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Nervenheilkunde 2022; 41(05): 309-319
DOI: 10.1055/a-1796-5491
Schwerpunkt

Geschlechtsinkongruenz im Kindes- und Jugendalter

Ethische Maßgaben und aktuelle BehandlungsempfehlungenGender incongruence in childhood and adolescenceEthical requirements and current treatment recommendations
Georg Romer Romer
1   Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster (UKM)
,
Thomas Lempp
2   Clementine Kinderhospital, Frankfurt am Main
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ZUSAMMENFASSUNG

In diesem Artikel wird ein praxisnaher Überblick über den aktuellen Wissensstand zur Geschlechtsinkongruenz und Geschlechtsdysphorie im Kindes- und Jugendalter dargestellt. Ausgehend von dem in der ICD-11 vollzogenen Paradigmenwechsel, wonach die Geschlechtsinkongruenz keine psychische Störung ist, werden die wichtigsten sich daraus ergebenden Neuerungen für den professionellen Umgang mit Geschlechtsdiversität diskutiert. Im Vordergrund steht dabei die Unterstützung geschlechtsdiverser Personen, ein Leben im empfundenen Geschlecht zu führen. Bei einer Geschlechtsinkongruenz im Kindesalter besteht meist kein weiterer Behandlungsbedarf. Im Jugendalter kann die fortschreitende körperliche Reifung zu einem geschlechtsdysphorischen Leidensdruck führen, der neben unterstützender Psychotherapie häufig die Empfehlung für gestufte somatomedizinische Interventionen zum Aufhalten der pubertären Reifung und zur Geschlechtsangleichung begründet. Die Voraussetzungen für individuelle Indikationen werden gemeinsam mit den hierbei zu berücksichtigenden ethischen Maßgaben ausgeführt.

ABSTRACT

This article presents a practical overview of the current state of knowledge on gender incongruence and gender dysphoria in childhood and adolescence. Based on the paradigm shift in the ICD-11, according to which gender incongruence is not a mental disorder, the most important resulting innovations for the professional handling of gender diversity are discussed. The focus is on supporting gender diverse persons to live their lives in their perceived gender. In the case of gender incongruence in childhood, there is usually no need for further treatment. In adolescence, progressive physical maturation can lead to gender dysphoric distress which, in addition to supportive psychotherapy, necessitates staged somato-medical interventions to halt pubertal maturation and for gender reassignment. The prerequisites for individual indications are explained together with the ethical requirements to be considered.

Schlüsselwörter

Geschlechtsinkongruenz - Geschlechtsdysphorie - Kinder und Jugendliche - Behandlungsempfehlungen

Key words

Gender incongruence - gender dysphoria - children and adolescence - treatment recommendations


Publication History

Article published online:
05 May 2022

© 2022. Thieme. All rights reserved.

© Georg Thieme Verlag KG Stuttgart · New York
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  • Literatur

