Abstract
There are various treatment approaches available for children and adolescents with gender identity disorder (GID). This chapter offers an overview of these, with a focus on bringing to light their underlying assumption and treatment goals. After such an account, the chapter focuses on the combined approach, which involves early medical treatment for children and adolescents with GID. This treatment has raised and may raise important ethical and legal concerns: this chapter disentangles and analyzes such concerns. The conclusion is not only that there is nothing unethical with providing transgender children and adolescents with early medical treatment but that it may be unethical not to do so.
Keywords
- Gender Identity
- Gender Stereotype
- Gender Dysphoria
- Gender Identity Disorder
- British Medical Association
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, access via your institution.
Buying options
Notes
- 1.
Electra is another mythological figure in ancient Greece, which inspired various works, the most famous of which are probably the tragedies Electra by Sophocles and Euripides. Here, Electra plans the murder of her mother’s lover, who killed her father. Sometimes the term “Oedipus complex” is also used for girls.
- 2.
I am grateful to Professor Mike Besser for this specification.
- 3.
In Italy, for example, Articles 328, 591, and 593 of the Penal Code, respectively, Omission or Refusal of Official Acts, Abandonment of the Incapacitated, and Omission of Rescue.
- 4.
Online at http://www.legislation.gov.uk/ukpga/1989/41/section/1. Last accessed 15 November 2011.
- 5.
Bolam v. Friern Hospital Management Committee [1957] 2 All ER 118, [1957] 1 WLR 634.
- 6.
A v. A Health Authority [2002] 1 FCR 481, [2002] Fam 213 at para 43; see also Re A (medical treatment: male sterilisation) [2000] 1 FCR 193; A Hospital NHS Trust v. S and others [2003] Lloyd’s Rep Med 137, (2003) 71 BMLR 188 at para 47.
- 7.
A Hospital NHS Trust v. S and others [2003] Lloyd’s Rep Med 137, (2003) 71 BMLR 188 at para 47.
- 8.
Bolitho v. City and Hackney HA [1998] AC 232 at 242, HL.
- 9.
Re J (A Minor) (Child in Care: Medical Treatment) [1992] 2 All ER 614.
- 10.
Gillick v. West Norfolk and Wisbech Area Health Authority [1985] 3 All ER 402 at 409 e-h per Lord Fraser and at 422 g-j per Lord Scarman; See also R v. D (1984) 2 A11 ER 449.
- 11.
Re S (A Minor) (Consent to Medical Treatment) [1994] 2 FLR 1065; Re E (A Minor) (Wardship: Medical Treatment) [1993] 1 FLR 386.
- 12.
I owe this important observation to Professor Peter Clayton.
- 13.
There might be ethical and pragmatic issues of resource allocation, which could explain why the state might not publicly fund some treatments for transgender people (or for the infertile, or for the intersex, or for the person who is dissatisfied with his/her physical appearance, and so on). However, pragmatic concerns relating to how to allocate resources and how to prioritize people’s needs are not principled reasons to deny medical treatment.
- 14.
This legal right has some limits under English law.
References
American Psychiatric Association. (2012). DSM 5 Development. Retrieved November 6, 2012, from http://www.dsm5.org/proposedrevision/pages/genderdysphoria.aspx
British Medical Association. (2011). Children and young people tool kit 2011. Retrieved November 14, 2012, from http://bma.org.uk/practical-support-at-work/ethics/ethics-a-to-z
Cohen-Kettenis, P. T. (1998). Pubertal delay as an aid in diagnosis and treatment of a transsexual adolescent. European Child and Adolescent Psychiatry, 7, 246–248.
Cohen-Kettenis, P. T., & Delemarre-van de Waal, H. (2005). Clinical management of adolescents with gender dysphoria. Presented at the congress. Endocrine Treatment of Atypical Gender Identity Development in Adolescents, London, 19–20 May 2005.
Cohen-Kettenis, P. T., Delemarre-van de Waal, H., & Gooren, L. J. G. (2008). The treatment of adolescent transsexuals: Changing insights. The Journal of Sexual Medicine, 5(8), 1892–1897.
Cohen-Kettenis, P. T., & Pfäfflin, F. (2003). Transgenderism and intersexuality in childhood and adolescence. Making choices. London: Sage Publications.
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., et al. (2012). Standards of care for the health of transsexual, transgender and gender non-conforming people, version 7. International Journal of Transgenderism, 13, 165–232.
