Adolescent Psychiatry - Volume 12, Issue 3, 2022

Background: There has been a rise in the numbers of adolescents identifying as transgender and seeking medical treatment for gender dysphoria. While gender clinics are developing across the country, not all transgender adolescents have access to these centers. There is, therefore, an increased need for other clinicians to be aware of interventions and guidelines to help transgender youth and their families. Objective: The aim of this article is to provide an overview of current literature and guidelines for treating transgender adolescents with gender dysphoria. Methods: Using keywords “gender”, “gender dysphoria”, “transgender”, “trans*”, “adolescent trans*”, the authors searched PubMed to gather current literature on treating transgender adolescents. Additionally, sources from primary transgender resources online were obtained, including current endocrine and psychological guidelines. Results: This article discusses important gender concepts that are relevant to treating all transgender individuals. It describes models of engagement with transgender adolescents seeking treatment, including assenting and consenting to medical intervention. Finally, we discuss the assessment of transgender adolescents’ needs and present an overview of the various guidelines outlining both non-medical and medical interventions targeted to treat gender dysphoria in this population. Conclusion: Knowledge of treating adolescents with gender dysphoria is imperative as gender dysphoria presents more commonly in practice. Multidisciplinary collaboration is required to provide comprehensive treatment to this population. Guidelines from professional organizations such as the World Professional Association for Transgender Health and the Endocrine Society provide instructions for clinical practice while the evidence base in this field continues to expand.

Background and Aims: The guidelines for transgender care are evolving and incorporate a multidisciplinary team approach. These roadmaps entail an understanding of gender development, mental health, and sociocultural factors in individual and family lives, as well as the specific medical needs in the process of transitioning and ongoing treatment. New research is continuing to update the best evidence-based practice. Multiple professional health organizations have published guidelines. The World Professional Association of Transgender Health has pioneered the Standard of Care, currently version seven. Other leading organizations have their own publications with an emphasis on specific relevant medical needs. In this paper, The World Professional Association of Transgender Health Standard of Care and the recommendation of multiple psychiatric and pediatric organizations are reviewed to provide an overview. Discussion: Most current guidelines have similar recommendations in providing care for transgender individuals. The more recent data has shown the benefits of medical transitioning in youth and updated recommendations in this age group. Healthcare professionals are encouraged to stay up to date with these current guidelines. Further research is recommended.

Background: Adolescents today have unprecedented and uninterrupted access to news and current events through broadcast and social media. Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) adolescents may be especially cognizant of media and public discourse pertaining to law and policy changes affecting the legal rights of their communities. The minority stress framework explains how sociopolitical discourse impacts mental health among sexual and gender minority youths. Objectives: This paper identifies and describes contemporary sociopolitical and legal issues that may impact LGBTQ adolescents’ mental health. Methods: Authors describe the minority stress framework as applied to gender and sexual identity and explore key sociopolitical and legal topics relevant to LGBTQ adolescents, including employment; medical care bans; health insurance coverage; conversion therapy; religious exemptions in health care; housing rights; and rights in schools and school districts, including participation in sports. Results: LGBTQ youth experience rejection, prejudice, and discrimination directly through adverse legislative or administrative action and more pervasively through the dominant cultural beliefs and sociopolitical messaging that such developments manifest. Conclusion: Mental health clinicians who are aware of legal issues and sociopolitical debate pertinent to LGBTQ rights are better prepared to address their significant impact on LGBTQ adolescents’ mental health.

Background: The treatment of transgender youth with an eating disorder presents particular considerations due to the unique combination of body dissatisfaction, drive for thinness, malnutrition coupled with the evolving gender identity in the midst of biological and physical changes. At this time, public awareness, societal acknowledgment and legislative initiatives have led to wider acceptance of Lesbian, Gay, Bi-sexual and Transgender rights. However, at the same time, transgender youth are at increased risk for mental health problems, including eating disorders. Objective: To describe two cases of trans adolescents with anorexia nervosa treated in a day treatment program. Methods: This paper will discuss the two clinical vignettes of the transgender adolescent with anorexia nervosa. The focused care included specific attention to the initial disclosure of gender identity in a safe space, name and pronoun preferences, and wardrobe and hairstyle changes. In addition, treatment focused on the reduction of social anxiety around meal consumption, with special attention given to the impact of weight on the development of secondary sex characteristics. Themes of identity, rejection and secrecy were explored. Conclusion: In summary, treating transgender youth with anorexia nervosa requires additional considerations is more complex than treating cis gender youth. Additional issues, such as hormonal treatments, the development of secondary sexual characteristics, and social and cultural factors, can exacerbate eating disorder symptoms. Treatment should focus on understanding the disorder's etiology and trajectory within this lens.

Background: At a time when suicides are increasing throughout the United States, lesbian, gay, bisexual, transgender, and two-spirit (LGBTQ2S) adolescents are at especially high risk for suicidal ideation, attempts, and completed suicide. Objectives: This study aimed to 1) provide an overview and clinical perspective on LGBTQ2S suicidal ideation, attempts, and completed suicide, 2) discuss how the literature maps on to theories of suicide and also point the way to clinical recommendations, and 3) give recommendations for clinical care based on this evidence. Methods: This article uses a narrative review style to discuss the current concerns regarding LGBTQ2S adolescent suicide. The Social Ecological Model, the Interpersonal Psychological Theory of Suicide, and Minority Stress Theory are used to describe the manner in which risks are acquired. Results: Emerging research demonstrates risks and protective factors in the lives of LGBTQ2S adolescents. The social context of LGBTQ2S adolescents puts them at risk for internalizing the experiences of discrimination evident in our society. In addition, there are other risk factors frequently associated with their LGBTQ2S status, such as substance misuse, homelessness, and lack of social support. Adolescents of color are especially vulnerable as they experience multiple marginalizations, often living in under-resourced communities with poor access to health care. Support to families can be provided in the form of psychoeducation based on research findings. Social support is crucial and can be effectively provided in schools. Access to mental health care needs to be increased, and barriers must be reduced. Conclusion: There is a need for more research, especially prospective study designs and research that centers on adolescents of color and homeless adolescents. While there may be barriers to addressing the current rate of suicidality in this population, clinicians who work with adolescents can use a range of therapies to support their LGBTQ2S adolescent patients and their families, decreasing the risk of suicidality.

Background: As one of the primary places of socialization for a young person, school is a critical part of any transgender student’s life. Mental health providers can play a fundamental role supporting these vulnerable young people as they navigate the hallways and classrooms of their schools. Objective: This article provides mental health personnel with information and resources for supporting transgender youth in the school setting. Methods: Some general principles for working effectively with educational institutions serving transgender youth are provided. In addition, three critical tools are introduced for maximizing conditions for a successful experience at school for these students. Results: Educational institutions have adopted a range of specific structures found effective in anticipating and managing various issues a transgender child may encounter at school. These include structured approaches for initial discussions with school officials about a child’s gender, and Gender Support Plans and Gender Communication Plans designed to codify ways a school will support a student around their emerging gender status. Awareness of these resources will help mental health providers effectively partner with patients and their families as they navigate educational institutions. Conclusion: For many transgender and other gender diverse students, the day-today tumult of school can be a source of great anxiety and concerns that they have no control over their circumstances. Using gender support and gender communication plans can diminish these feelings. Mental health providers must have a firm understanding of these plans and their implementation to provide the necessary support for gender diverse students.