Dr. Henry Paul, MD

Psychiatrist, Author and Educator

YOUNG CHILDREN AND GENDER IDENTITY (GENDER DSYPHORIA)

May 12th, 2015

“People who have gender dysphoria feel strongly that they are not the gender they physically appear to be.

For example, a person who has a penis and all other physical traits of a male might feel instead that he is actually a female. That person would have an intense desire to have a female body and to be accepted by others as a female. Or, someone with the physical characteristics of a female would feel her true identity is male.

Feeling that your body does not reflect your true gender can cause severe distress, anxiety, and depression. “Dysphoria” is a feeling of dissatisfaction, anxiety, and restlessness. With gender dysphoria, the discomfort with your male or female body can be so intense that it can interfere with the way you function in normal life, for instance at school or work or during social activities.” (WEDMD, 2015)

Gender dysphoria is another term for Gender Identity Disorder. Whether-or-not young children who express transgender issues can really be believed is a hotly debated issue right now. Is this ever just a phase? How do you respond when your toddler daughter’s first sentence is that she’s a boy and she says it over-and-over, day-after-day? What do you do when your three-year-old son insists on wearing nail polish like mommy, and a dress to pre-school?

How young is too young to know? In March 2015, a Medscape study looked at the usual patterns for development of gender identity. According to the study, “Several studies by Milton Diamond of the University of Hawaii indicate that gender development reaches a critical point during childhood, after which it becomes extremely difficult to modify in most individuals. While there may be a number of children who do not clearly fit into a neat binary model of gender in which the polar extremes of behavior are reserved for those with clear sex and gender congruence, it is increasingly clear that gender identity is at the very least an intrinsic characteristic that emerges during early development.”

For parents, dealing with a child’s gender identity issues can be overwhelming. It also brings on a flood of questions. What causes it? What treatment will help? What should parents do or not do?

The first thing is not to panic. Love your child. Talk with your child’s pediatrician and seek out a child psychiatrist, if necessary. Many very young children express gender dysphoria and turn out not to be transgender when older. Thus, it is considered risky to support any permanent changes (name, gender reassignment surgery,etc.) until a child is older. Also, with gender identity there are usually underlying conditions, known as co-morbidities, which need to be addressed. These co-morbidities include such things as depression, anxiety and suicidal tendencies. Remember, that supportive parenting practices are key to strengthening a child’s self-esteem. Listen, learn and keep the communication open. Those are the first steps!

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

UNDERSTANDING TRANSGENDER CHILDREN

May 8th, 2015

Children and teenagers are grappling with a very grown-up issue that suddenly has everyone talking because of the Bruce Jenner interview last month. What is it? Gender Identity! It is when a person’s gender identity does not correspond to that person’s biological sex assigned at birth. It is when the body says one thing and the mind clearly says another.

CBS News did a story in 2014 that I recommend you watch. Born this way: Stories of young transgender children looks at what it is like to be young and transgender in America. It begins interviewing 12 year-old Zoey, who says she always knew she was a girl even though she was born a boy. She told interviewer Rita Braver, “I would be like, ‘No, I’m not a boy. I’m a girl. You know, like, I like the color pink, I scream like a girl. I act like a girl. I breathe like a girl. I’m not a boy.””

Zoey’s mom tells about her fear after Zoey told her she was a girl, and how she finally accepted Zoey’s decision to live as an openly-transgender girl. But, make no mistake it wasn’t easy. Although, Zoey tells Braver she was supported by many friends and family, she still endured cruel treatment.

Thirteen year-old Venice, tells Braver how he is taking testosterone because he was born a girl but always felt like a boy. His mom and brother were supportive from the start, but his father struggled with Venice’s decision. His father actually went so far as to hire a therapist to convince Venice to remain a girl. Both parents, even though they were separated, joined a support group for parents of transgender children.

For the parents of six year-old Mati, it started when she was two. Mati, born a boy, wanted to be a girl. Her parents decided that her happiness was most important and so they supported her transition. Many people have criticized their choice. They tell Braver why they feel it was right.

