Risks of Hormonal Therapy for Teens Experiencing Gender Dysphoria

Review of a Peer-Reviewed Article
The article by Kaltiala-Heino, Bergman, Tyolajarvi and Frisen (2018) examines the literature available on gender dysphoria (GD) and the need to better understand the phenomenon of adolescents seeking hormonal treatment as teens while having psychiatric comorbidity. Because of a lack of understanding of the role that GD plays in the current trend of requesting hormonal therapy, the authors of this article saw a need to consolidate available information on GD, hormonal therapy, and adolescents with psychiatric comorbidity receiving hormonal therapy. The aim of the article is to provide more insight into what is actually known about this phenomenon and how doctors, psychologists, and patients should proceed. The article is well-written and focused on explaining the major issues at play and why they are important. As such, it should be viewed as an important source of information that is both non-biased and informative. As there is much that is non-scholarly in the debate or rather promotion of gender identity politics, this article fills a hole in the conversation by supplying much needed reference to legitimately scholarly data that can be used to frame the conversation in a properly scientific, academic and non-prejudicial way.
The study begins by defining gender dysphoria, which is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a real psychological disorder. The definition supplied by the DSM-5 and paraphrased by Kaltiala-Heino et al. (2018) is this: gender dysphoria is a psychological condition wherein the individual experiences a lack of congruence between his or her biological sex and the gender with which the individual self-identifies (p. 31). In other words, any individual who identifies as a gender other than that which is represented by the sex the person was born with would fit the definition of gender dysphoria, according to the DSM-5. Yet, such people are not being diagnosed with gender dysphoria in the mainstream media or in much of the medical world. Instead, they are celebrated as pioneers in the field of gender politics for taking steps in asserting the gender with which they self-identify and altering in some cases their biological sex to achieve congruence.
The authors then focus on what the International Classification of Diseases (ICD) says about transsexualism: the ICD is described as defining transsexualism as a disease in which a person is uncomfortable with his or her natural sex and wants to change it so as to be more biologically in line with the gender with which the person identifies. The purpose of beginning the study with these two definitions is important because it grounds the study within a medical understanding of the psychology of gender dysphoria and transsexualism. These definitions are used throughout the study.
The authors then focus on possible theories for why these states come about. They note that researchers today are positing that bio-psycho-social processes are at the root of the issue (Kaltiala-Heino et al., 2018, p. 32). They then note that treatment is intensifying in puberty stages of development and that there are ethical issues of concern still being debated in the medical community as a result of adolescent treatment of these issues through hormonal therapy. The authors note that psychiatric disorders tend to be common among individuals seeking hormonal therapy. They also look at the possibility that developmental challenges are not being met. For example, the developmental stages proposed by Erikson focus on clear obstacles that must be overcome during important developmental stages of life. If these conflicts are not resolved, the development of the individual can be impeded and have negative consequences on the person’s mental and physical health.
The methodology used to collect the data for the study is not discussed in detail; instead, the authors simply state that they are conducting a review of the relevant information published on the topic. They do not mention whether they are conducting a simple literature review or a systematic review. There is no indication that their review is systematic. However, they do reference more than 100 sources, which implies that a great deal of literature was consulted. The authors nonetheless conclude that there is very little data available on the experiences of adolescents with GD (p. 38). This conclusion raises the question of whether this is actually true and, if so, whether more information needs to be collected on this topic before researchers, psychologists, and medical doctors begin using hormonal therapy as a means of treating GD. If GD is being associated with psychological comorbidity, to what extent are the other mental health issues causing or appearing as a result of the individual’s GD? Is there a causal relationship or simply a correlational one?
These are the questions that are not answered by the study’s methodology. There is no hypothesis used or test conducted of variables. The study is exploratory in nature and meant to concisely represent what other researchers have published on the issue in the past. It aims to show where the discussion is heading and what possible areas remain to be focused on to ensure that the issues are addressed ethically. The need to better understand the experiences of adolescents with GD and to have both qualitative and quantitative data on the subject is expressed by Kaltiala-Heino et al. (2018) in their conclusion (p. 38). This is one of the most important findings of the article and it shows how much potentially undue emphasis is being put on gender identity politics when the actual understanding of the mental health status of these individuals is unclear at best. Individuals experiencing GD may need more comprehensive psychological assessment and may benefit from a family systems therapeutic approach, according to Kaltiala-Heino et al. (2018, p. 38).
If not addressed in more cautious manner, the authors argue that treating adolescents for GD could cause irreparable psychological and biological harm on the patients. In other words, professionals in the field are rushing too headlong and too fast into a mode of treatment that is not based upon any conclusive evidence of having a positive or beneficial impact on the patient’s bio-psycho-social health (p. 38). The authors argue that childhood transition to adulthood is fraught with many perils and that transitioning through a period of discomfort and uncertainty is normal and part of the conflict of that developmental stage that all adolescents go through, as Erikson has pointed out.
In conclusion, the study is a very good one in terms of asking unanswered questions about the assumptions often made and acted upon by researchers, academics, medical doctors and psychologists with respect to treating gender dysphoria and transsexualism. These are issues that should be considered sensitively but also ethically. To engage in a treatment method that could cause more harm than good without first understanding the full spectrum of the patient’s mental health status is to invite scrutiny, and the authors of this text are applying that scrutiny to an issue where it is long overdue. The document is well-researched and well-written and concludes with an appeal for caution and increased understanding of the stakes for adolescents if the present course continues.
References
Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics, 9, 31.