transgender Child: A Handbook for Families and Professionals." Read reviews or order this book safely from
  3. Nancy R. Nangeroni, "About the TG Symbol," GenderTalk, at:
  4. "Gender Identity Disorder, DSM-IV" American Psychiatric Association, at:
  5. "DSM-5: The Future of Psychiatric Diagnosis," American Psychiatric Association, 2012, at:
  6. "Dysphoria," Wikipedia, as on 2014-FEB-10 at:

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Copyright 2007 to 2019 by Ontario Consultants on Religious Tolerance
Original posting: 2007-JUN-08
Latest update: 2019-JAN-22
Author: B.A. Robinson

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