Transsexuality in Children and Adolescents

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The transsexuality in children and adolescents is of sexology, just like in adults, as a deviation from the sexual characteristics perceived and lived gender identity refers to ( transgender ). In contrast to the case of adults, those affected by a “ gender identity disorder ” are still before or immediately in puberty . Due to this fact, some psychologists reject the patient and thus the diagnosis "transsexual", although the new version of the ICD, Version 11 (diagnosis HA60, HA61) the possibility of a diagnosis of transsexuality also in adolescents with the new, non-pathologizing term "gender incongruence “Made possible. With a total occurrence of 1: 400 transsexual people in the population and an emerging 1: 1 ratio of transsexual men and women, estimates assume around 100 affected young people in Germany who are (as of 2007) undergoing treatment. The German Society for Transidentity and Intersexuality (dgti eV) estimates the proportion of young people from inquiries at currently (2018) 15%. This corresponds to about 270 affected young people based on applications according to §4 (3) TSG (Federal Justice Office, business burden of the local courts), which are added every year.

Diagnosis according to DSM and ICD

In the diagnosis catalogs it is a sub-area of gender identity disorder with a separate sub-item for children.

According to DSM, the Handbook of Mental Disorders, it is defined that those affected express the first characteristics in early childhood, around the age of two to four years. The diagnosis criterion is the wearing of clothing of the sex to which they were not assigned, which in older children is also disguised in the form of games with disguise. Other diagnostic criteria are atypical behavior such as playing with the “wrong” toy or playing with playmates of the “opposite sex”. Those affected tried to hide their body characteristics, called “biological sex characteristics”, by wearing androgynous clothing and appearing in the “opposite” sex. The criteria are viewed by human rights organizations worldwide as unsuitable and often as an attempt at reparative therapy.

The occurrence of the characteristics in early childhood is corroborated by the study situation and is an indication of a congenital condition (and not a mental disorder). The other criteria are thus called into question because they represent social norms that are applied to a gender identity that is independent of such norms.

During puberty and the onset of sexual maturity, the bodies change to the gender that does not correspond to the mental affiliation. Trans boys press off their breasts with chest corsets or bandages and make do with male penis dummies . Trans girls , for example, let their hair grow long or use various cosmetics. They also make do with mockups, like stuffed bras , in order to better approximate the stereotype of their own gender.

The new version of ICD-10 , ICD-11 (final status 6.2018) designates transsexuality in the future as "gender incongruence" (HA60), disagreement of identity gender with the assigned gender in puberty and as an adult, classified in the new category 17, states of sexuality Health that is not a category of mental disorders or illnesses. The diagnosis can be made at the onset of puberty. The diagnosis HA61, “gender incongruence in childhood”, is intended for children before puberty.

Social consequences

Due to the social pressure, the young people are forced to suppress their identity and lead a secret double life . This can lead to depression and, in worse cases , suicide . Due to the suppressed desire to belong to the opposite sex, disturbed social behavior develops. Unstable partnerships and a disturbed sex life up to complete isolation from the outside world can result. Despair because of the body that is perceived as inappropriate often turns into hatred of one's own body. This is usually followed by self-mutilation , in rare cases, in trans girls, self-removal of the penis ( penectomy ). Transsexualism in children often results in persistent bullying of the child in school . This can lead to severe psychological damage.

Even with an outing as a transident, the person concerned is often marginalized by his environment, such as in kindergarten or school. Tensions within the family can arise. Attempts are often made to use therapeutic measures or religiously motivated “reparative” therapies to force the affected child into behavior that is typical for his or her biological gender. Such so-called forced socialization measures are u. a. membership in a sports club or participation in events that are typical for the physical gender. In the case of a trans girl, this can be, for example, membership in a football club, which is supposed to encourage the child's male stereotypical behavior.

Studies show that depression and the risk of suicide are primarily determined by a supportive (from the perspective of the adolescents concerned) or negative family or school environment and the availability of qualified care.

therapy

There are two different ways. These depend on the treating specialists and psychologists.

In the first way, which is not really a therapy, the affected patient goes through his biologically / hormonally determined puberty. The assumption, which is largely based on the work of Kenneth Zucker, is that after the onset of biological-hormonal puberty, the certainty of the diagnosis of whether or not transsexuality is present is considerably greater: suspicion of transsexuality in childhood is only held in a quarter of the population Cases on until the onset of puberty. A larger proportion of these children would later identify as cisgender and homosexual. With the onset of puberty, the proportion of people who hold on to their self-identification as transsexuals increases significantly, according to the WPATH Standards of Care, and according to Dr. Meyenburg KGU Frankfurt am Main to more than 66%. The disadvantage of going without hormone therapy is precisely this puberty. Some of the bodies are irrevocably changed to the type of biological-hormonal sex. A major change has occurred in any trans girls due to bone structure, beard growth and broken voice . If there are trans boys, breasts must be surgically removed later. Hormone therapy is only started after puberty. A genital adjustment operation (GaOP) is generally refused in this way before the age of 18.

This approach, the renouncement of medical intervention, is propagated by a group of doctors such as Alexander Korte and Klaus M. Beier.

According to the Standards of Care v7 of the WPATH pp. 26-27, withholding puberty-suppressing and subsequent feminizing or masculinizing hormone therapy is not a neutral option for adolescents. After Kenneth Zucker was released from the Center for Addiction and Mental Health in Toronto, standards and approaches based on his work have come under increasing criticism.

