Gender Identity Development Research Articles

Coming Out is Part of the Life Cycle: A Qualitative Study using Two-Eyed Seeing to Understand A Two-Spirits Coming Out Process

ABSTRACT In two co-related studies about Two-spirit people in Atlantic Canada, the coming out stories share critical cultural perspectives about gender identity and sexuality from a L'nuwey (Mi'kmaw) perspective. This qualitative research implemented Etuaptmumk or Two-Eyed Seeing, a co-learning methodology using Indigenous and western perspectives for data collection and analysis. The findings surface stories about resiliency among Two-spirit people who face distress and anxiety, with supports mainly coming from family and community. According to their narratives, coming out is part of their cultural awakening process. The paper shares that Two-spirited people come out in intervals or phases, especially trans people. Sexuality and gender identity development are in flux until they reach a balanced and spiritual state. The Two-spirit identity process is non-linear that may evolve in a life cycle. The study captures the ongoing resurgence of regional Indigenous perspectives of gender identity and sexuality. The narratives share the physical, emotional, mental, and spiritual states of Two-spirit people during their coming out process. The stories are a source of hope and empowerment for the Two-spirit community relating to gender and sexuality. This study is the only current community-based evidence about coming out experiences of Two-spirit people in Atlantic Canada.

Shifts in demographics and mental health co-morbidities among gender dysphoric youth referred to a specialist gender dysphoria service.

Past research has identified shifts in the demographics and co-occurring mental health issues of youth referred to certain gender dysphoria services. The present study examined shifts in demographics (age, sex and social transition status), social adversity (bullying experiences and abuse) and psychological functioning (mood, anxiety, suicidality and autism spectrum disorder) at time of referral (of both children and adolescents) to the Gender Identity Development Service, London between the years of 2012 and 2015. Patients were 782 children and adolescents (M = 13.94, SD = 2.94, range 4-17; 63.8% assigned female at birth). Little change in sex ratio or age was observed between these two time points. However, we observed greater rates of depression and anxiety of birth-assigned females (but not birth-assigned males) in the more recent cohort, at the same time that reported social adversity (bullying and abuse) was falling. Also, of interest, the proportion of young people who had partially or fully socially transitioned prior to contact with the service had increased overtime. We discuss potential factors driving these shifts and their implications for supporting recent cohorts of gender diverse young people.

Shapes of gender identity: three stories with impact

The paper describes three stories of children and adolescents with atypical gender identity development followed in psychotherapy. These cases have already been published, but are revisited here to show how these experiences contributed to the creation of the therapeutic intervention model of the Gender Identity Development Service originally established in 1989 at St George’s Hospital, London. The service transferred to the Tavistock Centre in 1996. The first case shows the gradual recognition of dealing with the development of an atypical gender identity rather than a psychiatric condition. Reflection on this case led to the definition of possible therapeutic goals. The second case illustrates the difference between solid and fluid identities, an important distinction in the decision to consider the possibility of physical intervention. The third case shows the network management model and addresses issues concerning autonomy.

Conceptualizing relationships among transgender and gender diverse youth and their caregivers.

Family support and acceptance are protective for transgender and gender diverse (TGD) youths' mental health and identity development. Although some studies have examined the role of supportive family relationships for TGD youth, prior research has not fully explored how TGD youth and their caregivers understand or characterize these relationships within the family system. In this qualitative study, we explored perspectives of TGD youth and their caregivers regarding youth-caregiver and caregiver-caregiver relationships within the family system. We recruited a community-based sample of 20 families (20 TGD youth, ages 7 to 18 years, and 34 caregivers) from 3 U.S. geographic regions. TGD youth represented multiple gender identities; caregivers included mothers (n = 21), fathers (n = 12), and 1 grandmother. Each family member completed an individual semistructured interview that included questions about family relationships. Interviews were transcribed verbatim and transcripts were analyzed using a thematic analysis approach. Analyses revealed complex bidirectional family relationships, highlighting 5 contextual factors influencing these relationships: school, community, workplace, religion, and extended family. TGD youths' identity development was inextricably linked to how caregivers respond to, adjust to, and learn from their children, and how caregivers interact with one another. Findings illustrate how caregiver acceptance and family cohesion may be linked and how youth and caregivers identified shared contextual factors impacting the family system. This research highlights the importance of situating TGD youth and caregivers as equal partners in family level approaches to affirm and support TGD identity development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Disorders of Sex Development.

Disorders of Sex Development.

