By Lisa Esposito
MONDAY, Feb. 20 (HealthDay News) -- New studies show that children struggling with their gender identity also face higher risks for abuse and mental health problems, including post-traumatic stress disorder.
Children with gender identity disorder show a strong, persistent discomfort with their biological sex. They identify with and display behaviors usually seen in the opposite sex.
One study, from Children's Hospital Boston, looked at the emotional and behavioral problems of children and teens referred to its specialty clinic for evaluation and possible medical treatment.
"The study only focuses on kids who experience profound distress or [sadness] with their changing bodies, so the psychiatric manifestations of that distress include much higher risks for self-injurious behavior, depression, suicide attempts and anxiety," said Dr. Scott Leibowitz, a pediatric psychiatrist affiliated with the hospital's Gender Management Service.
Ninety-seven patients younger than 21 were included, 43 born as males and 54 as females. Forty-three patients already had psychiatric symptoms, 20 reported self-mutilation and nine had attempted suicide.
The studies appear online and in the March issue of the journal Pediatrics.
Dr. Walter Meyer III, author of an accompanying journal editorial, said many problems arise from the reactions these children face at home and in school.
"These kids are really normal -- they just want to be the other gender," said Meyer, a psychiatrist who works with transgender patients at the University of Texas Medical Branch, in Galveston. "The ones who are well-adjusted and well-accepted by their families and at school don't have the psychiatric issues."
The other study, from the Harvard School of Public Health, looked at long-term data on nearly 10,000 young adults, average age 23. Those who rated high for childhood gender nonconformity were more likely to report physical, psychological and sexual abuse as children. They were almost twice as likely to have post-traumatic stress disorder as young adults.
"Gender conformity" relates to how children express themselves -- through their clothes, their interests, their mannerisms -- and how these behaviors mesh with what's typical for their biological sex.
One expert said the study is "important," and that it helps tease out why these kids have trouble coping.
It "tests one of the key proposed factors -- childhood abuse," said Stephen Russell, a professor of family studies at the University of Arizona. "There has been concern that parents may react to gender nonconformity in harsh ways. This is perhaps the first study to show evidence of that and of the lasting implications for health."
Fear of the unknown is part of the problem.
"We've seen in studies of gender nonconforming LGBT [lesbian, gay, bisexual, transgender] youth that what most people think of as abuse comes from a place of concern and fear on the part of parents -- that is, they think they can help their kid by 'toughening them up' or teaching them to 'fit in,' " Russell said. "Many parents literally have no framework for understanding gender nonconformity in children."
Meyer, meanwhile, said he sees signs of growing awareness and acceptance, spurred by the media. Once parents are onboard, treatment can begin, sometimes quite early, he said.
"At age 5 or 6, treatment is mainly psychotherapy and working with family to help them [kids] adjust," Meyer said. "Sometimes that means reassuring them and letting them dress up at home. Some might start school taking on a new gender."
Pent-up need for treatment appears to exist.
Since Children's Hospital Boston established a Gender Management Service in 2007, the population of gender nonconformists seeking treatment quadrupled.
"By having clinical services that are specialized and interdisciplinary, you're providing an avenue for parents to come and present for treatment," Leibowitz said. "That brings a lot of people out of their closets, so to speak, and shows this is a less stigmatized issue, so that people can get the appropriate assessments and treatments that they deserve."
Some children receive treatment to delay puberty and buy them time while deciding whether to proceed with a gender change.
Puberty blockers, which are not covered by insurance, are expensive. "Injections can cost upwards of $1,000 a month." Leibowitz said. Newer implants cost about $3,400 for two years.
Blocking irreversible changes of puberty has advantages for those who eventually opt for full gender transition, through cross-sex hormones or sexual reassignment surgery, Leibowitz said. "In their bodies and appearance, they will be perceived by society as the gender they affirm and thus have healthier outcomes," he explained.
"We as individuals who do not experience an incongruence between our minds and bodies take for granted how easy life is," Leibowitz added. "You just need to meet one child and one family to see how this impacts their lives."
Visit the TransActive website for a list of resources for transgender youth.
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