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Describe your approach to an adolescent who was referred to you for suspected gender dysphoria. Describe how you would proceed with the clinical assessment and be certain to emphasize key elements associated with sensitivity in the clinical interview.

 

My approach starts with recognizing that gender dysphoria in adolescents is a serious medical concern that cannot be overlooked or ignored.  Mental health comorbidities co-exist as adolescents denied or delayed gender care may decompensate emotionally into self-harming behaviors.  Recent data of more than 30,000 transgender and gender-diverse young people, carried out over a decade, consistently show that access to gender-affirming care is associated with a reduction in rates of suicidality, depression, and self-harming behavior, (Turban, 2022).  As the clinician, I would then interview and review the adolescent’s presentation to ensure alignment with the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for gender dysphoria.  Once a diagnosis is confirmed, I would then develop a plan of care and discuss the necessary interventions moving forward in providing gender-affirming care. My objective as the clinician is to display my validation and affirmation of the adolescent’s preferred identity in attempting to alleviate the health disparities and challenges these clients often endure during transition.

 

As my clinical assessment continues, throughout my interaction my primary goal is establishing a safe and non-judgmental environment for the adolescent and their family members.  Assessment must be precise and appropriate (use of preferred pronouns), as well as timely as there is an ideal window of opportunity for patients to receive hormonal intervention, necessitating prompt referrals.  The goal there being to ultimately induce desired sex characteristics congruent with an individual’s identity. 

A recent study seeking to explore the perspectives of gender diverse people of ways to alleviate dysphoria in health care revealed two predominant themes.  A “bedside manner” composed of good communication, respect, trust, understanding and professionalism. Especially with regards to communication, it was seen to be important that service users are well prepared and educated for procedures and about what will happen during them. It was expected that a competent practitioner or researcher will ask the right questions (e.g. using sensitive and appropriate language that matches the individual’s experience) and not irrelevant or invasive ones, (Ker, et al.,2022).  The other important theme indicated was the correct use of language and pronouns that affirm the patient’s gender.   Both of these interventions are pretty basic and reasonable.  As people with gender dysphoria commonly identify feelings of “pain, loneliness, and isolation”, I would hope that any clinicians not empathetic and understanding enough of the emotional and physical turmoil these patients endure is already enrolled in some kind of intense sensitivity training.

 

References

Kerr, L., Jones, T., & Fisher, C.M. (2022).   Alleviating gender dysphoria: A qualitative study of perspectives of trans and gender diverse people. Journal of Health Services Research & Policy,27(1):4-13. doi:10.1177/13558196211013407

 

Turban, J.  (2022).  The evidence for trans youth gender-affirming medical care.  Psychology Today.  Retrieved at https:// www.psychologytoday.com/us/blog/political-minds/202201/the-evidence-trans-youth-gender-affirming-medical-careLinks to an external site.

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