Puberty blockers in gender dysphoria: an international perspective

Keira Bell, a patient who started to take puberty blockers at the age of 16 years for gender dysphoria (GD), recently won a legal battle against the Tavistock and Portman...

Gendered experiences of providing informal care for older people: a systematic review and thematic synthesis

Background and purposeThe caregiving’s impact on informal carers’ quality of life and gender-based stereotypes make older individuals’ informal care a complex process for which our knowledge is still limited. The purpose of this review is to identify how gender relates to informal carers’ experiences of providing care for people aged 60 years and over with mental and physical health needs by synthesising the available empirical data published between 2000 to 2020.Design and methodsThe systematic method for reviewing and synthesising qualitative data was performed using the PRISMA checklist and ENTREQ statement. The CASP tool was used to examine the quality of the included papers. Thematic synthesis was used as the methodological framework.ResultsThis review produced two analytical themes, the impact of gender on the caregivers’ labour and negotiating gender identity with self, society, and cultural norms. While informal caregivers share motivators, a linkage between traditional gender stereotypes impacts caregiving burden and coping strategies. Informal carers’ experiences entail a constant pursuit of self-agency after acquiring the caregiver role. Cultural values and their intersection with gender appear to influence caregivers’ healthy adjustment into their new caregiving identities. The flexibility to move beyond gender boundaries could mediate caregivers’ negotiations between self and society on developing their new caregiving identity. Providing intensive informal primary care to older people affects both men’s and women’s mental and physical health. Gender ideals of the feminine nurturing role further disadvantage women as they determine the caregiving arrangements, the strategies and resources to sustain the caring burden, and the adaptability to experience their new caregiving role positively. Men appear more flexible to debate their hegemonic masculinity and defend their existence in the caregiving role.Conclusion and implicationsTransgressing gender lines and expanding gender possibilities can ease the caregiving burden and strengthen caregivers coping potentials. Health professionals can empower informal careers to challenge gender binaries and expand gender possibilities by intentionally injecting the language of diversity in caring information and caring processes. The review findings outline a path for research on gender identity development in older people’s care.

Role of minimally invasive surgery (MIS) in different sexual development (DSD)

Differences/disorders of sex development (DSD) are a heterogeneous group of congenital conditions in which the development of chromosomal, gonadal, or anatomical sex is atypical. Patients usually present during the newborn period but occasionally some cases remain unrecognized until later in infancy or even adolescence. Genital appearance, psychosocial support, sociocultural background, gender identity development, and genetic and biochemical analysis in addition to ethical and legal implications need to be considered when deciding on the appropriate treatment strategy. Surgeons are important members of the multidisciplinary expert teams involved in the initial approach and long-term follow-up. Surgical care of DSD patients is one of the main challenges. Recommendations regarding the opportunity and timing of surgical procedures are still under discussion. Surgical procedures are aimed to reduce urologic problems, prevent the risk of gonadal germ-cell cancer, and facilitate sexual function and reproduction.Providing its excellent visualization, access to pelvic structures and less postoperative adhesion MIS has been an important tool in the diagnosis and treatment of DSD. The role of MIS will be summarized in: 1) Gonadal biopsy / gonadectomy 2) Treatment of urogenital sinus/vaginoplasty 3) Vaginal Replacement 4) Resection / treatment of Mullerian structures

Giftedness, Gender Identities, and Self-Acceptance: A Retrospective Study on LGBTQ+ Postsecondary Students

In a recent position statement, the National Association of Gifted Children argued the importance of providing equitable treatment of Lesbian, Gay, Bisexual, Transgender, Queer and other sexual and gender minority individuals (LGBTQ+) gifted youth to help them maximize their potential. However, there are very few empirical studies focusing on the intersection of giftedness and gender identities. Little is known regarding these students’ experience at, and outside of, school. Focusing on the individual process of gender identity development and self-acceptance, we interviewed nine LGBTQ+ postsecondary students in North America (aged between 19 and 29 years) who are graduates of an academically focused high school in Turkey. In particular, we studied their ways of thinking, stress coping strategies, and environmental factors that may have enabled their self-acceptance of LGBTQ+ identities. Findings of the study show that the mental health of LGBTQ+ is a function of individual factors (e.g., coping strategies), structural factors (e.g., a homophobic sociocultural environment), and the context. The findings also indicate the benefits of complexity and reflectiveness in thinking, metacognition and the ability to separate identity labels from identities, enabled by high school peer support, liberal curriculum and classroom discussions, and access to information during adolescence.