All of these children and their families should be applauded for doing the interview with CBS and Braver. It is their voice that will help others. Click here to watch the interview.

THE BRUCE JENNER INTERVIEW

April 24th, 2015

There is a lot of speculation and curiosity about the highly promoted interview between Diane Sawyer and Bruce Jenner that is running tonight on ABC. I am sure that after the interview there will be a lot of questions. Many Americans do not understand what a life-changing decision it is for a person to struggle with gender identity. The lack of understanding leads to confusion, paranoia, and discrimination. What I hope will come from the Jenner interview is a national dialog that will change the stigma surrounding transgender people in the United States.

Elliot Fukui, TransJustice Coordinator at the Audre Lorde Project, a community organization in New York City, spoke with CBS News recently about some of the common issues and misperceptions facing transgender people today. He says that it is important to support a person’s right to choose their identity, and he suggests a number of ways to do just that. Click here to read the CBS story and Fukui’s recommendations.

I just wrote last week in my blog about the great job that the media is doing bringing transgender characters and actors to television. It is evident that the diversification of today’s TV characters has certainly opened up plenty of discussions. Tonight Jenner will only add to the discussion, and that’s a good thing. I hope tomorrow to wake up and find the national dialog has exploded on this issue. It will only help people to understand gender identity and the need to embrace those who choose to make a change.

Disclaimer

This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

KUDOS TO THE MEDIA FOR BRINGING THE LGBT COMMUNITY MAINSTREAM

April 15th, 2015

Despite increased societal acceptance of homosexuality, coming out for those who are gay, lesbian, bisexual or transgender is rarely an easy task. Two decades ago there were no gays on television, but that has changed. Network TV’s first gay teen came out on the soap opera “One Life to Live”. Today, network television has gone a step further and now is introducing transgender characters. Just last month the soap opera “The Bold and the Beautiful” revealed a surprising story arc that introduced the first transgender character to daytime television; Maya Avant. In a USA Today article, CBS said, “The network says B&B is the only current show on broadcast or cable TV to include a transgender character as part of the regular cast.”

Transgender characters and actors appear in more shows with the most notable being Netflix’s “Orange is the New Black” and Amazon’s “Transparent”.

Following on the heels of B&B, Netflix and Amazon is Discovery Life’s new five-part series – a new reality show, “New Girls on the Block” that premiered last weekend. It is considered the first TV show to follow the lives of transgender women. It explores the lives of these women who are all in different phases of their transition.

It is evident that the diversification of today’s TV characters has certainly opened up plenty of discussions. Social media is abuzz with discussion groups about the characters, the shows and the issues they bring to the forefront. I welcome these shows and their diversity, and I hope that they expand the dialogue, understanding and support to LGBT individuals. Here is a link to the Huffington Post website with a good overview of how TV is changing the landscape for the LGBT community and furthering the very much needed national dialogue.

WHITE HOUSE CALLS FOR END TO LGBT CONVERSION THERAPY

April 13th, 2015

Very interesting call last week by the White House to end the use of “conversion” therapy on LGBT youths. ABC News reported that the Obama administration is calling for an end to the use on LGBT youth of “conversion” therapy.

“This administration supports efforts to ban the use of conversion therapy for minors,” Valerie Jarrett, a senior adviser to President Obama, wrote in a post on the White House website last week. This was triggered by the suicide of Josh “Leelah” Alcorn back in December.

Alcorn was born a boy who was dealing with an inner-struggle since he was four years old that he felt more like a girl. “To put it simply,” he said in a suicide note that posted to Tumblr after he died, “I feel like a girl trapped in a boy’s body, and I’ve felt that way ever since I was 4.” Josh felt his parents were never going to accept him transitioning, and he wrote how as time went on he felt more-and-more isolated. In the end, Alcorn took his life in December by stepping in front of a tractor-trailer on an Ohio Interstate.

