Navigating the Controversy: Understanding and Managing Gender Dysphoria in Young People
Dr Philip Morris AM
Introduction: Gender dysphoria is a complex and controversial area within medical practice, particularly in Western countries. The intersection of biological sex and gender identity presents challenges that demand careful consideration and ethical reflection. Prof Philip Morris AM, a Distinguished Fellow of the Pacific Rim College of Psychiatrists and President of the Australian National Association of Practising Psychiatrists (NAPP), sheds light on the multifaceted nature of gender dysphoria, advocating for a comprehensive and cautious approach in its management.
Defining Gender Dysphoria: The dichotomy between biological sex and gender identity is a central theme in discussions surrounding gender dysphoria. Recognized by the International Classification of Diseases (ICD-11) as gender incongruence and by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as gender dysphoria, this condition manifests as a misalignment between one’s assigned sex at birth and their deeply-felt gender identity. This incongruence is acknowledged as a spectrum, ranging from what might be considered normal variation to abnormalities that some may label as ‘unnatural.’
Navigating the Spectrum: Prof Morris draws parallels between the spectrum of gender dysphoria and the historical model used for understanding homosexuality. Unlike same sex attraction, gender dysphoria involves medical interventions for transitioning to the desired gender, and doctors are reminded of their ethical obligations, rooted in the Hippocratic Oath—to “first do no harm before doing good.”
Critical Considerations in Gender Dysphoria Treatment: The management of gender dysphoria prompts critical questions about appropriateness, causality, effectiveness, safety, and informed consent. Prof Morris emphasizes the lack of long-term outcome studies and the questions about the reversible and irreversible effects of medical interventions such as puberty blockers, gender-affirming hormones, and sexual reassignment surgery. The emotional and cognitive capacity of young individuals to make lifelong decisions is also a paramount concern.
The NAPP Guide’s Approach: In contrast to a strictly affirmation approach to medical transition, the NAPP Guide advocates for a compassionate, caring, and cautious approach. A comprehensive bio-psycho-social assessment is deemed essential before any medical intervention. Prof Morris stresses the importance of recognizing gender dysphoria as both a symptom and a syndrome, urging a focus on psycho-social interventions—such as psychotherapy, psychoeducation, individual therapy, school-home liaison, and family therapy—as first-line treatments.
The Role of Psychotherapy: The NAPP Guide places a strong emphasis on psychotherapy as a respectful, supportive, and exploratory process for children and adolescents experiencing gender dysphoria. Prof Morris notes that individuals who undergo medical transition sometimes express regret and a desire to de-transition, highlighting the need for careful consideration and long-term support.
Informed Consent and Cautious Guidance: Parents and children are urged to be fully informed about the potential risks associated with gender transition, and their consent is considered pivotal. The cautious approach advocated by NAPP aligns with general clinical guidance from national treatment advisory bodies in various countries (UK, Sweden, Norway, Denmark. Finland, and France)
Conclusion: Gender dysphoria demands a nuanced and empathetic approach. Prof Morris and the NAPP Guide provide valuable insights into the complexities of this condition, emphasizing the importance of comprehensive assessment, psycho-social interventions, and careful consideration of potential long-term consequences. In a landscape where controversy persists, a balanced and thoughtful approach remains paramount in supporting young individuals navigating their gender identity.