Gender Dysphoria in Adolescents: Review of Kaltiala-Heino et al.

Introduction and Overview of the Article

The article by Kaltiala-Heino, Bergman, Työläjärvi, and Frisén (2018) examines the literature available on gender dysphoria (GD) and the need to better understand the phenomenon of adolescents seeking hormonal treatment while presenting with psychiatric comorbidity. Because of a lack of understanding of the role GD plays in the current trend of requesting hormonal therapy, the authors saw a need to consolidate available information on GD, hormonal therapy, and adolescents with psychiatric comorbidity who are receiving hormonal treatment. The aim of the article is to provide greater 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. It should be viewed as an important source of information that is both unbiased and informative. As there is much that is non-scholarly in the debate — or rather the promotion — of gender identity politics, this article fills a gap in the conversation by supplying much-needed reference to legitimately scholarly data that can be used to frame the discussion in a properly scientific, academic, and non-prejudicial way.

Defining Gender Dysphoria and Transsexualism

The study begins by defining gender dysphoria, which is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a recognized psychological disorder. The definition supplied by the DSM-5 and paraphrased by Kaltiala-Heino et al. (2018) is as follows: 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 represented by their birth sex would fit the DSM-5 definition of gender dysphoria. Yet many such individuals are not being diagnosed with gender dysphoria in mainstream media or in much of the medical world. Instead, they are often celebrated as pioneers in the field of gender politics for taking steps to assert the gender with which they self-identify, and in some cases for altering their biological sex to achieve congruence.

The authors then turn to what the International Classification of Diseases (ICD) says about transsexualism. The ICD defines transsexualism as a condition in which a person is uncomfortable with his or her natural sex and wishes to change it in order to be more biologically aligned with the gender with which the person identifies. The purpose of beginning the study with these two definitions is significant because it grounds the discussion within a medical understanding of the psychology of gender dysphoria and transsexualism — definitions that are used consistently throughout the study.

Theories of Causation and Developmental Considerations

The authors then address possible theories for why these states arise. 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 also note that treatment is intensifying during the puberty stages of development and that ethical concerns are still being debated in the medical community as a result of adolescent treatment through hormonal therapy. The authors further note that psychiatric disorders tend to be common among individuals seeking hormonal therapy.

The article also considers the possibility that developmental challenges are going unmet. For example, the developmental stages proposed by Erik Erikson identify clear conflicts that must be resolved during important phases of life. If these conflicts are not resolved, an individual's development can be impeded, with negative consequences for both mental and physical health. The authors invoke this framework to underscore the complexity of adolescent experience and the risks of pursuing irreversible interventions before developmental processes have run their course.

Methodology and Evidence Gaps

The methodology used to collect data for the study is not discussed in detail. The authors simply state that they are conducting a review of relevant published information on the topic, without specifying whether the review is a simple literature review or a systematic one. There is no indication that their review is systematic. However, they do reference more than 100 sources, which implies that a substantial body 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 important questions: Is this scarcity of data actually the case, and if so, should more information be collected before researchers, psychologists, and medical doctors continue using hormonal therapy as a means of treating GD? If GD is frequently associated with psychological comorbidity, to what extent are 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 questions are not answered by the study's methodology. No hypothesis is tested and no variables are examined. The study is exploratory in nature, intended to concisely represent what other researchers have published and to identify where discussion is heading. It aims to show what areas remain to be addressed in order to ensure that the issues are handled ethically. The need for both qualitative and quantitative data on adolescent GD experiences is explicitly 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 illustrates how much potentially undue emphasis is being placed on gender identity politics when the actual understanding of these individuals' mental health status remains unclear. Individuals experiencing GD may benefit from more comprehensive psychological assessment and from a family systems therapeutic approach, according to Kaltiala-Heino et al. (2018, p. 38).

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 a patient's mental health status, is to invite scrutiny — and the authors of this article are applying that scrutiny to an issue where it is long overdue. The document is well-researched and well-written, and it concludes with an appeal for caution and for increased understanding of the stakes for adolescents if the present course of practice continues unchecked.

References

Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: Current perspectives. Adolescent Health, Medicine and Therapeutics, 9, 31.