ÇOCUK VE ERGENLERDE CİNSİYET HOŞNUTSUZLUĞU

Cinsiyet Hoşnutsuzluğu (CH), kişinin yaşadığı ya da dışa vurduğu cinsel kimlikle, onun için doğumda belirlenen cinsiyet kimliği arasında belirgin bir uyuşmazlık olması olarak tanımlanmaktadır. Dünya genelinde bu durumdaki çocuk ve ergenlere yönelik ortak yaklaşım kılavuzları oluşturulmaya çalışılmaktadır. Son yapılan çalışmalar cinsiyet hoşnutsuzluğu için bütüncül bir model olan biyo-psiko-sosyal modelin önemini vurgulamaktadır. Cinsiyet hoşnutsuzluğu olan gençlerde, bir azınlık olmanın verdiği stres ve deneyimlenen cinsiyet ile eşleşmeyen bir bedende yaşamanın verdiği sıkıntı sonucunda yüksek oranlarda duygusal ve davranışsal sorunlar saptanmaktadır. Cinsiyet hoşnutsuzluğu olan gençlere yönelik değerlendirme süreçleri karmaşıktır. Bu süreçte Çocuk ve Ergen Ruh Sağlığı ile ilgili uzman bir hekim tarafından cinsiyete özgü belirtiler ve olası psikopatolojilere yönelik birçok önemli faktör göz önünde bulundurulmalıdır. Tedavi kılavuzlarına göre farklı yaş gruplarında tedavi başlangıcı ile ilgili farklılıklar bulunmakla birlikte, klinikler arasında uygulanan farklı yaklaşımlar açısından henüz görüş birliği sağlanamamıştır.

GENDER DYSPHORIA IN CHILDREN AND ADOLESCENTS

Gender dysphoria (GD) is defined as an apparent incongruence between assigned sex and experienced gender. Scholars across the world are attempting to achieve guidelines for a universal approach for children and adolescents experiencing GD. Recent studies have highlighted the importance of the biopsychosocial model as a holistic template for gender dysphoria. Youth with gender dysphoria often evince emotional and behavioral problems resulting from the stress of being marginalized and being forced to inhabit a body that does not match the experienced gender. The assessment processes for young people with GD are complex: numerous crucial factors regarding gender identity and possible psychopathologies must be contemplated by a child and adolescent psychiatrist. Treatment guidelines establish different protocols of beginning treatment for different age groups; however, consensus has not yet been achieved in approaches applied to GD in discrete clinics.

