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Gender + Sexuality

Gender Affirming-Care, Explained

A social worker and therapist on common misconceptions and giving trans people the support they need.

Gio Dolcecore 21 Mar 2024The Conversation

Gio Dolcecore is an assistant professor of social work at Mount Royal University in Calgary. This article was originally published in the Conversation.

In late January, Alberta Premier Danielle Smith unveiled policies on gender-affirming care and parental rights. These policies want to change access to medical treatments, participation in athletics and whether transgender children can use preferred pronouns and names in school.

Meanwhile, op-eds in newspapers have brought attention to how professionals are supporting transgender children and the long-term effects of medical interventions. And suggested that “adults can live with the consequences, but inexperienced children can’t.”

This suggests medical professionals are not assessing maturity and readiness in transgender children, and also that children should not be transitioning prior to adulthood.

As a registered clinical social worker and registered marriage and family therapist who works primarily with the 2SLGBTQIA+ population, I want to explain gender-affirming care and how professionals use it. I also want to discuss detransition, because too many people misunderstand and misuse the term.

There are several important assessments that must be considered prior to addressing maturity. For gender-affirming care, a child has to be assessed as a mature minor, which is a rigorous assessment completed by a professional such as a psychologist or social worker.

Gender-affirming care

According to the Canadian Paediatric Society, gender-affirming care assesses psychological, social, medical and surgical options for gender-diverse people. These assessments explore an individual’s personal, familial and environmental histories, as well as their mental health and physical health. Practitioners use this knowledge to best understand one’s functioning and strengths, and to give people the kind of support they need.

Although medical doctors may be the first point of contact for children exploring their gender identity, many other professions can provide gender-affirming care, such as psychologists, social workers, teachers, counsellors and recreational coaches.

Allowing children to express gender creatively is one of the first steps explored by mental health experts when working with transgender children, youth and their families. Gender creativity is a term used to identify the fluidity of gender; how one’s identity is not set in stone and can change as we learn more about ourselves.

Allowing a child to express independent thought and creativity with gender expression will not lead children to assume they are in need of medical interventions. On the contrary, as a professional, these interventions are used to support a child’s understanding of their options through improving self confidence and self-esteem.

Methods can include social play, such as learning more about their own likes, forms of expression and ultimately exploring what makes them happy. The intention behind this is to help children build confidence and self worth, allowing them to engage in social settings authentically without fearing social consequence.

Importance of support

It is normal for us to compare ourselves to others, or to what we understand of social customs and rules. These social customs suggest our assigned sex at birth must match socially regulated forms of gender expression.

Transitioning begins the moment one confirms to themselves that their identity is different from these social rules. This doesn’t mean everyone who feels this way will go on to socially or medically transition.

Once a child can identify that they feel a certain way, it is vital for them to receive support from parents, caregivers, teachers and their broader community. Gender non-conforming young people are at risk for mental health struggles such as anxiety, depression, self-harm and attempted suicide.

One possible explanation for this could be minority stress, which is the distinct, chronic stressors minorities experience related to their identity, including victimization, prejudice and discrimination.

It is important to think critically about the social and political contexts that limit gender expression, because it impacts everyone, and can directly harm gender-diverse children. Considering this and minority stress, this is why it is important to allow children the space and freedom to freely express themselves, so that they can understand gender expression has more than two options: conform to social expectations or medically transition.

When children are provided gender-affirming care, mental health professionals support them in better understanding their emotions. This involves identifying feelings and learning how to emotionally regulate. This also includes addressing negative beliefs about their feelings, normalizing emotional responses and supporting children to become more self-compassionate.

Some believe mental health professionals focus on gender dysphoria when providing such care to children and youth. This is the feeling of uneasiness or distress because your gender identity does not match your assigned sex at birth.

However, children and youth are provided with various forms of support prior to medical interventions being used. Medical interventions are oftentimes the last method a child is provided, and when it is provided, some have described it as life-saving.

Practitioners use gender-affirming care to promote gender euphoria — the joy of aligning gender identity with gender expression. This is done by supporting children in finding confidence and self-worth by promoting their social and psychological well-being.

What is detransitioning?

Some gender-diverse children will need medical interventions but that doesn’t mean they have to persist for a lifetime. By providing children and youth access to medical interventions, professionals are addressing the severity of dysfunction caused by gender dysphoria.

“Detransition” is a term used to describe those who have undergone medical and/or surgical interventions, and then reverted back. There is evidence showing people undergo corrective approaches after medical or surgical interventions due to discrimination, stigma and family pressure.

It is crucial to understand that transgender individuals who use medical and surgical means for a period of time and stop, may not be detransitioning.

There are individuals who identify as non-binary who begin medical interventions, at a limited dose or for a duration of time, instead of committing life long. In my practice, I have seen many individuals begin hormone treatment and with the support of their doctor change the dosage as they continue to explore their gender identity.

There is a need for further research exploring detransition, especially in terms of how therapists can best support individuals who decide to stop or change their medical intervention plans with their doctors.

Ultimately, gender-affirming care is about providing people with the support they need. To help them see themselves in ways that promote joy, confidence and happiness. It is not about pathologizing gender expression.

Gender transition is not about fitting into preset ideals, but rather, finding joy in day-to-day experiences that is cultivated by our happiness, confidence and sense of belonging.The Conversation  [Tyee]

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