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Why Denying Youth Gender-Affirming Care Could Increase Suicide? A Clinical Psychology Podcast Episode.


Why Denying Youth Gender-Affirming Care Could Increase Suicide? A Clinical Psychology Podcast Episode.

Continuing our celebration of Pride Month here on the podcast, I want to look at the benefits of gender-affirming care on transgender youth. Since gender-affirming care saves lives, it improves mental health and it decreases gender dysphoria and the associated negative mental health outcomes. However, one debate that is raging across the world is whether underage transgender youth should be allowed to undergo gender-affirming care if they’re going through a mental health crisis. A crisis that could led to suicide. In this clinical psychology podcast episode, we’ll look at why denying youth gender-affirming care could increase suicide, what we can do to help transgender youth and ultimately why giving youth a way of their gender dysphoria with gender-affirming care could save lives. If you enjoy learning about mental health, gender dysphoria and clinical psychology then this is a great episode for you.


Today’s psychology podcast episode has been sponsored by Working With Children and Young People: A Guide To Clinical Psychology, Mental Health and Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.


Some Basic Facts About Transgender Individuals and Gender Dysphoria

I wanted to kick off this podcast episode by focusing on some facts about transgender individuals and gender dysphoria based on findings from research studies so we all understand what is actually happening. Since I know no one really investigates the truth about transgender people on their own and a lot of people rely on negative, biased media reports for their information. I used to be the same.


Therefore, according to Anderson et al. (2023), there are nearly 1.4 million Americans that have gender dysphoria, meaning they do not identify with the sex they were assigned at birth. As well as Parker et al. (2022) found that 64% of Americans support transgender people against discrimination.


In addition, below is an extract from an introduction I wrote for an academic paper where I was talking about the negative impact of gender dysphoria on mental health:


“Half of all transgender youth report a history of suicidal ideation (James et al., 2016) and low self-esteem (MacCarthy et al., 2015) emphasising the need for mental health support for this clinical population. Also, research suggests gender dysphoria is an additional major cause of this mental health disparity. Gender Dysphoria refers to the psychological distress associated with the gender incongruence between the individual’s gender assigned at birth and their gender identity (APA, 2013) and Gender Dysphoria is associated with depression, suicidality, anxiety and eating disorders (Petersen et al., 2017) due to the profound emotional and physical suffering the dysphoria causes an individual (Morris & Galupo, 2019).”


As a result, you can see how gender dysphoria leads to an increase in stark and dangerous mental health outcomes. This is why gender-affirming care is so important and why it saves lives.


Below is another extract from my draft introduction that explains why gender-affirming care is so important, useful and valuable in saving lives:


“Gender-affirming practices aim to reduce the psychological stress caused by gender dysphoria (Keo-Meier et al., 2015; Olson et al., 2016). For instance, trans-masculine participants experienced improved mental health and quality of life after receiving top surgery (Poudrier et al., 2019) and testosterone (Keo-Meier et al., 2015). Also, gender-affirming practices help participants to experience significantly lower rates of psychological distress and suicidal ideation compared to transgender individuals not undergoing gender-affirming practices (Almazan & Keuroghlian, 2021) with similar findings being found by additional studies (Sansfcon et al., 2020; Swan et al., 2021). Due to gender-affirming practices aid participants in living authentically through the process of social transitioning. Social transitioning refers to the process where transgender individuals express themselves in a way that reflects their gender identity to the outside world (Austin et al., 2022). Typically, this process involves changing their clothing, hairstyle, accessories to reflect their internal state of Self more accurately amongst other practices (Austin et al., 2022). Social transitioning has a history in psychological literature demonstrating its profound positive impact on transgender individuals through qualitative studies (Austin & Craig, 2015). For instance, using a transgender individual’s chosen pronouns and name in multiple domains of functioning (like school, home and the workplace) caused decreased suicidal ideation by 65% and depression by 71% (Russell et al., 2018). Further, socially transitioned transgender youth who were supported in their gender identity were found to have only minimally increased anxiety levels and developmentally normative levels of depression, suggesting mental health difficulties can be avoided in this population (Olson et al., 2016). Consequently, research demonstrates gender-affirming practices, including social transitioning, are critical to reducing the psychological distress and severe negative mental health outcomes caused by gender dysphoria.”


Furthermore, Parker et al. (2022) found that Americans were seriously split over whether to allow gender-affirming surgery at all for anyone. Americans were generally undecided about whether to allow adults to have a surgery, but most Americans were flat out against allowing children under 18 to surgically change their gender.


