Understanding Gender Variance in Children and Adolescents

Abstract

Gender variance is an umbrella term used to describe gender identity, expression, or behavior that falls outside of culturally defined norms associated with a specific gender. In recent years, growing media coverage has heightened public awareness about gender variance in childhood and adolescence, and an increasing number of referrals to clinics specializing in care for gender-variant youth have been reported in the United States. Gender-variant expression, behavior, and identity may present in childhood and adolescence in a number of ways, and youth with gender variance have unique health needs. For those experiencing gender dysphoria, or distress encountered by the discordance between biological sex and gender identity, puberty is often an exceptionally challenging time. Pediatric primary care providers may be families' first resource for education and support, and they play a critical role in supporting the health of youth with gender variance by screening for psychosocial problems and health risks, referring for gender-specific mental health and medical care, and providing ongoing advocacy and support.

Psychiatric Diagnoses and Comorbidities in a Diverse, Multicity Cohort of Young Transgender Women

“…43 The majority (72%) of our sample reported cross-sex hormones; however, a high prevalence of psychiatric diagnoses and comorbidities was still observed. Clinicians should familiarize themselves with current international guidelines for the provision of clinical care to transgender young people 37,44,45 to best meet both medical and mental health needs of this at-risk population.…”

Multidisciplinary Care for Gender-Diverse Youth: A Narrative Review and Unique Model of Gender-Affirming Care

“…For youth with gender-related body dissatisfaction, medical interventions may be considered once pubertal development has started, with distinct recommendations for early (Tanner stages 2–3) and late (Tanner stages 4–5) pubertal youth. 6 , 8 , 12 Gonadotropin-releasing hormone analogues (GnRHa) represent a reversible intervention that suppresses sex hormone production (i.e., puberty “pausers” or “blockers”), thereby preventing progression of pubertal changes. 6 , 13 If used early, GnRHa can alleviate distress related to impending pubertal changes (some of which are irreversible) and, for those who subsequently proceed with gender-affirming hormones, reduce the need for invasive procedures to achieve a desired phenotype.…”

“…For late pubertal adolescents, gender-affirming hormones may be administered to facilitate development of secondary sex characteristics that are congruent with gender identity. 12 , 13 Estrogen, sometimes in conjunction with an androgen-receptor blocker, is used for feminization, and testosterone is used for masculinization. Before initiating these interventions, an evaluation by a licensed mental health provider documenting readiness for treatment is recommended.…”

Experiences of Gender Minority Stress in Cisgender Parents of Transgender/Gender-Expansive Prepubertal Children: A Qualitative Study

“…These stressors resemble minority stress and may take a toll on the health of parents and, in turn, families. Parenthetically, it should be noted that the published literature has focused on parents who are cisgender (i.e., individuals whose affirmed gender corresponds with their sex assigned at birth; Simons, Leibowitz, & Hidalgo, 2014).…”