  • 1 Romer G, Möller B. Geschlechtsinkongruenz und Geschlechtsdysphorie im Jugendalter. Ärztliche Psychotherapie 2020; 15 (02) 87-94
    CrossrefGoogle Scholar
  • 2 WHO. ICD-11: International Classification of Diseases, 11th Revision. The global standard for diagnostic health information. 2022 https://icd.who.int/en
  • 3 Nieder TO, Strauß B.. S3-Leitlinie zur Diagnostik, Beratung und Behandlung im Kontext von Geschlechtsinkongruenz, Geschlechtsdysphorie und Trans-Gesundheit. Zeitschrift für Sexualforschung 2019; 32 (02) 70-79
    Article in Thieme ConnectGoogle Scholar
  • 4 American Psychiatric Association. Diagnostisches und Statistisches Manual Psychischer Störungen DSM-5®. Göttingen: Hogrefe; 2018
  • 5 Coleman E, Bockting W, Botzer M. et al Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International journal of transgenderism 2012; 13 (04) 165-232
    CrossrefGoogle Scholar
  • 6 Turban JL, King D, Li JJ. et al Timing of social transition for transgender and gender diverse youth, K-12 harassment, and adult mental health outcomes. Journal of Adolescent Health 2021; 69 (06) 991-998
    CrossrefPubMedGoogle Scholar
  • 7 Hatchel T, Valido A, De Pedro KT. et al Minority stress among transgender adolescents: The role of peer victimization, school belonging, and ethnicity. Journal of Child and Family Studies 2019; 28 (09) 2467-2476
    CrossrefGoogle Scholar
  • 8 Kaltiala R, Bergman H, Carmichael P. et al Time trends in referrals to child and adolescent gender identity services: a study in four Nordic countries and in the UK. Nordic Journal of Psychiatry 2020; 74 (01) 40-44
    CrossrefPubMedGoogle Scholar
  • 9 Arcelus J, Bouman WP, Van Den Noortgate W. et al Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry 2015; 30 (06) 807-815
    CrossrefPubMedGoogle Scholar
  • 10 Åhs JW, Dhejne C, Magnusson C. et al Proportion of adults in the general population of Stockholm County who want gender-affirming medical treatment. PLoS One 2018; 13 (10) e0204606
    CrossrefPubMedGoogle Scholar
  • 11 Clark TC, Lucassen MFG, Bullen P. et al The Health and Well-Being of Transgender High School Students: Results From the New Zealand Adolescent Health Survey (Youth’12). J Adolesc Health 2014; 55 (01) 93-99
    CrossrefPubMedGoogle Scholar
  • 12 https://de.statista.com/statistik/daten/studie/272600/umfrage/anzahl-von-operationen-fuer-geschlechtsumwandlungen-in-deutschland/
  • 13 Meyer-Bahlburg HF. From mental disorder to iatrogenic hypogonadism: Dilemmas in conceptualizing gender identity variants as psychiatric conditions. Archives of sexual behavior 2010; 39 (02) 461-476
    CrossrefPubMedGoogle Scholar
  • 14 Steensma TD, Zucker KJ, Kreukels BP. et al Behavioral and emotional problems on the Teacher’s Report Form: A cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents. Journal of abnormal child psychology 2014; 42 (04) 635-647
    CrossrefPubMedGoogle Scholar
  • 15 Steensma TD, Biemond R, de Boer F. et al Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. Clinical child psychology psychiatry 2011; 16 (04) 499-516
    CrossrefPubMedGoogle Scholar
  • 16 Skagerberg E, Parkinson R, Carmichael P. Self-harming thoughts and behaviors in a group of children and adolescents with gender dysphoria. International Journal of Transgenderism 2013; 14 (02) 86-92
    CrossrefGoogle Scholar
  • 17 Wiech M, Kutlar C, Gunthard M. et al Psychische Auffalligkeiten und gesundheitsbezogene Lebensqualitat bei Jugendlichen mit Geschlechtsdysphorie. Praxis der Kinderpsychologie und Kinderpsychiatrie 2020; 69 (06) 554-570
    CrossrefPubMedGoogle Scholar
  • 18 Turban JL, King D, Kobe J. et al Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. PLos one 2022; 17 (01) e0261039
    CrossrefPubMedGoogle Scholar
