Sexual incongruence in children and adolescents - Support, psychotherapy and medical interventions

Abstract

In recent years, the treatment of people with gender incongruence and gender dysphoria has developed towards variable and needs-oriented support and self-determined decision making by those affected in the framework of informed consent. In the case of minors, the focus is on orientation towards the needs of those affected, the promotion of the ability to judge and the close involvement of those with custody, in order to prevent psychological aberrations and to ensure good support. Neither the interruption of puberty nor the omission of a puberty blockade is a neutral event for adolescents who have strong gender dysphoria and are developing secondary sexual characteristics. Careful use of terminology and pronouns enables respectful treatment of those affected. From Tanner stage 2-3 on, puberty blockade in adolescents with gender incongruence can reduce psychological problems. Sex-appropriate hormone treatment can be introduced in the case of continuous gender dysphoria and a confirmed diagnosis of permanent transidentity in minors capable of decision making. Psychological support depends on need and can facilitate a psychologically healthy development of adolescents with gender incongruence. A high percentage of adolescents with gender dysphoria suffer from secondary psychological problems such as anxiety, depression, suicidal tendencies and self-injury, especially when there is a lack of support from the family and school environment.