A Backwards-step for Gillick: Trans Children's Inability to Consent to Treatment for Gender Dysphoria-Quincy Bell & Mrs A v The Tavistock and Portman NHS Foundation Trust and Ors [2020] EWHC 3274 (Admin).

The case of Quincy Bell & Mrs A v The Tavistock and Portman NHS Foundation Trust and Ors is a judicial review into the treatment practices of the Gender Identity Development Service (GIDS) run by Tavistock and Portman NHS Foundation Trust (Tavistock). The Divisional Court considered whether children and young people with Gender Dysphoria (GD) can ever be Gillick competent to consent to treatment with Puberty Blockers (PBs), and if so whether GIDS provided sufficient information to support an informed consent. This commentary examines the six key areas of the judgment: the nature of GD and its treatment with PBs; the categorisation of PBs as experimental treatment; the high bar set to achieve Gillick competence; the convergence of information provision and competence; the role of parental consent; and finally the protective jurisdiction of the court. The conclusion of the court that transgender children aged under 16 years will find 'enormous difficulties' in reaching the Gillick threshold to be able to consent to PBs, and that even 16- to 17-year olds would benefit from a 'best interests determination' from the court, signals judicial thinking which is markedly protectionist. Considering the broad contemporary stance in healthcare of facilitating competence, valuing patient participation, and respecting rights, I argue that this judgment is out of step. It has implications not only for transgender children, but it may also be a worrying signal of a greater general retreat from Gillick and a corresponding advance in emphasis on judicially determined best interests.

The Violence of Postmodern "Gender Identity" Medicine

The medical “transition” of children with “gender dysphoria” is increasingly normalized in North America, Western Europe, Australia, New Zealand, and the United Kingdom. Although each country has specific national gender identity development services, the rationale for prescribing hormone treatment is broadly similar. A minority rights paradigm underpinned by postmodern theory has gained traction in the past 10 years and has been successful in influencing public policy, the education of pediatricians, endocrinologists, and mental health professionals. In this view, any response other than an affirmation of the child’s claim to be the opposite sex or “born in the wrong body” is understood as a denial of their human rights to have their “outer” body match their authentic “inner” self. The postmodern paradigm has brought about a concomitant shift in the classification of the patient from a child who suffers “gender dysphoria” to a child who is “transgender”. Yet the practice of putting children on a medical pathway brings severe, life-long consequences including bone/skeletal impairment, cardiovascular and surgical complications, reduced sexual functioning, and infertility. Examination of postmodern “transgender” health care reveals it is rarely expert, evidenced-based or objective but on the contrary, is highly politicized and controversial. Although the High Court in the United Kingdom has ruled those children 16 years and under cannot consent to hormone treatment, several lobby groups, as well as the NHS Tavistock and Portman Hospital Trust Gender Identity Development Service (GIDS), have been granted legal permission to challenge the ruling. With the example of the United Kingdom, I demonstrate that if the appeal is successful, children’s rights to protection from bodily and psychological harm will continue to be abused by the postmodern social justice paradigm which, in the very name of upholding children’s rights, violates them.

From a Pictogram to a Symbol: Working with a Transgender Patient in an NHS Gender Clinic Using Piera Aulagnier's Theory of Identity Formation

This article presents clinical work with a transgender patient who was attending a regional NHS gender clinic in England. It aims to link aspects of the patient's identity formation with the theoretical framework offered by the French psychiatrist and psychoanalyst Piera Aulagnier. Emphasizing the complexity of (gender) identity and its process of development, the concept of the ‘birth of the body’ is used to situate the development of gender identity as a process of the creation of an individual narrative, with the experience of embodiment based on unconscious fantasy as specifically troubling for transgender individuals. This struggle may be seen in the clinical material presented. Recommendations are made for working with transgender clients who suffer from a disturbance in creating and navigating relationships. By using the concept of the ‘word‐bearer’, an exploration may be opened up of the unconscious dynamics between the clinic as an object that offers understanding, and the service user who is seeking meaning and a remedy for subjective suffering.

