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Not conforming to gender is not a disorder, says group
September 27th, 2011
01:57 PM ET

Not conforming to gender is not a disorder, says group

People who do not conform to their gender roles or cultural expectations do not have a disorder, declared the health association for professionals who treat transgender patients.

The World Professional Association for Transgender Health, composed of doctors, psychologists and others professionals, updated its standard of care for the first time in 10 years and announced its revisions this week at its conference in Atlanta, Georgia.  This international group, called WPATH, meets every two years.

“People who don’t fit cultural expectations of what it means to be male or female are not inherently disordered,” said Eli Coleman, who chaired a committee to update the WPATH standard of care. “Society stigmatizes these individuals and we have prejudice and discrimination. This causes a lot of people distress.”

Transgender kids: Painful quest to be who they are

But some people have gender dysphoria, a condition in which they feel uncomfortable with their bodies because they don’t match their gender.  This causes mental distress that can be relieved by making changes to their appearance, body or hormones, Coleman said.  At other times, gender dysphoria does not need medical interventions.

“It’s not a lifetime diagnosis,” said Coleman, professor and director of Human Sexuality at the University of Minnesota Medical School.  “Some people learn that they can feel comfortable if they’re allowed to express their gender in some manner that doesn’t necessarily require hormonal or surgical sex requirements.”

WPATH also called reparative therapies – those that seek to change the person - “unethical.” Coleman likening them to treatments that were designed to turn gay people into heterosexuals.

“Treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success, particularly in the long term,” the guidelines stated.  “Such treatment is no longer considered ethical.”

Also another controversial issue around transgender health is when children should receive medical interventions.

Hormone treatments prevent children from experiencing puberty of their sex. Girls who feel more like boys take hormone-suppressing medications so they will not develop breasts and start menstruating. Boys who identify as girls can take blockers to avoid developing broad shoulders, deep voice and facial hair. The drugs put their puberty on pause, so they can figure out whether to transition gender.

The protocol is that hormonal interventions should not be given to a child until he or she has started puberty and has a documented history of gender dysphoria, Coleman said.  The guidelines do not state an age when it’s OK to start hormone-blockers, because puberty starts at different ages for all kids.

Here are the guidelines for hormone treatment for teens:

•        The teenager has a long-lasting pattern of gender nonconformity or gender dysphoria

•        Gender dysphoria emerged or worsened with the onset of puberty. Tanner Stages are predictable sequences of puberty.  Children should be at least be at Tanner Stage 2, in which boys will get enlarging scrotum and testes, and girls will see the signs of breast development.

•        Any co-existing psychological, medical, or social problems that could interfere with treatment have been addressed.

•        The teenager has given informed consent or parents or guardians have consented to treatment and support the individual.

The Endocrine Society also has recommendations - for endocrine specialists and also advises that hormone blockers start only after girls and boys show signs of physical changes confirmed by levels of estrogen and testosterone.

Hormone blockers are reversible, because once a child stops taking drugs,  natural puberty begins.

If a teen decides he or she wants to transition to the other gender, that individual can elect to receive either estrogen or testosterone.  The use of cross-gender hormones is partially irreversible and that decision should be made with the teenager, the family and the treatment team.

But irreversible interventions like gender reassignment surgery should be held off until adulthood, the group recommended.


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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.