Late-Onset Transgender Identity Development of Adolescents in Psychotherapy for Mood and Anxiety Problems: Approach to Assessment and Treatment

  • Melina SevleverEmail author
  • Heino F. L. Meyer-Bahlburg
Special Section: Transgender Identities Emerging During Adolescence


The rate of adolescents with gender-nonconforming behavior and/or gender dysphoria seeking mental health care has dramatically increased in the past decade. Many of these youths also present with co-occurring psychiatric problems, including depression, anxiety, suicidality, substance use, and others. This combination may generate a complex clinical picture that challenges the ability of clinicians to accurately diagnose gender distress and develop suitable treatment recommendations. This article illustrates those challenges with two adolescent patients who developed late-onset gender dysphoria in the course of long-term mental health care for diverse psychiatric problems preceding the emergence of gender dysphoria. One underwent full progression from gender dysphoria as a male through social and medical transition to female, the other a less definitive progression from gender dysphoria as female through social transition to male without deciding for any medical treatment. The report provides details on the assessment procedures and the resulting findings, the rationale for treatment recommendations, and short-term follow-up information.


Gender dysphoria Transgender Adolescence 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by the authors.


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Authors and Affiliations

  1. 1.Department of Psychiatry, Neurological InstituteColumbia University Irving Medical CenterNew YorkUSA
  2. 2.Department of Psychiatry/NYS Psychiatric Institute, Vagelos College of PhysiciansSurgeons of Columbia UniversityNew YorkUSA

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