I know there are a lot of reasons why people feel like this and I acknowledge the majority of the time these reasons are coming from a good place, but in reality, a lot of the arguments don’t hold that much water. Especially when we investigate the mental health angle and how a gender-affirming surgery can be the difference between a child committing suicide or living.


Should Transgender Youth Have The Right To Determine Their Gender?

The first argument I’ve heard way too much about is the idea that children are too young to understand the consequences of any medical decision. Due to if we think about changing your pronouns that is very easy to reverse, you can’t reverse surgery. As well as Jackson (2023) found that some transgender youth still commit suicide even after gender-affirming treatment.

However, we still need to remember that these children are going through the psychological distress that gender dysphoria causes because their post-puberty state does not match their internal reflection of their gender. This dysphoria is extremely distressing and self-harm is very, very possible and so is suicide if we stop a child from getting any form of help because we apparently know better.


For the sake of improving the mental health of transgender youth, they deserve the right to choose their own gender.


As a result, transgender youth are in a mental health crisis (Marcia, 2006) caused by the extreme distress of there being an incongruent between their external and internal reflection of their gender. Then we need to acknowledge that if there is a failure to overcome their childhood crisis then this can be fatal or disastrous (Jennings, 2015), also if children are asking for the right to choose their own gender then it isn’t because it’s trendy, it’s a craze or it’s a fad.


It's because they don’t have it already.


Adults already have the right to choose their own gender, so why don’t children have the same right?


This is ultimately an equality question, because I have no idea what children will have to do to be treated equally to adults.


Americans and everyone all over the world have already been asking for the right to choose by people assigned female at birth (let me think this is when women were asking for the right to vote so they could be treated equally by men) and people assigned black at birth (black people wanted to be treated equally).


And before women and black people gained more equal rights, they were treated like children. Women weren’t allowed to work, they weren’t allowed to vote because they were deemed by men to be too dim to understand politics and they weren’t allowed the freedom to do whatever they wanted with their lives.


All minorities are treated as children before they gain equal rights.


Everyone should have the right to choose about their own life so children would be no exceptions. This already happens in other ways, like we allow children to dye their hair, get their haircuts, go wherever they want with their friends, and more. Let’s extend this right to choose to the really important things that ultimately save lives.


And there is a brilliant and rather heartbreaking comment I’ve seen that I think is so true. Remembering that minors cannot vote, it is all well and good that we spent our time debating and arguing about what minors need to be safe, secure and protected. At the same time, these minors are in chatrooms and planning and discussing the advantages of secret suicide (Jennings, 2015; Marcia, 2006).


This is not okay and we need to do something about this. The easiest and most effective way to decrease these secret suicide discussions is to simply allow children to choose their own gender, and implement both the social and possibly medical methods of gender-affirming care.


Why The Agony Of Transgender Youth Matters

As aspiring and qualified psychologists, it is our job to get children out of a mental health crisis and into a safe place, so children can survive. We always put the psychological needs of our client before ourselves because our client is the most important person, and we need to help them.


Whatever a client is going through that is important to us as psychologists, we need to make sure we help them, so they can go through to live a full, happy and productive life.

Their agony and distress matter to us.


Also, whenever we’re with clients, we never invalidate them. We never tell someone with depression that they aren’t depressed because we don’t feel depression, or their depression isn’t valid because it’s unusual or uncommon in our culture. 


We never do that because that doesn’t help our clients and it certainly doesn’t help decrease their psychological distress.


So let’s never do that to transgender youth either.


Clinical Psychology Conclusion

At the end of the day, as adults, we need to realise that when a child is telling us they’re undergoing gender dysphoria and they’re extremely distress, we need to treat this as fact. The child isn’t lying and if we don’t listen to them then this could have horrific consequences.


Since for transgender youth, they are undergoing a mental health crisis and unless they get support and acceptance and some form of gender-affirming care, social transitioning is still a brilliant range. Then you can think of this as a glass bottle that is getting more and more pressurised. And at some point the glass bottle will shatter, the child will have a breakdown and they might commit suicide.


We cannot allow that to happen.


You can argue as much as you want about whether gender-affirming care is moral or ethical for children, but your arguments do nothing to help a grieving mother or father of a dead child.

So the takeaway from this episode is don’t close every door on a child’s hope for acceptance. Because if you do that, there will only be a single door left open for the child to take and when they go through that door, they will not return, they will not feel like they have another choice and they will not be alive.