In the note, he said, “Please don’t be sad, it’s for the better. The life I would’ve lived isn’t worth living in … because I’m transgender. I could go into detail explaining why I feel that way, but this note is probably going to be lengthy enough as it is. To put it simply, I feel like a girl trapped in a boy’s body, and I’ve felt that way ever since I was 4. I never knew there was a word for that feeling, nor was it possible for a boy to become a girl, so I never told anyone and I just continued to do traditionally ‘boyish’ things to try to fit in.”

Stock photo 123RF

This is a sad situation, but we have to be careful not to be too quick to blame anyone. Sexual transitioning is being discussed more by mainstream media, and that is a good thing, but there is a long way to go. Thanks to social media, there are communities and groups that have formed to support those dealing with gender identity. These groups have also been educating society in general about gender identity and the struggles and hurdles that these individuals face.

Actress Hilary Swank who, 15 years ago, won an Oscar for playing murdered transgender teen Brandon Teena in “Boys Don’t Cry,” said last week on the Meredith Viera show, “I think we have taken strides since that movie……. But we still have a long way to go! ….”

The firestorm on social media set off by the death of Alcorn has called for an end to “transphobia”. The national dialogue has started and that’s a good thing. Let’s remember that “coming out” is a controversial issue and is not easy, especially for adolescents. Despite that you may have trouble accepting it, you should provide emotional support to your loved one. Click here for a list of guidelines for dealing with LGBT teens.

Here is a link to Slate.com with Josh “Leelah” Alcorn’s entire note.

“COMING OUT” IS NEVER EASY

January 8th, 2015

Despite increased societal acceptance of homosexuality, coming out for gay and lesbian teens is rarely an easy task. Many gay and lesbian youths first become aware of being homosexual during adolescence. The American Academy of Pediatrics defines homosexuality as the persistent sexual and emotional attraction to one’s gender and is part of the continuum of sexual expression. While the American Psychiatric Association for many years considered homosexuality an illness, it changed its position in 1973 and re-classified homosexuality as a psychologically viable sexual orientation/expression.

There has been much discussion about the genesis of homosexuality, but it remains unclear how and why sexual orientation evolves. Not all homosexual behavior, especially in early adolescence, is a predictor of future homosexuality. It is common for adult heterosexual males and females to report having had homosexual contact during their adolescent years. The exact percentage of adolescents, who are homosexual, is not known. Many people view homosexuality as a choice, while others feel it is not. This debate rages on.

In August 2014, Daniel Pierce came out to his parents and grandparents. Sadly, the outcome was not good. Pierce decided to start filming the interaction with his family, which quickly turned verbally abusive and physically violent. The five-minute video posted to YouTube went viral garnering nearly four million views. Later Pierce appeared on Dr. Drew to discuss his situation (click here to watch the interview).

One thing, I want to make clear, is that when a child does come out it affects the entire family. A lot of support, love and understanding is needed for all involved. When a person decides to “come out” it is important to know what resources are available for support for all. It is important to remember that when a child “comes out” there is a process that parents need to go through, too. They often are perplexed, shocked, angry and scared and can’t understand it. They need their support. All parents want to love their children and support them but often anxiety interferes. With the proper understanding of their particular child and homosexuality, they can do just that. There are groups like PFLAG that can help. PFLAG’s vision and mission are as follows:

Our Vision. PFLAG envisions a world where diversity is celebrated and all people are respected, valued, and affirmed inclusive of their sexual orientation, gender identity, and gender expression.

Our Mission. By meeting people where they are and collaborating with others, PFLAG realizes its vision through:

Support for families, allies and people who are LGBTQ
Education for ourselves and others about the unique issues and challenges facing people who are LGBTQ
Advocacy in our communities to change attitudes and create policies and laws that achieve full equality for people who are LGBTQ

In our culture, homosexual youths have to deal with a number of mental health issues. The ongoing discrimination fuels anxiety, depression and other stress-related mental health problems among LGB people. My next blog will specifically look at some of these issues.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.