Despite growing global attention on and acknowledgement of gender diversity, young people who identify as transgender face an uphill battle for acceptance in the face of misunderstanding and misinformation, stigma, discrimination and bullying, putting their mental health and even their lives at risk.
Transgender individuals are at an increased risk of mental health conditions such as depression, anxiety and substance abuse,[i] with almost half of transgender adults having suicidal thoughts and nearly a third attempting suicide.[ii]
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.[iii] While almost one in ten teenage deaths in South Africa year is the result of suicide,[iv] the risk of suicide is even greater amongst transgender youth who don’t receive the support they need.[v]
“It is important to understand that identifying as transgender is not a mental illness or disorder. 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.
“Additionally, 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,” Prof Gerhard Grobler, psychiatrist and past president of the South African Society of Psychiatrists (SASOP), said.
He said these risks have been widely shown to reduce significantly when youth receive social and psychological support in “being the gender they identify with and feel is their authentic self”.
While the percentage of youth who identify as transgender is small (a study in the USA estimated 0.7% of teenagers aged 13-17, and 0.6% of adults[vi]), the spotlight has been turned on transgender teens in recent years through increased public and media visibility of transgender people and heated social media debates amongst high-profile figures.
People identifying as transgender is, however, “not a new phenomenon”, Prof Grobler said, as gender non-conforming people have been documented in the histories of cultures across the globe, including in Africa.[vii]
Prof Grobler explained that “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 said, while gender is a social construct of expected attributes, behaviours, roles and activity (including dress) assigned to males or females, and can vary in different cultures. He said it was increasingly accepted by healthcare professionals that gender identity operates on a spectrum rather than being a fixed, binary “either/or” state.
He emphasised that gender identity and sexual orientation were not the same: “Gender identity refers to one’s internal sense of gender, of being male or female or non-binary. Sexual orientation refers to one’s physical, romantic and/or emotional attraction to others, and is not defined by gender identity. Transgender people could be straight, gay, bisexual or asexual, just as non-transgender people can be.”
For parents whose children display gender non-confirming attributes and behaviours, or state that they wish to transition to their preferred gender, Prof Grobler said it was vital to understand and accept that this was 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 – appreciate that they have likely spent significant time contemplating this, and it has taken courage to share it with you.”
“While some children may later shift their gender identity again, rather than labelling it as a passing phase, treat it as real and accept their identity in the here and now,” he advised.
Supporting a child or young person who identifies as transgender takes patience, understanding and being willing to advocate on behalf of your child, Prof Grobler said.
He highlighted 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. While this can include medical treatment and surgical procedures, this is not always the case and usually occurs much later in the process.
- 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. And 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 is 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 that you can advocate for your child.
- Parents and loved ones of a person transitioning need support too – seek help from mental health professionals and support groups for parents of transgender youth.
Prof Grobler warned that there was no scientific evidence to support so-called conversion or reparative “therapy” aimed at changing a person’s sexual orientation or gender identity, and that the evidence in fact showed that these discredited practices were more likely to be harmful and destructive.
“SASOP opposes any forms of such treatment,” he said.
“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,” he said.
Resources and organisations that can provide further information and support:
Groote Schuur Hospital Transgender Clinic – counselling, mental health support, gender-affirming care, info on support groups: http://www.psychiatry.uct.ac.za/psych/clinical-services/groote-schuur-hospital / Tel: 021 404 2151 or email GSH.PsychOPD@westerncape.gov.za
American Psychological Association info & resources: https://www.apa.org/topics/lgbtq/sexual-orientation
REFERENCES USED IN THIS ARTICLE:
[i] Bränström R & Pachankis J. 2019. Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. American Journal of Psychiatry: https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010080
[ii] Adams J & Vincent B. 2019. Suicidal Thoughts and Behaviors Among Transgender Adults in Relation to Education, Ethnicity, and Income: A Systematic Review. Transgender Health: https://www.liebertpub.com/doi/full/10.1089/trgh.2019.0009
[iii] Peterson et al. 2017. Suicidality, self-harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria. Journal of the American Association of Suicidology: https://onlinelibrary.wiley.com/doi/abs/10.1111/sltb.12289
[iv] South African Depression and Anxiety Group (SADAG). Facts about Teen Suicide. https://www.sadag.org/index.php?option=com_content&view=article&id=2067:top-10-facts-on-teen-suicide&catid=94&Itemid=132
[v] Peterson et al. 2017. Suicidality, self-harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria. Journal of the American Association of Suicidology: https://onlinelibrary.wiley.com/doi/abs/10.1111/sltb.12289
[vi] UCLA School of Law Williams Institute. 2017. https://williamsinstitute.law.ucla.edu/publications/age-trans-individuals-us/
[vii] Jobson et al. 2012. Transgender in Africa: Invisible, inaccessible or ignored? SAHARA-J Journal of Social Aspects of HIV/Aids: https://www.tandfonline.com/doi/full/10.1080/17290376.2012.743829