Gender Dysphoria 

Treatments

A Parent-and Peer- Based Treatment Protocol & Counseling  

Treatment Summary: This treatment approach uses looks at the psychosocial factors and mechanisms that contribute to GID. The focus in counseling is how parents and same-gender peers interact with a child or adolescent wit GID. The parents are the only ones that attend treatment sessions with their child. Counseling is for both individual and family, to help with any depression or anxiety they may be experiencing as a result of GID and can help in the improvement of the individual’s self-esteem and help them learn to function with their biological gender and helping the child interact with their parents and peers. Early diagnosis and treatment can prevent the negative outcomes that are associated with Gender Identity Disorder. In most cases of children with GID it ahs been shown to have faded at puberty. 

• Reference: Heino, F.L, (2002). Gender Identity Disorder in Young Boys: A Parent and Peer- Based Treatment Protocol. Journal of Clinical Child Psychology and Psychiatry, vol.7 (3),360-376. 

• Submitter: Marisa Ybarra 

Gender Role Conflict Theory 

Treatment Summary: The Gender Role Conflict theory provides the framework for clients that are struggling with their identity and in the transgender process. In the first stage, awareness, the counselor will explore the client’s history and current distress to determine if he meets the criteria for Gender Identity Disorder. The second stage, seeking information, involves the client addressing the negativity they may experience from family, friends and society while living without shame and denial. The third stage, exploration, involves the client becoming more comfortable with being transgender and the impact it has on their lives. The exploration stage has three sub categories; identity, incorporation and transitional options. The fourth stage, disclosure, is where the client will inform people in their lives of their transgender identity. The final stage, integration, has two stages, acceptance and post transitional resolution. Acceptance is where the client will embrace their biological self and their new identity. Post transitional resolution occurs at the termination of therapy. 

• Reference: Wester, S.R., McDonough, T.A., White, M., Vogel, D.L., & Taylor, L. (2010). Using gender role conflict theory in counseling male-to-female transgender individuals. Journal of Counseling and Development, 88. Retrieved from http://search.proquest.com/docview/219050752?accountid=7078 

• Submitter: Liesa Pavoggi 

Parent- and Peer-Based Treatment In Young Boys 

Treatment Summary: (Note: It is important to read the relevant research before attempting to treat a child with GID. This particular study views the disorder as something that needs to be fixed or “problem behavior”. While some children may need gendered role models other children believe themselves to be the opposite sex. To view these children’s identity as a problem will only cause the suppression of their “real” selves, which may manifest as an issue in later life.) This treatment is based on Attachment Theory. It is specifically designed to treat 4-6 year-old boys. Therapy consists of a minimum of five sessions. The parents will participate in the first two sessions without the child and a third wrap-up session, and the child will participate in two sessions. When the nuclear family is intact, both parents are required to meet with the therapist during the parent-only sessions. The parent’s are asked to have the child undergo a physical examination and should ask for a “form covering potential physical symptoms of somatic intersexuality and of precocious (pubertal development)”. Before the first session, an assessment is made by having each parent complete individual questionnaires that focus on the gender-specific issues and symptoms of psychopathology. The questionnaires are then compared to ensure agreement between the perspectives of each parent. Any disparity between the parents would need to be discussed, since this would affect the child’s treatment. The first session (parent only) begins with ascertaining the reason for the parents’ visit, discusses the cross-gender behavior, investigates the onset and development of the behavior, and views family or individual photos to demonstrate the clinical-development history. At this session, the parents are assigned homework. They must maintain a “structured diary” for at least two weeks. In this diary they are to discuss occurrences of cross-gender behavior and “other problem behavior”. During the second session, the parents and therapist review the diary. The therapist then begins a detailed semi-structured interview and a family history. Child’s First Session(3rd Session) Next the child evaluation begins. The evaluation usually consists of two sessions and involves structured and unstructured activities. The evaluation begins as soon as the parents leave; the therapist notes any issues involving separation from the parents. In the corner of the therapist office is a “toy” corner. In this corner there is a variety of both male and female specific toys. The child is asked to Draw-a-Person test that is GID specific. Next, a break is given to the child; during this break the child is told he can play in the toy corner. The therapist pretends to do paperwork while observing the child at play. After the break the child is given the Gender-Role Assessment Schedule�Child (GRAS-C). The child is then given LEGOs and told to build whatever he would like. Depending on the comfort level of the child, the therapist may then give the child the Gender Identity Interview. Child’s Second Session (4th Session) In the second session with the child, the toys in the toy corner are replaced with gender specific clothing (male-mask, cape, sword; female- high heels, boa, hats) intended for role-playing. The therapist will complete any remaining sections of the GRAS-C. While completing the GRAS-C, he is given the opportunity to play dress-up, table activities, LEGOs, or 

• Reference: Meyer-Bahlburg, H. F. L., (2002). Gender identity disorder in young boys: A parent- and peer-based treatment protocol. Clinical Child Psychology and Psychiatry, 7(3), 360-376. doi: 10.1177/1359104502007003005 

• Submitter: Sandra Frey 

Pro -Pubertal Delay 

Treatment Summary: Gender identity disorder is a complicated disorder and involves long term therapy. For those before the age of 16, administering Gonadotropin-releasing hormone (GnRH), will block/delay normal puberty development. GnRH delays the development of hormones of the biological sex. This hormonal delay gives the individual, their parents, and their doctors time to investigate the patient’s identity and options of sex reassignment (SR). While the individual is on treatment, it is reported that alienation, suicide, and depression decrease. 