Death, suicide and pain is all that remains when we take away gender-affirming care.

 


I really hope you enjoyed today’s clinical psychology podcast episode.


If you want to learn more, please check out:


Working With Children and Young People: A Guide To Clinical Psychology, Mental Health and Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.



Have a great day.


Clinical Psychology References and Further Reading

Almazan, A. N., & Keuroghlian, A. S. (2021). Association between gender-affirming surgeries and mental health outcomes. JAMA surgery156(7), 611-618.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.


Anderson, D., Wijetunge, H., Moore, P., Provenzano, D., Li, N., Hasoon, J., Viswanath, O., Kaye, A. D., Urits, I. (2023). Gender dysphoria and its non-surgical and surgical treatments. Health Psychology Research, 10(3). doi:10.52965/001c.38358


Austin, A., & Craig, S. L. (2015). Transgender affirmative cognitive behavioral therapy: Clinical considerations and applications. Professional Psychology: Research and Practice46(1), 21.


Austin, A., Papciak, R., & Lovins, L. (2022). Gender euphoria: A grounded theory exploration of experiencing gender affirmation. Psychology & Sexuality13(5), 1406-1426.


Cummings Center for the History of Psychology (1957). Richard Evans interviews Carl Jung - Personality, organization, fundamental concepts [video]. Available at: https://www.youtube.com/watch?v=tLeXXoumkqU


Jackson, D. (2023). Suicide-related outcomes following gender-affirming treatment: A review. Cureus, 15(3). doi:10.7759/cureus.36425


James, S., Herman, J., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. A. (2016). The report of the 2015 US transgender survey.


Jennings, K. (2015, October). Leelah Alcorn and the continued struggle for equity for LGBT students. In The Educational Forum (Vol. 79, No. 4, pp. 343-346). Routledge.


Keo-Meier, C. L., Herman, L. I., Reisner, S. L., Pardo, S. T., Sharp, C., & Babcock, J. C. (2015). Testosterone treatment and MMPI–2 improvement in transgender men: A prospective controlled study. Journal of consulting and clinical psychology83(1), 143.


Marcia, J. E. (2006). Ego identity and personality disorders. Journal of Personality Disorders, 20(6), 577-596.


Meinecke, L. D. (2017). Neglected by assessment: Industry versus inferiority in the competition for scarce kidneys. (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (ProQuest No. 10689852)


Morris, E. R., & Galupo, M. P. (2019). “Attempting to dull the dysphoria”: Nonsuicidal self-injury among transgender individuals. Psychology of Sexual Orientation and Gender Diversity, 6(3), 296–307. https://doi.org/10.1037/sgd0000327


Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3).


Parker, K., Horowitz, J. M., Brown, A. (2022, June 28). Americans’ complex views on gender identity and transgender issues. Pew Research Center. Retrieved from


Peterson, C. M., Matthews, A., Copps-Smith, E., & Conard, L. A. (2017). Suicidality, Self-Harm, and Body Dissatisfaction in Transgender Adolescents and Emerging Adults with Gender Dysphoria. Suicide & life-threatening behavior, 47(4), 475–482. https://doi.org/10.1111/sltb.12289


Poudrier, G., Nolan, I. T., Cook, T. E., Saia, W., Motosko, C. C., Stranix, J. T., Thomson, J. E., Gothard, M. D., & Hazen, A. (2019). Assessing Quality of Life and Patient-Reported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study. Plastic and reconstructive surgery, 143(1), 272–279. https://doi.org/10.1097/PRS.0000000000005113


Pullen Sansfaçon, A., Medico, D., Suerich-Gulick, F., & Temple Newhook, J. (2020). “I knew that I wasn’t cis, I knew that, but I didn’t know exactly”: Gender identity development, expression and affirmation in youth who access gender affirming medical care. International Journal of Transgender Health, 21(3), 307-320.


Rogers, C. R. (1961). On becoming a person. Boston, MA: Houghton Mifflin.


Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 63(4), 503–505. https://doi.org/10.1016/j.jadohealth.2018.02.003


Swan, J., Phillips, T. M., Sanders, T., Mullens, A. B., Debattista, J., & Brömdal, A. (2023). Mental health and quality of life outcomes of gender-affirming surgery: A systematic literature review. Journal of Gay & Lesbian Mental Health, 27(1), 2-45.


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