Connolly, P. (2003). Transgendered peoples of Samoa, Tonga and India: Diversity of psychosocial challenges, coping, and styles of gender reassignment. Presented at the Harry Benjamin International Gender Dysphoria Association Conference, Ghent, Belgium.
Council for International Organizations of Medical Sciences. (2002). International Ethical Guidelines for Biomedical Research Involving Human Subjects Prepared by the Council for International Organizations of Medical Sciences (CIOMS) in collaboration with the World Health Organization (WHO), Geneva. Retrieved November 11 2012, from http://www.cioms.ch/publications/layout_guide2002.pdf
De Sutter, P. (2009). Reproductive options for transpeople: Recommendations for revision of the WPATH’s Standards of Care. International Journal of Transgenderism, 11, 183–185.
De Vries, A. L., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality, 59, 301–320.
Delemarre-van de Waal, H. A., & Cohen-Kettenis, P. T. (2006). Clinical management of gender identity disorder in adolescents: A protocol on psychological and paediatric endocrinology aspects. European Journal of Endocrinology, 155, 131–137.
Di Ceglie, D. (2009). Engaging young people with atypical gender identity development in therapeutic work: A developmental approach. Journal of Child Psychotherapy, 35, 3–12.
Directive 2001/20/EC of the European Parliament and of the Council of 4 April 2001. Retrieved November 14, 2012, from http://www.eortc.be/services/doc/clinical-eu-directive-04-April-01.pdf
Drop, S. L., de Waal, W. J., & de Muinck Keizer-Schrama, S. M. (1998). Sex steroid treatment of constitutionally tall stature. Endocrine Review, 19, 540–558.
Fenner, B., Mananzala, R. (2005). Letter to the hormonal medication for adolescent guidelines drafting team. Presented at the congress Endocrine Treatment of Atypical Gender Identity Development in Adolescents, London, 19–20 May 2005.
Gaffney, B., & Reyes, P. (2009). Gender identity dysphoria. In M. Lanyado & A. Horne (Eds.), The handbook of child and adolescent psychotherapy: Psychoanalytic approaches. New York, NY: Routledge.
Gender Identity Research and Education Society (GIRES). (2008). Guidance on combating transphobic bullying in schools. Retrieved September 11, from http://www.gires.org.uk/assets/Schools/TransphobicBullying.pdf
General Medical Council (GMC). (2007). 0–18: Guidance for All Doctors, 2007. Retrieved November 11, 2012, from http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_12_13_assessing_best_interest.asp
Giordano, S. (2011). Sex and gender: Issues of public health and justice. In M. Boylan (Ed.), The morality and global justice. Colorado: Perseus Academics.
Giordano, S. (2012). Children with gender identity disorder, a clinical, ethical and legal analysis. London: Routledge.
Golombok, S., Cook, R., Bish, A., & Murray, C. (1995). Families created by the new reproductive technologies: Quality of parenting and social and emotional development of the children. Child Development, 66, 285–289.
Golombok, S., & Fivush, R. (1994). Gender development. Cambridge: Cambridge University Press.
Golombok, S., MacCallum, F., & Goodman, E. (2001). The ‘test-tube’ generation: parent–child relationships and the psychological well-being of in vitro fertilization children at adolescence. Child Development, 72, 599–608.
Golombok, S., Murray, C., Brinsden, P., & Addalla, H. (1999). Social versus biological parenting: Family functioning and socioemotional development of children conceived by egg or sperm donation. Journal of Child Psychology and Psychiatry, 40, 519–527.
Golombok, S., Spencer, A., & Rutter, M. (1983). Children in lesbian and single-parent households: Psychosexual and psychiatric appraisal. Journal of Child Psychology and Psychiatry, 24, 551–572.
Golombok, S., Tasker, F., & Murray, C. (1997). Children raised in fatherless families from infancy: Family relationships and the socioemotional development of children of lesbian and single heterosexual mothers. Journal of Child Psychology and Psychiatry, 38, 783–791.
Green, R. (2007). Gender development and reassignment. Psychiatry, 6, 121–124.
Gross, R. (2010). Psychology. London: Hodder Education.
Grossman, A., & D’Augelli, A. R. (2006). Transgender youth invisible and vulnerable. Journal of Homosexuality, 51, 111–128.
Haber, C. H. (1991). The psychoanalytic treatment of a preschool boy with a gender identity disorder. Journal of the American Psychoanalytic Association, 39, 107–129.
Haraldsen, I. R., Haug, E., Falch, J., Egeland, T., & Opjordsmoen, S. (2007). Cross-sex pattern of bone mineral density in early onset gender identity disorder. Hormones and Behavior, 52, 334–343.