• Reference: Cohen-Kettenis, P., Delemarre-van de Waal, H., & Gooren, L. (2008). The Treatment of Adolescent Transsexuals: Changing Insights. Journal of Sexual Medicine, 5(8), 1892-1897. doi: 10-1111/j.1743-6109.2008870.x. 

• Submitter: Cheryl L. Caldwell 

Cognitive Behavioral Treatment 

Treatment Summary: Puberty Blocking Hormonal Therapy. A course of hormone-blocker drugs given to an adolescent over several months or years that prevent the development of secondary sex characteristics. This is usually assigned through a clinical test battery to see if the patient is recommended for cross-sex hormonal therapy and later sexual reassignment surgery. In most cases there is no regret with the choice and a significant elimination of the gender dysphoria. 

• Reference: Zucker, K. J., Bradley, S. J., Owen-Anderson, A., Singh, D., Blanchard, R., & Bain, J. (2011). Puberty-Blocking Hormonal Therapy for Adolescents with Gender Identity Disorder: A Descriptive Clinical Study. Journal of Gay & Lesbian Mental Health, 15(1), 58. Retrieved from EBSCOhost. 

• Submitter: Shanna Schopmeyer 

Genital Sex-Reassignment Surgery 

Summary of Treatment: The World Professional Association for Transgender Health (WPATH) has set standards of care (SOC) that states a professional consensus when dealing with psychiatric, psychological, medical, and surgical management of Gender Identity Disorder (GID). If a patient and mental health professional agree that Genital Sex-Reassignment Surgery is the best treatment for GID, then phases of the surgery begin. Male to Female transsexual patients receive breast implants as well as genital surgery to ultimately remove the penis and create a vagina. Female to Male transsexual patients can begin with hormonal treatment to lower the voice and begin to grow body hair. A series of complicated surgeries that are still being explored include the creation of a penis using tissue from other parts of the body. 

• Reference: Sohn, M., Hartmut, A.G., & Bosinski, MD. (2007). Gender Identity Disorders: Diagnostic and Surgical Aspects. Journal of Sexual Medicine, 4: 1193-1208. 

• Submitted by: Christina Herrera 

Bolstering Self-Esteem as Intervention Technique in the Management of Symptoms of Gender Identity Disorder among Adolescents 

Treatment Summary: In this study, researchers screened eighty middle school students using a “Gender Identity Disorder Symptom Scales (GIDSS)” from two schools. The adolescents were divided into two groups. Those with high symptoms were the experimental group, and low scores represent the control group. Permissions for students to take part in the study was obtained from school principles. Treatment consisted of an 8-week program, which began with a pre-test management. The treatment consisted of one hour weekly sessions. The first was to lay foundation of trust and expectations. Second meeting included discussion of the nature and concept of gender identity development. Third session discussion of identification of symptoms of gender identity disorders. Fourth course involved changing self-esteem. Fifth session more discussion about using self-esteem to becoming more comfortable with themselves. Sixth session involved teaching participants how to strengthen their self-esteem. Seventh session focused on the reality and consequences of having gender identity disorder. The eighth and final involved a recap of previous sessions. Post-test was given to both the experimental and control group. The control was not provided treatment. The experimental showed a decrease in symptoms as a result of the introduction to goal setting skills, decision making; problem-solving, self-satisfaction and improvement of self-esteem. (Busari, 2013) 

• Reference: Busari, A. O. (2013). Bolstering Self-Esteem as Intervention Technique in the Management of Symptoms of Gender Identity Disorder among Adolescents. Gender & Behavior, 11(2), 5535-5545. 

• Submitter: Jeannette Vick 

Gender-Affirming Hormone Therapy 

Summary of Treatment: Gender-affirming hormone therapy (GAHT) is an option that transgender and gender-diverse clients may seek to achieve changes consistent with their gender identity.  When administered under medical supervision, GAHT in adults is considered safe. However, some long-term risks have been identified. Careful monitoring and screenings are required to reduce the number of adverse effects. The administration of GAHT differs and depends on the developmental age of the client at the onset of therapy, and it also depends on the treatment goal of the client. GAHT is not recommended for youth who have not reached the early stages of puberty. GAHT for clients desiring feminine embodiment consists of estrogen and androgen-lowering medication to develop feminine physical characteristics. Clients who have masculine goals are administered testosterone to develop masculine physical characteristics. Hormone levels are monitored to maintain a level of concentration to support good bone health and not supraphysiologic (Coleman et al., 2022). 

• Reference: Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., & Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8 (vol 23, pg S1, 2022). International Journal of Transgender Health, 23, S259–S261. https://doi.org/10.1080/26895269.2022.2125695  

• Submitted by: Laura House 

Interpersonal Psychotherapy (IPT) 

Summary of Treatment: Treatment using interpersonal psychotherapy (IPT) for patients with gender dysphoria will help individuals manage gender-related stress, rather than altering their gender identity. The therapist’s objective is to establish a strong therapeutic relationship with the client in order to provide a safe space for self-disclosure. The goal is to improve mental stability to improve quality of life and self-fulfillment. The therapist works with the patient to identify and modify maladaptive communication patterns and connect with preexisting and new support systems. Alleviating emotional challenges associated with gender dysphoria through interpersonal and social strategies are the main focus for patient care. 

• Reference: Barbisan, G. K., Moura, D. H., Lobato, M. I. R., & Da Rocha, N. S. (2020). Interpersonal psychotherapy for gender dysphoria in a transgender woman. Archives of Sexual Behavior, 49, 787-791. 

• Submitted by: Amina Williams