Predictors of eating-related psychopathology in transgender and gender nonbinary individuals

ObjectiveResearch examining the prevalence and severity of eating-related psychopathology in transgender and gender nonbinary individuals is limited. This study examined how identity development and minority stress relate to the presence of disordered eating behaviors and cognitions in transgender and gender nonbinary individuals, and improvement at one-year follow-up. MethodsData come from a multi-site, longitudinal study of transgender and gender nonbinary individuals (n = 287) and includes assessment of transgender congruence, receipt of gender-affirming care, minority stress, and disordered eating symptoms. Hierarchical multivariable logistic regression was used to test for associations between identity development, minority stress, and eating-related psychopathology. ResultsEighty-three participants (28.9%) met criteria for current eating-related psychopathology. Loss of control eating was the most commonly endorsed behavior, followed by laxative, diuretic, or other medication use, and compulsive exercise. Higher transgender congruence was associated with lower odds of disordered eating symptoms (OR = 0.72, 95% CI 0.55–0.94), whereas increased internalized transphobia was associated with greater odds of disordered eating symptoms (OR = 1.41, 95% CI = 1.04–1.91). Participants with eating-related psychopathology had greater odds of having received gender-affirming psychotherapy in the year prior to assessment (OR = 2.33, 95% CI = 1.32–4.14). ConclusionsResults suggest that gender identity development and internalized transphobia are associated with eating-related psychopathology in transgender and gender nonbinary individuals. Mental health providers should consider assessing all transgender and gender nonbinary individuals for eating-related psychopathology and unique risk factors associated with disordered eating, including low transgender congruence and internalized transphobia.

Playing gender(s): the re/construction of a suspect ‘gender identity’ through play

ABSTRACT The present work intends to analyse how pre-school aged children experience the re/construction of a ‘gender identity’ and the processes that create it as an essential, factual, and unchangeable reality – therefore, suspect. Given the growing importance of ‘gender identity development’ in child development literature, as well as the arising voices of ‘gender non-conforming’ childhoods, this theme seems particularly relevant when faced with the limitations imposed by macrosocial discourses of cisheteronormativity. Using grounded theory and ethnography, the re/construction processes were observed in a mixed-age kindergarten classroom in Porto and analysed through the feminist lens of gender performativity. It was possible to observe the following dimensions: clothing and accessories as performative marks of gender; beauty and its role in constructing femininities; play as a regulatory fiction, that is both shaped by and constructs gender differences; gender borders and how they can be reinstated, negotiated or defied.

ОСОБЛИВОСТІ ФОРМУВАННЯ СТАТЕВО-ГЕНДЕРНОЇ ІДЕНТИЧНОСТІ У ДІТЕЙ З ПОРУШЕННЯМИ ПСИХОФІЗИЧНОГО РОЗВИТКУ

The article covers the issues of sexual education for children with mental and physical disabilities, giving particular attention to the key features in gender identity development in children with disabilities. The authors take into consideration the modern model of social and sexual development, which includes sexual identity, sex-role behavior, and sexual orientation. Major milestones in social and sexual development of typically developing children are analysed and compared to those of children with disabilities. Sexual orientation and gender identity are described with regard to four spectrum components: biological sex, gender identity, gender expression and sexual attraction. Development of gender identity is a continues process, which takes understanding of the concept of gender, mastering gender expectations and stereotypes, identification with a parent, learning gender privileges. Children with mental and physical disables face a number of challenges when it comes to their sexual orientation and gender identity development, such as: difficulties in mastering behavioral rules and social expectations; lack of reliable sources of information on gender expression and expectations; lack of information on different types of human relations; high dependence on their caregivers also with regard to the information they obtain; caregivers make presumptions for them being cisgender and heterosexual. When it comes to parents they also experience difficulties dealing with sexual education of their children with disabilities. Conducted research shows that parents of children with disabilities more often use euphemisms, have doubts when and how to talk to their children about physiology of the other sex, how to explain the gender idea, compared to the parents of typically developing children. A closer look is taken at the forms of sexual behavior that cause most parental concerns: masturbation, inappropriate behavior at public places, etc.The authors argue that timely and adequate sexual education for children with disabilities can contribute not only to their quality of personal and social life, but also protect children from possible abuse. Key words: sexual and social development, sexual education, gender identity, sexual orientation, children with special educational needs, disability and sexuality.

A retrospective qualitative analysis of Christianity and its influence on gender identity development among transgender adults who were assigned female at birth

Purpose While many studies have addressed the intersection between sexual orientation and religious/spiritual identity development, few studies have explicitly explored the interaction between transgender and gender diverse (TGGD) identities and religious/spiritual identity development. As such, the role of religion in TGGD identity development is not well understood, particularly as to how experiences in childhood may shape current identities. Materials and methods The authors analyzed a series of semi-structured interviews with seven TGGD individuals. The participants were all assigned female at birth (AFAB) andhad been raised in the Christian faith. Interview questions focused on participants’ experiences with gender and religious identity development during childhood and adolescence. Results Four major themes emerged among participants: invisibility within faith communities, rejection, conflict/ambivalence about gender and religion, and intellectual curiosity (e.g., questioning religious doctrine). Conclusion Implications for identity development, clinical intervention, and faith community outreach are discussed regarding TGGD people who were AFAB.

