‘It’s not a passing phase’ – an expert speaks out about the challenges facing transgender youth

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Transgender youth are at high risk of mental health issues and suicide.
Transgender youth are at high risk of mental health issues and suicide.
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It’s a life filled with misunderstanding, misinformation, stigma, discrimination and bullying.

Despite growing global attention on and acknowledgement of gender diversity, young people who identify as transgender face an uphill battle to be accepted.

Studies show they are at an increased risk of mental health conditions such as depression, anxiety and substance abuse, says psychiatrist and past president of the South African Society of Psychiatrists (SASOP), Prof Gerhard Grobler. Almost half of transgender adults have suicidal thoughts and nearly a third attempt suicide, he adds.

Similarly, transgender youth – already facing the physical changes and emotional turmoil of adolescence – are at high risk for mental illness and life-threatening behaviours. Studies have shown that more than a third of transgender youth have a history of self-injuring behaviours and a third report at least one suicide attempt.

Almost one in 10 teenage deaths in South Africa is the result of suicide, but the risk of suicide is even greater among transgender youth who don’t receive the support they need.

“It is important to understand that identifying as transgender is not a mental illness or disorder,” Prof Grobler says. “However, gender dysphoria – a state of intense distress that can arise from the sense of a mismatch between one’s sex assigned at birth and one’s lived gender identity – is a real condition that can benefit from treatment such as gender-affirming counselling or psychotherapy.

“Youth identifying as transgender may experience anxiety and depression, increasing their risk of self-harm, due to stigma, lack of acceptance, a feeling that they have to hide their true selves, low self-esteem, social isolation and, at its worst, bullying, harassment and abuse.”

These risks can be significantly reduced when youth receive social and psychological support in “being the gender they identify with and feel is their authentic self”, the professor adds.

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What is transgender?

Prof Grobler explains transgender is an umbrella term encompassing various expressions where people’s birth-assigned sex differs from their experienced gender identity.

Sex is assigned at birth as either male or female and has to do with physical, biological attributes, he says, but gender is a social construct of expected attributes, behaviours, roles and activity assigned to males or females, and it can vary in different cultures. Gender identity operates on a spectrum rather than being a fixed, binary “either/or” state.

“Gender identity refers to one’s internal sense of gender, of being male or female or non-binary,” he says. “Sexual orientation refers to one’s physical, romantic and/or emotional attraction to others, and is not defined by gender identity. Transgender people can be straight, gay, bisexual or asexual, just as non-transgender people can be.”

What parents can do

For parents whose children display gender non-confirming attributes and behaviours, or state that they wish to transition to their preferred gender, Prof Grobler says it’s vital to understand and accept that this is not “just a phase”.

“Adolescents in particular are grappling with separation and independence, forming their own identities and autonomy. No one decides on or just chooses a gender identity overnight, and it’s important to appreciate that they have likely spent significant time contemplating this, and it has taken courage to share it with you,” he points out.

“Some children may later shift their gender identity again, but rather than labelling it as a passing phase, treat it as real and accept their identity in the here and now.”

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Supporting a child or young person who identifies as transgender takes patience, understanding and a willingness to advocate on behalf of your child, Prof Grobler says.

He highlights some pointers for parents, families and friends of youth who identify as transgender and choose to transition:

  • Understand that every person’s transition and how they choose to live in their gender identity differs. The process of transitioning is complex and takes many steps that can include medical treatment and surgical procedures.
  • Engage with schools and other institutions to address your child’s situation and particular needs, with their consent.
  • Respect your child’s privacy and don’t “out” them before they are ready.
  • Don’t force them to act, dress, etc in a more gender-conforming way.
  • Seek support from a mental health professional who specialises in children and adolescents and is competent in working with gender diverse and non-conforming young people. Also help your child to find peer groups and support networks for trans youth.
  • Respect their choice of name and pronouns. Don’t misgender or “dead name” (using their old name) a person – to them, it’s like denying their existence.
  • Don’t make assumptions about how your child would like to dress, what sport they want to play, and other gendered stereotypes. Let them take the lead in their own individuality and show you what their gender means to them.
  • Don’t make assumptions about their sexual orientation.
  • Educate yourself on transgender terms, issues, and rights so you can advocate for your child.
  • Parents and loved ones of a person transitioning need support too, so seek help from mental health professionals and support groups for parents of transgender youth.

Prof Grobler warns there’s no scientific evidence to support so-called conversion or reparative “therapy” aimed at changing a person’s sexual orientation or gender identity, and evidence suggests these discredited practices are more likely to be harmful.

“SASOP opposes any forms of such treatment,” he says. “However, a transition in gender identity can be extremely stressful and psychotherapy can play a vital supporting role in helping a person come to self-fulfilling acceptance and self-actualisation, as well as developing the life skills to cope with prejudice, discrimination, and rejection.”

The following resources and organisations can provide further information and support:

Groote Schuur Hospital Transgender Clinic – counselling, mental health support, gender-affirming care, info on support groups. Tel: 021 404 2151

Matimba – emotional and psychological support for transgender youth and their families. Tel: 074 0845 237

OUT – counselling, health services, advocacy. Tel: 012 430 3272

Gender Dynamix – trans & diverse gender resources and information portal. Tel 021 447 4797

Triangle Project – counselling, health care, support groups. Helpline 021 712 6699

American Psychological Association info & resources

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