Treating Transgender Youth

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ABSTRACT

Site a statistical or longitudinal study in Abstract (Intro & Summary)
Keywords: Transgender, Gender Nonconforming, Gender Queer, Gender Non-Binary, Gender Fluid, Gender Minority, Gender-Affirmative Care, Puberty Blockers, Hormone Blockers, Puberty Suppression, Gender-Affirming Hormones

INTRODUCTION

Gender identity refers to an individual’s psychological sense of one’s gender as male, female, or other (Connolly et al., 2016). Gender identity is understood to be a complex intersection of biology, development, and socialization within a cultural context and research suggests that children develop a strong sense of gender identity at a young age, primarily influenced by cognitions and emotions, rather than by physically identifiable sex characteristics (Hidalgo et al., 2013). Because gender identity develops between 1.5 – 3 years old (with sexual orientation developing as early as age 8), understanding how to work with transgender youth is essential for any professional working with children in the medical or mental health fields (Keo-Meier et al., 2018).
Transgender refers to individuals whose sex assigned at birth is different from their current gender identity or gender expression (Turban & Ehrensaft, 2017).

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The term transgender has been used as an umbrella term to describe all individuals who experience incongruence between their internal gender identity and birth-assigned sex, however this term also includes people who identify in between boy/girl or man/woman (Turban, 2017). New terms are emerging, including gender nonconforming, gender fluid, gender queer or gender non-binary that capture the broader group of gender-variant youth, beyond only individuals who identify as transgender (Connolly et al., 2016).

Prevalence of TGNC Youth and Psychiatric Co-Morbidity

The size of the transgender or gender nonconforming (TGNC) population has been historically difficult to measure and likely underestimated due to the range of stigma, discrimination and prejudice these individuals experience, which reduces self-identifying substantially (Cicero & Wesp, 2017). According to recent research, the prevalence of young people who identify as TGNC in the United States is between 0.17% – 1.3%, significantly higher than previously estimated (Connolly et al. 2016). In another important large school-based study of adolescents to determine the prevalence of TGNC identity in Minnesota was 2.7% and varied significantly across gender, race/ethnicity, and economic indicators (Eisenberg et al., 2017). Other previous research identified the rate of adults who identify as transgender as closer to 0.6% (Timmins et al., 2017).

With additional research designed to specifically identify TGNC youth found for those seeking gender-affirming surgeries, middle and high school students were as high as 1% and 0.17% of college students vs. 0.015% of adults (Connolly et al., 2016). While incidence may still be fairly low as percentage of overall population, there has been a significant increase in the number of TGNC youth seeking medical and mental health services in the past decade (Shumer et al., 2016). As such, the mental health field is at a crossroads in defining standards of care given the ever-evolving understanding of gender development (Edwards-Leeper et al.,

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