Houk, C. P., & Lee, P. A. (2006). The diagnosis and care of transsexual children and adolescents: A pediatric endocrinologists’ perspective. Journal of Pediatric Endocrinology and Metabolism, 19, 103–109.
Hume, D. (1783). On Suicide. Retrieved on 11 September 2012, from http://www.anselm.edu/homepage/dbanach/suicide.html
Imbimbo, C., Verze, P., Palmieri, A., Longo, N., Fusco, F., Arcaniolo, D., et al. (2009). A report from a single institute’s 14-year experience in treatment of male-to-female transsexuals. The Journal of Sexual Medicine, 6, 2736–2745.
Jones, M. (2006). Adolescent gender identity and the courts. In M. Freeman (Ed.), Children’s Health and Children’s Rights. Leiden: Martinus Nijhoff Publishers.
Kreukels, B. P. C., & Cohen-Kettenis, P. T. (2011). Puberty suppression in gender identity disorder: The Amsterdam experience. Nature Reviews. Endocrinology, 7, 466–472.
Levine, B. S. (2009). Real-life test experience: Recommendations for revisions to the standards of care of the world professional association for transgender health. International Journal of Transgenderism, 11, 186–193.
Marshall, W. A., & Tanner, J. M. (1969). Variations in pattern of pubertal changes in girls. Archives of Disease in Childhood, 44, 291–303.
Marshall, W. A., & Tanner, J. M. (1970). Variations in the pattern of pubertal changes in boys. Archives of Disease in Childhood, 45, 13–23.
Moller, B., Schreier, H., Li, A., & Romer, G. (2009). Gender identity disorder in children and adolescents. Current Problems in Pediatric and Adolescent Health Care, 39, 117–143.
Murad, M. H., Elamin, M. B., Garcia, M. Z., Mullan, R. J., Murad, A., Erwin, P. J., et al. (2010). Hormonal therapy and sex reassignment: A systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology, 72, 214–231.
Raymond, J. G. (1994). The transsexual empire. The making of the She-male. London: Teachers College Press.
Reed, B., Rhodes, S., Schofield, P., & Wylie, K. (2009). Gender variance in the UK: Prevalence, incidence, growth and geographic distribution. London: GIRES.
Roberts, F. L., Brett, M. A., Johnson, T. W., & Wassersug, R. J. (2008). A passion for castration: Characterizing men who are fascinated with castration, but have not been castrated. The Journal of Sexual Medicine, 5, 1669–1680.
Spack, N. (2008). An Endocrine Perspective on the Care of Transgender Adolescents. Presented at the 55th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, 28 October–2 November 2008. Symposium on disability (2001). Journal of Medical Ethics, 6, 383–388.
UNICEF. (1989). Convention on the Rights of the Child, Adopted by General Assembly resolution 44/25 of 20 November 1989, Entry into force 2 September 1990, in accordance with article 49. Retrieved November 14, 2012, from http://www2.ohchr.org/english/law/crc.htm#art2
Wallien, M. S. C., Van Goozen, S. H. M., & Cohen-Kettenis, P. T. (2007). Physiological correlates of anxiety in children with gender identity disorder. European Child and Adolescent Psychiatry, 16, 309–315.
Wallien, M. S. C., Veenstra, R., Kreukels, B. P. C., & Cohen-Kettenis, P. T. (2010). Peer group status of gender dysphoric children: A sociometric study. Archives of Sexual Behavior, 39, 553–560.
World Medical Association. (2008). Declaration of Helsinki. Retrieved on 11 September 2012, from http://www.wma.net/e/policy/b3.html.
Wylie, K., Fung, R., Boshier, C., & Rotchell, M. (2009). Recommendations of endocrine treatment for patients with gender dysphoria. Sexual and Relationship Therapy, 24, 175–187.
Acknowledgments
I wish to thank Iain Brassington for reading and commenting on this work.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Giordano, S. (2014). Medical Treatment for Children with Gender Dysphoria: Conceptual and Ethical Issues. In: Kreukels, B., Steensma, T., de Vries, A. (eds) Gender Dysphoria and Disorders of Sex Development. Focus on Sexuality Research. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-7441-8_11
Download citation
DOI: https://doi.org/10.1007/978-1-4614-7441-8_11
Published:
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4614-7440-1
Online ISBN: 978-1-4614-7441-8
eBook Packages: Behavioral ScienceBehavioral Science and Psychology (R0)