Gender identity development in children and young people: A systematic review of longitudinal studies

Children are presenting in greater numbers to gender clinics around the world. Prospective longitudinal research is important to better understand outcomes and trajectories for these children. This systematic review aims to identify, describe and critically evaluate longitudinal studies in the field. Five electronic databases were systematically searched from January 2000 to February 2020. Peer-reviewed articles assessing gender identity and psychosocial outcomes for children and young people (<18 years) with gender diverse identification were included. Nine articles from seven longitudinal studies were identified. The majority were assessed as being of moderate quality. Four studies were undertaken in the Netherlands, two in North America and one in the UK. The majority of studies had small samples, with only two studies including more than 100 participants and attrition was moderate to high, due to participants lost to follow-up. Outcomes of interest focused predominantly on gender identity over time and emotional and behavioural functioning. Larger scale and higher quality longitudinal research on gender identity development in children is needed. Some externally funded longitudinal studies are currently in progress internationally. Findings from these studies will enhance understanding of outcomes over time in relation to gender identity development in children and young people.

Moving beyond ‘gender-neutral’: creating gender expansive environments in early childhood education

ABSTRACT In this research, feminist post-structuralism and queer theory were used to examine Australian early childhood educators’ views on children’s gender identity development, and the content on gender in the Australian Government’s Early Years Learning Framework. The methodology and study design were based upon qualitative phenomenological research methods. The participants consisted of 12 early childhood educators who worked in kindergarten and long day care settings. The data was collected through semi-structured focus groups and semi-structured interviews. Feminist post-structuralist discourse analysis was used to identify discourses deployed within participants’ responses in relation to how they may enable or constrain pro-diversity spaces. Implications of this research include the need for further support and guidance for educators through policy, curriculum, resources and teacher education. This research highlighted the need to trouble the notion of ‘gender-neutral’ and the value of fostering gender expansive environments in early childhood education.

Understanding and Managing Gender Identity Variance in Minors: A Qualitative Research on the Parental Role in Italy

Identities that differ from what is expected of each gender challenge the crystallised binary form of social organisation. Furthermore, having a gender-variant child is an experience that confronts parents with something unknown to them that questions most of their assumptions. In the Italian context, there is a lack of awareness about the population of transgender and gender-variant minors, and what their or their families’ needs are. In the present study, we interviewed the parents of gender-variant minors from Italy and asked them to describe the ways they got to know their child’s gender identity and how they managed such a completely new situation. The interviews were transcribed literally and analysed through discourse analysis. We carried out descriptions of how parents configure this topic and the different positionings adopted thorough their experience of understanding and managing gender variance. Overall, we discussed and promoted parent-children interacting modalities aimed at co-constructing and sharing the process of gender identity development, instead of adopting self-referential or ideological positionings. The present article offers a qualitative exploratory study of gender-variant minors and their families in the Italian context. The limitations of the study and suggestions for future research are also presented.

Perceptions of Support Among Transgender and Gender-Expansive Adolescents and Their Parents

PurposeTo capture and compare the perspectives of parents and their transgender and gender expansive (TGE) adolescents during pivotal moments of gender identity development and to report the level of adjustment during these parental experiences. MethodsWe utilized a mixed-methods approach and interviewed 36 parents and 23 TGE adolescents at our Gender Clinic. Parents retrospectively identified “pivotal moments” in their child’s gender identity development and rated their levels of support and adjustment. Adolescents independently rated their parent’s level of support during these moments to allow for comparative analyses. ResultsThe supportive behavior most frequently identified by parents was connecting the adolescent to services, while adolescents considered their parents’ use of the affirmed name or pronouns to be most supportive. We found a positive correlation between the parents’ perceptions of support and those of TGE adolescents during pivotal moments (r = 0.4, p < 0.001). Adolescents rated the degree of parental support to be 3.73 points (95% confidence interval: [2.67,4.8], p < 0.001) higher on a Likert scale than corresponding ratings provided by parents in a generalized estimating equation model. Parents experienced moderate need for adjustment during these moments. ConclusionsProviders may use these findings to guide parents toward gender affirmative behaviors that may protect against negative mental health outcomes.