An 11-year-old birth-sex male presents to primary care. The child has been identifying as female for 5 years and his parents are asking about how to delay secondary sexual characteristic changes associated with puberty.
What gender-affirming therapy can be offered to a preadolescent identifying as transfemale?
When is the ideal time to start gender-affirming therapy for a preadolescent patient?
The only gender-affirming therapy offered to a pre-adolescent who identifies as trans-female is mental health support and counseling. Mental health professionals have an important role to play in transgender and gender-nonconforming children. Even before the children have disclosed their authentic gender identity that may differ significantly from the assigned sex during birth, such children will experience symptoms of anxiety, depression, behavioral problems, social isolation, suicidal ideation, and school struggles (Rafferty, 2018). Therefore, the appropriate counseling and mental health support can play a significant role in ensuring that pre-adolescent individuals who identify as transgender receive the necessary support before reaching the legal age to go through gender-affirming therapy (Rafferty, 2018).
Through counseling and mental health support, pre-adolescents can learn how to effectively articulate their gender experience and effectively identify various needs related to their gender that might not be related to their sex during birth (Jackson & Crall, 2016). Therapists can therefore play a significant role in spending time with pre-adolescents who identify as transgender to gather historical information related to their childhood experiences of gender and how the children’s support system has accommodated it. Through therapy, mental health practitioners can therefore help pre-adolescents identify as transgender to develop strategies for self-acceptance, disclose their gender to others, strategies for intimate partnerships, integrate the transgender identity, and social transition that is desirable (Jackson & Crall, 2016).
The ideal time to start gender-affirming therapy for a pre-adolescent patient is 12 years. Therefore, the Endocrine Society has approved the use of puberty blockers among transgender adolescents as young as 12 years old (Rafferty, 2018).
- Jackson, R. K., & Crall, C. S. (2016). Should Psychiatrists Prescribe Gender-Affirming Hormone Therapy to Transgender Adolescents? AMA Journal of Ethics, 18(11), 1086–1094. https://doi.org/10.1001/journalofethics.2016.18.11.ecas3-1611
- Rafferty, J. (2018). Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics, 142(4), e20182162. https://doi.org/10.1542/peds.2018-2162