  • 19 Becker I, Gjergji-Lama V, Romer G. et al Merkmale von Kindern und Jugendlichen mit Geschlechtsdysphorie in der Hamburger Spezialsprechstunde. Prax Kinderpsychol Kinderpsychiatr 2014; 63 (06) 486-509
    CrossrefPubMedGoogle Scholar
  • 20 Chodzen G, Hidalgo MA, Chen D. et al Minority stress factors associated with depression and anxiety among transgender and gender-nonconforming youth. Journal of Adolescent Health 2019; 64 (04) 467-471
    CrossrefPubMedGoogle Scholar
  • 21 Surace T, Fusar-Poli L, Vozza L. et al Lifetime prevalence of suicidal ideation and suicidal behaviors in gender non-conforming youths: a meta-analysis. European Child & Adolescent Psychiatry 2021; 30 (08) 1147-1161
    CrossrefPubMedGoogle Scholar
  • 22 Herman JL, Brown TN, Haas AP.. Suicide thoughts and attempts among transgender adults: Findings from the 2015 US Transgender Survey. 2019
    PubMedGoogle Scholar
  • 23 De Vries AL, McGuire JK, Steensma TD. et al Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics 2014; 134 (04) 696-704
    CrossrefPubMedGoogle Scholar
  • 24 Achille C, Taggart T, Eaton NR. et al Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: preliminary results. International journal of pediatric endocrinology 2020; 01: 1-5
    Google Scholar
  • 25 Allen LR, Watson LB, Egan AM. et al Well-being and suicidality among transgender youth after gender-affirming hormones. Clinical Practice in Pediatric Psychology 2019; 07 (03) 302
    CrossrefGoogle Scholar
  • 26 de Lara DL, Rodríguez OP, Flores IC. et al Psychosocial assessment in transgender adolescents. Anales de Pediatría 2020; 93 (01) 41-48
    CrossrefPubMedGoogle Scholar
  • 27 Kaltiala R, Heino E, Työläjärvi M. et al Adolescent development and psychosocial functioning after starting cross-sex hormones for gender dysphoria. Nordic journal of psychiatry 2020; 74 (03) 213-219
    CrossrefPubMedGoogle Scholar
  • 28 Kuper LE, Stewart S, Preston S. et al Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy. Pediatrics 2020; 145 (04) e20193006 DOI: 10.1542/peds.2019-3006.
    CrossrefPubMedGoogle Scholar
  • 29 Hembree WC, Cohen-Kettenis PT, Gooren L. et al Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism 2017; 102 (11) 3869-3903
    CrossrefPubMedGoogle Scholar
  • 30 Coleman E, Bockting W, Botzer M. et al Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International journal of transgenderism 2012; 13 (04) 165-232
    CrossrefGoogle Scholar
  • 31 Herrmann L, Bindt C, Schweizer K. et al Autism Spectrum Disorders and Gender Dysphoria Among Children and Adolescents: Systematic Review on the Co-Occurrence. Psychiatrische Praxis 2020; 47 (06) 300-307
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Steensma TD, McGuire JK, Kreukels BP. et al 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 (06) 582-590
    CrossrefPubMedGoogle Scholar
  • 33 Nonhoff T.. Persistenz und Desistenz der Geschlechtsdysphorie im Kindes- und Jugendalter – ein systematisches Review (Bachelorarbeit). Institut für Psychologie, Westfälische Wilhelms-Universität Münster. 2018
    PubMedGoogle Scholar
  • 34 Malpas J, Glaeser E, Giammattei SV. Building resilience in transgender and gender expansive children, families, and communities: A multidimensional family approach. In: Keo-Meier C, Ehrensaft D (eds). The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children. Washington: American Psychological Association 2018: 141-156
    PubMedGoogle Scholar
  • 35 Olson KR, Durwood L, DeMeules M. et al Mental health of transgender children who are supported in their identities. Pediatrics 2016; 137: 3
    CrossrefPubMedGoogle Scholar
  • 36 Edwards-Leeper L, Feldman HA, Lash BR. et al Psychological profile of the first sample of transgender youth presenting for medical intervention in a US pediatric gender center. Psychology of Sexual Orientation and Diversity 2017; 04 (03) 374
