Aron Janssen, M.D.
Clinical Director, NYU Gender & Seuxality Service
NYU Langone Medical Center
Working with Gender Variant
Youth
Speaker Name
Title
Organization
Introduction
• Aron Janssen, M.D.
– Clinical Asst Prof of Child and Adolescent Psychiatry
– Clinical Director, NYU Gender and Sexuality Service
– Prof for “Sex Matters: Identity, Behavior and
Development” through CAMS
– Follow me on twitter @LGBTDoc
Why should we care?
Medical/Mental
Health Disparities*
– Suicide Attempts
• Bullying modifier
– Substance Use, HIV,
Homelessness
– Depression, Violence
– 20% of transgender/gender variant
patients were refused care by their
physicians
– 28% were verbally harassed in their
doctor’s office
*National Transgender Discrimination Survey (2009)
– 50% felt they had to teach their
providers about their health needs
Gender: What are the components?
Birth Sex
Gender
Role
Gender
Identity
Birth Sex
Gender
Role
Gender
Identity
Birth Sex
Gender
Role
Gender
Identity
Birth Sex
Gender
Role
Gender
Identity
+
Male or Female? Boy or Girl?
Terminology (note – always in flux)
Birth Sex
Gender
Role
Gender Non-Conforming/Gender Variant
Gender
Identity
someone not fully conforming to expectations around gender
can include variations in gender role and/or identity
Transgender
umbrella term to describe a mismatch between birth sex and either
gender role or gender identity
Cisgender
defining an alignment between birth sex and gender identity
Genderqueer
any number of non-binary identities or expressions
Gender Dysphoria
DSM-5 term – highlighted later
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Prevalence of Gender Dysphoria
• Earliest Estimates:
– 1 in 37,000 males and 1 in 107,000 females
• More recent Estimates:
– 1 in 11,900 males and 1 in 30,400 females*
• Why is this inaccurate?
• 2014: Large Dutch Population Study**
– 1.1% male assigned at birth and 0.8% female
assigned at birth identified as ‘incongruent gender
identity.’
•
*Kesteren, et. al. 1993
“immutable, stable, and
resistant to conscious
control”
Sexuality: Components?
How an individual
defines their
sexuality
Sexual
Orientation
What is “sex”
anyway?
Sexual
Identity
Sexual
Behavior
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Sexual Orientation and Gender Identity
Born as:
Male
Identify as:
Male
Attracted to:
Men
Women
Female
Female
Both
Intersex
Other
Neither
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When: Developmental Timeline
Sexual Behavior
So what comes
first?
Sexual Orientation
Gender
Identity
Birth
age 2-3
Gender
Stability
age 4-5
Gender
Constancy
age 5-7
Can begin as early as 4-5
but typically develops just
prior to noticeable signs of
puberty
puberty--------adolescence-
adulthood
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Policy Implications
•
•
•
•
Intake Documentation
Patient Experience
Electronic Medical Records
Insurance/Billing/Legal
Assessment
Health
Providers
Peers
Individual
Community
Family
Health
Providers
Peers
Individual
Family
Family
Community
*Family factors:
-level of support
-level of understanding
-family functioning
*Family assessment
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Health
Providers
Community
Peers
Individual
Family
Minority Stress Theory
-Meyer, 2003
Community
• Physical Spaces
– Home vs. School vs. Hosptial
– Camps, Groups, Etc
– Neighborhood/Safety
• Education
– Opportunities for safe education
– Bathrooms, Sports, Activities
• Religious/Community Values
• Legal
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GD – Treatment
• 5 aspects of clinical work
– 1. Diagnostic Assessment
– 2. Psychotherapy*
– 3, 4, 5. “Triadic Therapy”
• Real life experience in the desired gender role, i.e.
‘social transition.’
• Hormonal Treatment
• Sex Reassignment Surgery
Psychotherapy & Social Transition: case
example
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Hormone Treatment (kids)
• Once puberty begins, external hormones can be given
that halt the progression of puberty until kids reach the
age at which they can decide for themselves
• Not routinely covered by insurance and cost up to
$1000/month
• Note: puberty is irreversible
Hormonal Treatment
• Generally requires 1 letter from a qualified mental health
professional
• For biological females: Testosterone
– First can use analogues to suppress menses
• For biological males: Estrogen
– Can also augment with agents such as propecia
(which block formation of DHT  less male pattern
baldness)
Questions?
Aron Janssen, M.D.
Clinical Director, Gender and Sexuality Service
[email protected]
646-754-4885
@LGBTDoc
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