Description

Transgender describes youth with incongruent gender identity and birth-assigned sex. These youth may have gender identities that are opposite from the birth-assigned sex, neither female nor male, a combo of female and male, or fluid.

• They may experience gender dysphoria, which is distress stemming from gender identity/birth-assigned sex incongruence.
• Gender dysphoria is also a psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), with primary criteria of long-standing distress and decreased psychosocial function.
• Some youth desire to socially and/or medically transition to their affirmed gender.

Epidemiology

• Recent data from state-level population-based surveys and Centers for Disease Control and Prevention (CDC) surveys indicate the prevalence of transgender adolescents (13 to 17 years) in the United States is 0.7%, equivalent to 150,000 youth.
• There has been an increase in the number of transgender youth presenting to specialty clinics.

Etiology

Not well understood. Gender identity development and gender nonconformity are thought to be due to interplay between biologic (genetic, endocrine, neurologic), cultural, and environmental factors.

Commonly Associated Conditions

Transgender youth are at risk for following psychosocial morbidities:

• Depression
• Anxiety
• Suicidality and nonsuicidal self-injury
• Physical and verbal victimization/bullying
• Poor school performance
• Drug and alcohol abuse
• Homelessness
• Eating disorders
• Obesity