    CrossrefGoogle Scholar
  • 37 Reisner SL, Greytak EA, Parsons JT. et al Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity. Journal of Sex Research 2015; 52 (03) 243-256
    CrossrefPubMedGoogle Scholar
  • 38 Leibowitz S, de Vries ALC. Gender dysphoria in adolescence. International Review of Psychiatry 2016; 28 (01) 21-35
    CrossrefPubMedGoogle Scholar
  • 39 Gibson DJ, Glazier JJ, Olson KR. Evaluation of anxiety and depression in a community sample of transgender youth. JAMA network open 2021; 04 (04) e214739-e214739
    CrossrefPubMedGoogle Scholar
  • 40 Ashley F. Thinking an ethics of gender exploration: Against delaying transition for transgender and gender creative youth. Clinical child psychology and psychiatry 2019; 24 (02) 223-236
    CrossrefPubMedGoogle Scholar
  • 41 Ehrensaft D, Giammattei SV, Storck K. et al Prepubertal social gender transitions: What we know; what we can learn – A view from a gender affirmative lens. International Journal of Transgenderism 2018; 19 (02) 251-268
    CrossrefGoogle Scholar
  • 42 Spivey LA, Edwards-Leeper L. Future directions in affirmative psychological interventions with transgender children and adolescents. Journal of Clinical Child & Adolescent Psychology 2019; 48 (02) 343-356
    CrossrefPubMedGoogle Scholar
  • 43 Haid-Stecher N, Fuchs M, Ortner N. et al TransIdentität--Die Entwicklung der Identität bei transidenten Jugendlichen. Praxis der Kinderpsychologie und Kinderpsychiatrie 2020; 69 (06) 541-554
    CrossrefPubMedGoogle Scholar
  • 44 Deutscher Ethikrat Ad hoc Empfehlung „Trans-Identität bei Kindern und Jugendlichen: Therapeutische Kontroversen – ethische Orientierungen“. Prax Kinderpsychol Kinderpsychiatr 2020; 69 (06) 515-516
    CrossrefPubMedGoogle Scholar
  • 45 Wiesemann C. Trans-Identitat bei Kindern und Jugendlichen: Medizinethische Grundsatze für individuelle Behandlungsentscheidungen. Praxis der Kinderpsychologie und Kinderpsychiatrie 2020; 69 (06) 517-524
    CrossrefPubMedGoogle Scholar
  • 46 De Vries AL, Steensma TD, Doreleijers TA. et al Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine 2011; 08 (08) 2276-2283
    CrossrefPubMedGoogle Scholar
  • 47 Mahfouda S, Moore JK, Siafarikas A. et al Puberty suppression in transgender children and adolescents. The Lancet Diabetes & Endocrinology 2017; 05 (10) 816-826
    CrossrefPubMedGoogle Scholar
  • 48 Mahfouda S, Moore JK, Siafarikas A. et al Gender-affirming hormones and surgery in transgender children and adolescents. The Lancet Diabetes & Endocrinology 2019; 07 (06) 484-498
    CrossrefPubMedGoogle Scholar
  • 49 Wiesemann C, Ude-Koeller S, Sinnecker GH. et al Ethical principles and recommendations for the medical management of differences of sex development (DSD)/intersex in children and adolescents. European journal of pediatrics 2010; 169 (06) 671-679
    CrossrefPubMedGoogle Scholar
  • 50 Levitan N, Barkmann C, Richter-Appelt H. et al Risk factors for psychological functioning in German adolescents with gender dysphoria: poor peer relations and general family functioning. European child & adolescent psychiatry 2019; 28 (11) 1487-1498
    CrossrefPubMedGoogle Scholar
  • 51 Chew D, Tollit MA, Poulakis Z. et al Youths with a non-binary gender identity: a review of their sociodemographic and clinical profile. The Lancet Child & Adolescent Health 2020; 04 (04) 322-330
    CrossrefPubMedGoogle Scholar
  • 52 de Vries AL, Richards C, Tishelman AC. et al Weighing current knowledge and uncertainties in decisions about gender-related treatment for transgender adolescents. International Journal of Transgender Health 2021; 22 (03) 217-224
    CrossrefPubMedGoogle Scholar