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

  • Special Section: Clinical Approaches To Adolescents With Gender Dysphoria
  • Published:
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Abstract

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.

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Authors and Affiliations

  1. Department of Psychiatry, Neurological Institute, Columbia University Irving Medical Center, 710 West 168th Street, 12th Floor, New York, NY, 10032, USA

    Melina Sevlever

  2. Department of Psychiatry/NYS Psychiatric Institute, Vagelos College of Physicians, Surgeons of Columbia University, New York, NY, USA

    Heino F. L. Meyer-Bahlburg

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  1. Melina Sevlever
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  2. Heino F. L. Meyer-Bahlburg
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Correspondence to Melina Sevlever.

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Sevlever, M., Meyer-Bahlburg, H.F.L. Late-Onset Transgender Identity Development of Adolescents in Psychotherapy for Mood and Anxiety Problems: Approach to Assessment and Treatment. Arch Sex Behav 48, 1993–2001 (2019). https://doi.org/10.1007/s10508-018-1362-9

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  • DOI: https://doi.org/10.1007/s10508-018-1362-9

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