Gender Dysphoria Clinical Trial
Official title:
Gender Dysphoria Among Adolescents
The aim of this study is to explore how gender dysphoria is experienced among adolescents aged 13 - 18 from a clinical population. The method is qualitative, with a phenomenological approach. Qualitative in-depth data on how gender dysphoria is experienced by the adolescents themselves is lacking in the research literature. As a consequence the within perspective from the clients is lacking. In addition, one aim is to help develop further hypothesis and clinical theory and rationale.
For some children and adolescents their ascribed gender at birth do not match with their
gender expression or how they identify later in life. If the mismatch between ascribed gender
at birth and gender identity and expression and how the body looks like is associated With
distress or discomfort of any kind, this is referred to as gender dysphoria in the Research
literature and DSM-V (DSM-V, 2014; Kreukels et al., 2012; Wren, 2014). After initial attempts
with so called reparative therapy at changing clients' gender identity in accordance with
their ascribed gender at birth, sex reassignment became the treatment of choice to gender
dysphoria (Wierckx et al., 2014; Wren, 2014). Since the advent of sophisticated physical
treatment like hormonal therapy and surgical techniques, capable of removing certain
characteristics of the sexual body, an increasing number of clinics globally have started to
offer puberty suppression to pubertal adolescents with gender dysphoria, in order to allow
more time before making decisions regarding gender identity. This is referred to as the Dutch
model, and the clinical aim is to reduce the pressure the youth are experiencing when the
body is developing in a way that creates a lot of distress. Many countries have established
special clinics, which focus on development of treatment programs, and there has been a steep
increase in number of referrals the last years (Kaltiala-Heino, Sumia, Työläjärvi, &
Lindberg, 2015). In Norway, 450 clients were referred to the Norwegian National Unit for
Gender Dysphoria and Transsexualism (Nasjonal behandlingstjeneste for transseksualisme, NBTS)
in 2016. Half of them were under 18, and the number has been multiplied the last years
(Nasjonal behandlingstjeneste for transseksualisme, årsrapport 2016). However, clinical
treatment has been initiated without clarifying what gender dysphoria is, how it is
experienced by those suffering from it and how it should be understood theoretically. A
common concern in the research literature and among clinicians has been that important
medical interventions have been utilized while the understanding of gender dysphoria among
adolescents and Young adults and its psychological implications could be better understood
(Kaltiala-Heino et al., 2015; Wren, 2014). In addition, activists and clients have claimed
that their perspectives have been overseen by researchers and clinicians (Wren, 2014).
Furthermore, there has been increased attention toward gender dysphoria both nationally and
internationally. The aim of this project is to do an interview study in collaboration with
chief physician at the NBTS, Ira Haraldsen and a reference group with former clients, in
order to produce knowledge on how clients between the ages of 13 and 18 years that are being
treated at the NBTS experience the gender dysphoria, how they understand the condition and
make sense of their experiences and how it affects their lives. Much of the research on
gender dysphoria has been quantitative, based on self report from the clients themselves or
reports from health professionals (Drescher & Byne, 2012). This means that the research has
focused on predictors of good outcome, and delivered important knowledge on the treatment of
gender dysphoria. However, there has not been done much research on the psychological nature
of gender dysphoria, what psychosocial consequences this has for the development of gender
identity and identity in general and how this is experienced by the young people themselves.
There is also a lack of theoretical incorporation of gender dysphoria within the clinical and
developmental psychological literature, and a psychological approach to it. Furthermore,
studies on the outcome of puberty suppression and sex reassignment have demonstrated that
although many adolescents improve mentally after transitioning into an other gender and
gender dysphoria ameliorate, many are still suffering from severe psychiatric conditions and
psychosocial adjustment (Kaltiala-Heinoet al., 2015). Studies have also demonstrated that
adolescents undergoing this treatment is in need of psychological monitoring, but the
research on how this should be implemented is lacking (de Vries et al., 2014).
NBTS has been at the forefront internationally implementing the Dutch model. The plan is to
interview participants that have been referred to NBTS, consisting of clients that are in
different phases of the treatment. The methodological approach will be qualitative and
phenomenological, aiming to shed light on how gender dysphoria is experienced subjectively,
and focusing on the diversity of presentations rather than searching for general principles.
An other important aim is to contribute to theory development, drawing on clinical
psychological theories as well as biological and medical knowledge and concepts from gender
studies. In relation to this, an aim is to generate hypothesis and stimulate further studies.
The collaboration between NBTS and the reference group is an opportunity to fill a gap in the
international research between clients and activists one the one hand and researchers and
clinicians on the other, and contribute to improved understanding of adolescents suffering
from gender dysphoria and how clinicians can help them. This is in line with Standards of
Care, the recommendations for treatment of gender dysphoria published by the World
Professional Association for Transgender Health. According to this report, the perspectives
of people having gender dysphoria are essential to ensure good health care, given the
discrimination many are experiencing. Besides, in 2015, the Norwegian Directorate of Health
published a report on the health services offered to people with gender dysphoria, named Rett
til rett kjønn - helse til alle kjønn, based on the work of an expert group consisting of
clinicians, activist and clients. The report concludes that there is a need to do more
Research on how gender dysphoria is experienced and what consequences it has for young People
living with it. Furthermore, the expert group concludes that there is a need for increased
knowledge and awareness of gender dysphoria and how young people living with it should be
helped among health professionals working in both specialist and primary health care.
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