Free WebinarGender Dysphoria in Young People: Controversy, Compromise, and Consensus?
Gender Dysphoria in Young People: Controversy, Compromise, and Consensus?
15th November 2021
7.30pm – 9.30pm (AEST)
This webinar will be of major interest to psychiatrists wishing to understand the very different approaches to the treatment of gender dysphoria in young people and whether there is any ‘middle-ground’ in this debate that could lead to a consensus position.
The treatment of gender dysphoria is controversial. On the one hand the ‘affirmation model’ involves transitioning a young person to the appearance of their preferred gender using puberty blockers and cross-sex hormones, while on the other hand the ‘cautious, conventional approach’ offers psychotherapeutic exploration of the causes of the gender identity concerns and avoids hormonal interventions. This webinar highlights the key issues in this clinical discourse. Case examples compliment the presentations.
|7.30 pm - 7.35pm||Introduction of topic and speakers.||Prof Philip Morris (president NAPP)|
|7.35 pm - 8.00pm||Diagnostic issues from a child psychiatrist perspective |
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.
|Dr Cary Breakey (senior child and adolescent psychiatrist)|
|8.00pm - 8.25pm||Psychosocial treatment & social contagion|
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. I will present some case studies that highlight some of these factors and how to work with them therapeutically.
|Prof Dianna Kenny (clinical psychologist)|
|8.25pm - 8.45pm||Puberty blockers - the pros and cons||Prof John Whitehall (paediatrician)|
|8.45pm - 9.10pm||Iatrogenic damage and consent issues|
Iatrogenic risks are real so we should expect to encounter them in gender-related interventions. I will provide a brief checklist and suggestions how such iatrogenic errors may be reduced. My presentation emerges from ‘real-life’ discussions with experts in the field; two directors of gender services; many senior clinicians engaged in treating gender dysphoria/incongruence who wished to remain anonymous fearing for their professional safety; conversations with health professionals in my supervision/teaching/workshops who spoke on the condition of confidentiality; finally, families whose children or grandchildren were suffering with gender-related concerns, some after surgery. I suggest that iatrogenic damage is reduced if clinicians accept the wide gaps in evidence-based knowledge and acknowledge the complexity of childhood psychopathology and pathogenesis as reflected in frequent revisions of practice guidelines RANZCP (2019a, 2019b, 2021), NAPP (2021).
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’.
|Dr George Halasz (child and adolescent psychiatrist and senior lecturer)|
|9.10pm - 9.20pm||Conversion therapy legislation - what are and are not conversion practices for gender dysphoria?|
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.
|Prof Philip Morris|
|9.20pm -9.30pm||Questions and discussion|
In order to keep track of numbers registration are limited to one individual.