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  • 1. Akgül GY, Budak BY, Ayaz AB, Fiş NP. Cinsiyet Hoşnutsuzluğu Olan Ergenlerin Psikiyatrik İzlemleri: Marmara Üniversitesi Tıp Fakültesi Çocuk Psikiyatri Kliniği Deneyimi. Turk J Child Adolesc Ment Health 2020;27(3):156-62.
  • 2. Hsieh S, Leininger J. Resource list: Clinical care programs for gender-nonconforming children and adolescents. Pediatric Annals 2014;43:238-44. [CrossRef]
  • 3. Janssen A, Leibowitz S (Eds.). Affirmative Mental Health Care for Transgender and Gender Diverse Youth: A Clinical Guide. Springer, 2018. [CrossRef] 4. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gendernonconforming people, version 7. International Journal of Transgenderism 2012;13(4):165-232. [CrossRef]
  • 5. Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L. Gender dysphoria in adolescence: current perspectives. Adolescent Health, Medicine and Therapeutics 2018;9:31. [CrossRef]
  • 6. Turban JL, de Vries ALC, Zucker KJ, Shadianloo S. Transgender and gender non-conforming youth. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions 2018.
  • 7. Bockting W. From gender dichotomy to gender diversity: implications for psychotherapy and the real life experience. Sexologies 2008;17:211e24. [CrossRef]
  • 8. Cohen-Kettenis PT, Klink D. Adolescents with gender dysphoria. Best Practice & Research Clinical Endocrinology & Metabolism 2015;29(3):485-95. [CrossRef]
  • 9. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth ed. Arlington, VA, American Psychiatric Press, 2013. [CrossRef]
  • 10. Clark TC, Lucassen MFG, Bullen P, et al. The health and wellbeing of transgender high school students: results from the New Zealand adolescent health survey (Youth’12). Journal of Adolescent Health 2014;55:93-9. [CrossRef]
  • 11. Arcelus J, Bouman WP, Van Den Noortgate W, et al. Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry 2015;30:807-15. [CrossRef]
  • 12. Steensma TD, Kreukels BP, de Vries AL, Cohen-Kettenis PT. Gender identity development in adolescence. Horm Behav 2013;64:288-97. [CrossRef]
  • 13. Coolidge FL, Thede LL, Young SE. The heritability of gender identity disorder in a child and adolescent twin sample. Behavior Genetics 2002;32:251-7. [CrossRef]
  • 14. Erickson-Schroth L. Update on the biology of transgender identity. Journal of Gay & Lesbian Mental Health 2013;17(2);150-74. [CrossRef]
  • 15. Baba T, Endo T, Honnma H, Kitajima Y, Hayashi T, Ikeda, H, et al. Association between polycystic ovary syndrome and female-to-male transsexuality. Human Reproduction 2007;22:1011-6. [CrossRef]
  • 16. Ruigrok AN, Salimi-Khorshidi G, Lai MC, et al. A metaanalysis of sex differences in human brain structure. Neuroscience & Biobehavioral Reviews 2014;39:34-50. [CrossRef]
  • 17. Guillamon A, Junque C, Gomez-Gil E. A review of the status of brain structure research in transsexualism. Archives of Sexual Behavior 2016. [CrossRef]
  • 18. Mueller SC, De Cuypere G, T’Sjoen G. Transgender research in the 21st century: a selective critical review from a neurocognitive perspective. American Journal of Psychiatry, 2017;174(12):1155-62. [CrossRef]
  • 19. Berglund H, Lindstrom P, Dhejne-Helmy C, et al. Maletofemale transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids. Cerebra Cortex 2008;18:1900-8. [CrossRef]
  • 20. Schoning S, Engelien A, Bauer C, et al. Neuroimaging differences in spatial cognition between men and male-tofemale transsexuals before and during hormone therapy. Journal of Sexual Medicine 2010;7:1858-67. [CrossRef]
  • 21. Soleman RS, Schagen SE, Veltman DJ, et al. Sex differences in verbal fluency during adolescence: A functional magnetic resonance imaging study in gender dysphoric and control boys and girls. Journal of Sexual Medicine 2013;10:1969-77. [CrossRef]
  • 22. Lee JW. Psychology of gender identity. Nova Publishers. 2005.
  • 23. Martin CL, Ruble DN. Patterns of gender development. Annual Review of Psychology 2010;61:353-81. [CrossRef]
  • 24. Steensma TD, McGuire JK, Kreukels BP, Beekman AJ, Cohen-Kettenis PT. Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry 2013;52(6):582- 90. [CrossRef]
  • 25. Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L. Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics 2018;9:31. [CrossRef]
  • 26. Ehrensaft D. Raising girlyboys: A parent’s perspective. Studies in Gender and Sexuality 2007;8(3):269-302. [CrossRef]
  • 27. Drescher J. Controversies in gender diagnoses. LGBT Health 2013;1(1):10-14. [CrossRef] 28. Steensma TD, Biemond R, de Boer F, Cohen-Kettenis PT. Desisting and persisting gender dysphoria after childhood: a qualitative followup study. Clin Child Psychol Psychiatry. 2011;16(4):499-516. [CrossRef]
  • 29. Ristori J, Steensma TD. Gender dysphoria in childhood. Int Rev Psychiatry 2016;28(1):13-20. [CrossRef]
  • 30. Cohen-Kettenis PT, Pfäfflin F. Transgenderism and intersexuality in childhood and adolescence: Making Choices 2013;(Vol. 46). Sage.
  • 31. Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health 2015;9(1):9. [CrossRef]
  • 32. Zucker KJ, Bradley SJ, Owen-Anderson A, Kibblewhite SJ, Wood H, Singh D, Choi, K. Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. Journal of Sex & Marital Therapy 2012;38(2):151-89. [CrossRef]
  • 33. de Vries AL, Doreleijers TA, Steensma TD, Cohen- Kettenis PT. Psychiatric comorbidity in gender dysphoric adolescents. J Child Psychol Psychiatry 2011;52(11):1195- 202. [CrossRef]
  • 34. Wallien MS, Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry 2007;46(10):1307-14. [CrossRef]
  • 35. Yildirim B, Perdahli Fis N, Yazkan Akgul G, Ayaz AB. Gender dysphoria and attention problems: possible clue for biological underpinnings. Psychiatry and Clinical Psychopharmacology 2017;27(3):283-90. [CrossRef]
  • 36. Holt V, Skagerberg E, Dunsford M. Young people with features of gender dysphoria: Demographics and associated difficulties. Clinical Child Psychology and Psychiatry 2016;21(1):108-18. [CrossRef]
  • 37. Skagerberg E, Carmichael P. Internalizing and externalizing behaviors in a group of young people with gender dysphoria. International Journal of Transgenderism 2013;14:105-12. [CrossRef]
  • 38. Zucker KJ. Adolescents with gender dysphoria: Reflections on some contemporary clinical and research issues. Archives of Sexual Behavior 2019;48(7):1983-92. [CrossRef]
  • 39. de Graaf NM, Steensma TD, Carmichael P, Cohen- Kettenis PT, de Vries ALC, Kreukels BPC, et al. Suicidality in adolescents diagnosed with gender dysphoria: A crossnational, cross-clinic comparative analysis. Paper presented at the meeting of the European Association for Transgender Health, Rome, Italy, 2019.
  • 40. De Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer- Onnes IA, Doreleijers TA. Autism spectrum disorders in gender dysphoric children and adolescents. Journal of Autism and Developmental Disorders 2010;40(8):930-6. [CrossRef]
  • 41. Akgül GY, Ayaz AB, Yildirim B, Fis NP. Autistic traits and executive functions in children and adolescents with gender dysphoria. Journal of Sex & Marital Therapy 2018;44(7):619- 26. [CrossRef]
  • 42. Van Der Miesen AI, Hurley H, De Vries AL. Gender dysphoria and autism spectrum disorder: A narrative review. International Review of Psychiatry 2016;28(1):70-80. [CrossRef]
  • 43. de Vries ALC, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality 2012;59:301-20. [CrossRef]
  • 44. Ehrensaft D. From gender identity disorder to gender identity creativity: True gender self child therapy. Journal of Homosexuality 2012;59:337-56. [CrossRef]
  • 45. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/genderincongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2017;102(11):3869-903. [CrossRef]