The discursive and clinical production of trans youth: gender variant youth who seek puberty suppression

Abstract

This article focuses on therapeutic interventions with gender variant youth and, in particular, pubertal suppression. The aim is to address the question of which kinds of subjects are enabled, and which are made invisible, through discursive and clinical practices. The analysis demonstrates the conceptual value of drawing on discursive and queer theoretical approaches. The published work of selected clinicians is used as a way in to the complexities that various clinical understandings and approaches bring with them. A key focus is on problems inherent in the construction of gender variant youth as 'persisting' or 'desisting' in their cross-gender wishes. Psychologists working in this area have substantial challenges to face, such as the challenge of negotiating understandings about what is a 'successful' outcome and the complexity of reporting fluidity and uncertainty in the context of a scientific forum where 'results' are expected. This article addresses the challenge of engaging psychological, discursive and clinical practices in ways that enable empowered, viable, gender variant possibilities, rather than representing gender variant youth as incoherent subjects.

Cisgenderism in psychology: pathologising and misgendering children from 1999 to 2008

“…Even 'affirmative' clinical interventions can promote cisgenderism and lead to 'poor mental health' outcomes when they focus solely or primarily on the intrapsychic issues of children with self-designated gender, thereby failing to address the systemic inequities that some authors (e.g., Giordano, 2008;Marksamer, 2008;Roen, 2011) suggest are largely responsible for these children's problems. Some clinicians have already adopted this approach.…”

“…Several clinics and physicians now offer hormone blockers that delay pubertal changes, an option made available by recent developments in paediatric endocrinology (Möller, Schreier, Li, & Romer, 2009;Roen, 2011). These hormone blockers may facilitate socialisation with peers of children's own self-designated gender, prevent severe distress and inhibit physiological changes that are difficult to reverse without expensive adult surgical interventions (Giordano, 2008;Marksamer, 2008;Roen, 2011). However, access to hormone blockers for young people typically requires evaluation and approval by mental health professionals, even in countries where pathways for adult access to hormones are available outside of mental health contexts.…”

“…For example, one recent psychological approach describes the erasure of children's self-designated gender and expression as a positive therapeutic outcome because the intervention aims to reduce 'comorbid' behaviour associated with 'extreme cross-gender' behaviour (Rosenberg, 2002). Thus, even some 'supportive' approaches use pathologising terms like 'severe', 'conditions', 'extreme' and 'comorbidity', similar to earlier clinical models designed to reduce 'atypical' gender behaviour (see also Roen, 2011).…”

Gender experience and satisfaction with gender allocation in adults with diverse intersex conditions (divergences of sex development, DSD)

“…Aron, 1994;Benjamin, 1994;Stoller, 1968;Williams, 2002). The bringing together of different hermeneutic approaches with empirical methods and experiences from research with other sexual minorities (see Mair, 2010;Roen, 2011) could further develop research on identities of people with DSD.…”

Parentalité et jeunes transgenres : un survol des enjeux vécus et des interventions à privilégier pour le développement de pratiques transaffirmatives

“…Une grande partie des études publiées sur le sujet des jeunes trans ciblent la question du développement de l'identité Pollock et Eyre, 2012), souvent à partir d'un point de vue étiolo-gique (Wren, 2002 ;Zucker, 2005 ;Roen, 2011), ou concernent essentiellement le traitement médical et l'intervention psychosociale (Zucker, 2008 ;Zucker, 1995 ;Langer, 2004 ;Roberts et al, 2012 ;Vries et al, 2014 ;Mallon, 2009 ;Grossman et D'Augelli, 2007). Ce que l'on sait de ces études, c'est que le développement de l'identité se produit dans la majorité des cas avant l'âge adulte (Beemyn et Rankin, 2011 ;Olson, Forbes et Belzer, 2011), souvent dès 3 ou 4 ans (Ehrensaft, 2014), et que le sentiment d'incongruence entre l'identité de genre et le sexe assigné émerge vers l'âge de 10,4 ans (intervalle de 6 à 15 ans) (Grossman et Anthony, 2006).…”