Reflections on the Clinician’s Role with Individuals Who Self-identify as Transgender

Abstract

The fact that modern patterns of the treatment of trans individuals are not based on controlled or long-term comprehensive follow-up studies has allowed many ethical tensions to persist. These have been intensifying as the numbers of adolescent girls declare themselves to be trans, have gender dysphoria, or are “boys.” This essay aims to assist clinicians in their initial approach to trans patients of any age. Gender identity is only one aspect of an individual’s multifaceted identity. The contributions to the passionate positions in the trans culture debate are discussed along with the controversy over the official, not falsifiable, position that all gender identities are inherently normal. The essay posits that it is relevant and ethical to investigate the forces that may have propelled an individual to create and announce a new identity. Some of these biological, social, and psychological forces are enumerated. Using the adolescent patient as an example, a model for a comprehensive evaluation process and its goals are provided. The essay is framed within a developmental perspective.

The Gender Affirmative Treatment Model for Youth with Gender Dysphoria: A Medical Advance or Dangerous Medicine?

“…Others express concern about this approach (Biggs, 2020 ; D’Angelo et al, 2021 ; Levine, 2018 , 2021 ; Malone, 2021 ). They note the limited and low-quality evidence base for the benefits, not only of mastectomy as I have done in this Letter, but for early social transition and the hormonal treatments for GD adolescents.…”

What Women Want? The State of the Art regarding the Treatment of Young Women with Hypoactive Sexual Desire Disorder

“…Despite sexual health being more than the mere absence of disease and comprising dimensions of sexual pleasure and sexual rights [1], definitions of health are in close dialogue with those of dysfunction. The concept of sexual desire has been the subject of refinement throughout the years but can be understood as a subjective feeling triggered by either external or internal stimuli [2] that might lean individuals toward or away from sexual behavior [3] either with oneself or with a partner [4]. Sexual desire is also defined as having a responsive dimension, one that does not occur spontaneously in the body but as a response to a partner’s sexual initiative [5‒8].…”