Some doctors recommend "reconciliation with the biological sex". In the textbook "Disorders of Gender Identity" by H. Bosinski, published in 2005, "gender-compliant" games are described as "therapy" on p. 411.

The final report, which was submitted by the Federal Magnus Hirschfeld Foundation on behalf of the Federal Ministry of Health, "Scientific inventory of the actual and legal aspects of options for action, including international experience on the planned ban on so-called conversion therapies", led to a ban on "conversion treatments" in children and adolescents which, among other things, are directed against the "expressed gender identity" ( § 1 of the law on protection against conversion treatments ). Self-determined measures for gender reassignment are exempt from this prohibition ( Section 3 ).

In the second type of treatment, the onset of puberty is paused by hormones. These are GnRH analogues used. These act on the pituitary gland and prevent the production of sex hormones in the ovaries or testicles . The bodies remain in the prepubertal state. During this time, the gender identity can be further consolidated. Depending on the result, the medication is changed: either the blockade of puberty can be ended so that the body develops to the gender assigned at birth, or a transition to the different identity gender is initiated by administering additional hormones. With estradiol , breast growth begins in trans girls. Trans boys break their voices through the added testosterone , beard growth occurs, muscle growth accelerates.

Dr. Meyenburg reports that a third of adolescents who start hormone therapy discontinue it after a short time and without lasting after-effects. This type of therapy is therefore considered to be open-ended, as it offers good development opportunities in every direction at an early stage.

The question of when hormone therapy or gender reassignment surgery can be carried out is linked to the ability of a child to give consent. As with other medical measures, this can also be determined individually. Gender reassignment operations are now also carried out in Germany after the social law requirements have been met for people under the age of 18.

In the Federal Republic of Germany there are no laws or regulations that prescribe a minimum age for the hormonal or surgical treatment of transsexuality. The responsibility always rests with the guardians, the treating doctors and psychologists, and (depending on age) with the patient himself.

literature

  • Gerhard Schreiber (Ed.): Transsexuality in Theology and Neuroscience. Results, controversies, perspectives. de Gruyter, Berlin / Boston 2016, ISBN 978-3-11-044080-5 .
  • Mirjam Siedenbiedel: Self-determination about one's own gender: legal aspects of the treatment request of transsexual minors . Nomos, 2016, ISBN 978-3-8487-3366-8 .
  • Hans-Christoph Steinhausen : Mental disorders in children and adolescents: Textbook of child and adolescent psychiatry and psychotherapy. Elsevier , Munich 2006, ISBN 3-437-21562-0 , pp. 351-353. (online) .
  • Peter Keins: Trans * Children: A little primer. CreateSpace Independent Publishing Platform, 2015, ISBN 978-1-5087-8966-6 .
  • Erik Schneider: Normalized Children: Effects of Gender Normativity on Childhood and Adolescence. transcript, Berlin 2015, ISBN 978-3-8376-2417-5 .
  • Wilhelm F. Preuss: Gender dysphoria, trans identity and transsexuality in childhood and adolescence. Ernst Reinhardt Verlag, 2016, ISBN 978-3-497-02554-1 .

Web links

Youtube movie:

Individual evidence

  1. ↑ bundesjustizamt.de , case numbers of the Federal Ministry of Justice and Consumer Protection (BmJV)
  2. ↑ Bernd Meyenburg, Karin Renter Schmidt, Gunter Schmidt: Assessment according to the transsexual law. In: Journal of Sex Education. 28/2015, pp. 107-120. ISSN  0932-8114
  3. ^ A b c Johanna Olson, Sheree M. Schrager, Marvin Belzer, Lisa K. Simons, Leslie F. Clark: Baseline Physiologic and Psychosocial Characteristics of Transgender Youth Seeking Care for Gender Dysphoria. In: Journal of Adolescent Health. 2015, doi: 10.1016 / j.jadohealth.2015.04.027 .
  4. ↑ Trapped in the wrong body. (No longer available online.) FAZ , July 16, 2007, archived from the original on March 3, 2013 .;
  5. ↑ icd.who.int WHO ICD-11 (Joint Linearization for Mortality and Morbidity Statistics)
  6. ↑ Kenneth J. Zucker on transsexualism. Retrieved March 24, 2017 .
  7. ↑ Outcry prompts CAMH to review its controversial treatment of trans youth. Retrieved March 24, 2017 .
  8. ↑ WPATH Standards of Care v7 Section VI. (No longer available online.) Archived from the original on January 28, 2014 ; Retrieved May 10, 2010 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.wpath.org
  9. ↑ Living in two sexes. AZ Mainz, May 16, 2015.
  10. ^ Reform of the transsexual law. In: Journal of Sex Education. Edition 1, 3/2016.
  11. ^ GIS in children and adolescents, Deutsches Ärzteblatt 2008. Accessed on March 24, 2017 .
  12. ↑ Outcry prompts CAMH to review its controversial treatment of trans youth. Retrieved March 24, 2017 .
  13. ↑ Final report of the expert commission on the prohibition of so-called conversion therapies
  14. ↑ Law for the protection against conversion treatments BT 19/18768
  15. ↑ Living in two sexes. AZ Mainz, May 16, 2015.
  16. ↑ Mirjam Siedenbiedel: Self-determination about one's own gender. Nomos Verlag, 2016, ISBN 978-3-8487-3366-8 .