Gender Dysphoria in Young People: Controversy, Compromise, and Consensus?

15th November 2021

Introduction

Prof Philip Morris AM

Psychosocial treatment & social contagion

Prof Dianna Kenny

Rapid onset gender dysphoria (ROGD) is a relatively new clinical presentation amongst primarily adolescent females. Working with transgender-declaring young people therefore presents many challenges, including the fact that clinicians must develop and trial therapeutic approaches “on the go” in the consulting room. In my work with this group of young patients, I have learnt that each case presents a unique challenge with respect to their developmental status, cognitive capacity, psychological insight, attachment experiences and interpersonal relationships, and the role of family members, peer groups, and the school environment in motivating and maintaining their transgender identity.

Diagnostic issues from a child psychiatrist perspective

Dr Cary Breakey

Cary will discuss the characteristics of Gender Disorders and Gender Dysphoria that have made diagnosis somewhat different from our usual clinical approaches, and the implications of this for treatment pathways.

Evaluating patients must include the normal processes of considering differential diagnoses, and critically the existence of co-morbidities which may be having impacts on the patient’s presentation. These will be discussed in the context of examples from clinical experience.

Puberty blockers – the pros and cons

Prof John Whitehall

Iatrogenic damage and consent issues

Dr George Halasz

Iatrogenic risks are real so we should expect to encounter them in gender-related interventions.

Iatrogenic risks arise from uninformed consent at critical points: social transition, advanced hormone and/or surgical intervention which cannot take-for-granted, nor assume that the delicate interaction between patient and psychiatrist is motivated by the patient’s wish to understand themselves and/or their symptoms more deeply and wish to engage in ‘exploration’. Many young people prefer ‘affirmation’ of their self-labelling regardless of co-morbid conditions. Emerging medico-legal concerns with ‘conversion practice legislation’ add further complex layers of ‘iatrogenic comorbidity’ and ‘cascade iatrogenesis’.

Conversion therapy legislation – what are and are not conversion practices for gender dysphoria?

Prof Philip Morris AM

Prof Morris’ presentation will cover the rise of legislation outlawing ‘conversion therapies’ and how these laws capture cautious, conventional, caring and exploratory psychotherapy for young persons experiencing gender dysphoria.

Question and Answer

The Panel