Current Problems in Pediatric and Adolescent Health Care
Volume 39, Issue 5 , Pages 115-116, May 2009

Foreword

Article Outline

 

Pediatric providers are the consultants of choice for parents and colleagues about questions related to sexuality in younger children. One of the most puzzling consults is the request for advice about young boys who only want to wear dresses, young girls who refuse to put one on, and children as young as preschool age who insist on being treated as members of the opposite gender. These concerns have left many of us scratching our heads.

In this issue we are honored to have an extensive review by Drs. Möller, Schreier, Li and Romer about just such children and youth, whose discomfort with their own gender may be fleeting or may indicate sexual orientation issues or whose insistence that they are inhabiting the wrong body is extensive and enduring. While there are other recent publications addressing medical, psychosocial and ethical issues in the treatment of youth with gender discomfort and gender identity disorder (GID),1, 2, 3 the space and flexibility of Current Problems in Pediatric and Adolescent Health allow for a thorough exploration of this issue accessible to a broad spectrum of pediatric clinicians. The collaboration of authors from Germany and the United States gives us a window into the extensive research and clinical experience in Europe as well as North America about the diagnosis and care of youths with GID, including persistently transgender youths.

Möller and colleagues have systematically laid out the possible genetic, biological, psychosocial and cultural factors that may influence a child's discomfort with his or her gender. They have reviewed a variety of psychotherapeutic options that have been studied, ranging from behavioral techniques influencing gender expression to supporting the child's own exploration of gender identification. Armed with this information, the pediatric clinician can now advise parents on the range of possible outcomes, encourage individual, group or family therapy if needed, and help parents support their child's ability to socialize safely with both boys and girls.

Some of the most fascinating research and emerging clinical practice discussed in this review are the studies in Europe that have involved placing early adolescents on puberty-blocking hormones, to prevent the development, in a persistently transgender child, of unwanted secondary sexual characteristics, followed by cross-gender hormone treatment. The initiation of semi-permanent cross-gender treatment of a minor raises ethical issues, and yet the positive outcomes reported in this review and elsewhere raise additional questions about the ethics of not treating transgender adolescents until adulthood.4 While Möller and colleagues focus on diagnosis and psychiatric support, there are links available for protocols about the medical management of transgender adolescents.

North American psychiatry began to look at transsexualism in adults and gender identity issues in children in the 1960s,5 at the same time that the Second Wave of feminism called into question assumptions about and even definitions of sex, gender, gender roles and sexuality.6, 7 While these issues may seem far from daily pediatric clinical practice, their reverberations have changed forever the landscape in which we practice medicine, nursing, psychiatry and related disciplines and have affected, to greater or lesser degree, the way children are being raised. Only a minority of children express extreme discomfort with their gender, and yet their struggles and the advice we give to them and their parents can lead us to reflect on how we discuss gender issues for all children and improve our practice overall.

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References 

  1. Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ. The treatment of adolescent transsexuals: changing insights. J Sex Med. 2008;5:1892–1897
  2. Houk CP, Lee PA. The diagnosis and care of transsexual children and adolescents: a pediatric endocrinologists' perspective. J Pediatr Endocrinol Metab. 2006;19:103–109
  3. Zucker KJ. Gender identity disorder in children and Adolescents. Annu Rev Clin Psychol. 2005;1:467–492
  4. Giordano S. Lives in a chiaroscuro (Should we suspend the puberty of children with gender identity disorder?). J Med Ethics. 2008;34:580–584
  5. Zucker KJ, Spitzer RL. Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? (A historical note). J Sex Marital Ther. 2005;31:31–42
  6. Rosen R. The world split open: How the modern women's movement changed America. New York: Viking; 2000;
  7. Haraway DJ. Simians, cyborgs, and women: The reinvention of nature. New York: Routledge; 1991;

PII: S1538-5442(09)00024-8

doi:10.1016/j.cppeds.2009.02.002

Current Problems in Pediatric and Adolescent Health Care
Volume 39, Issue 5 , Pages 115-116, May 2009

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