Supporting Transgender Students’ Mental Health

Vermont Queer and Allied Youth Summit

May 14, 2011Morganne Ray

Director of Client ServicesOutright Vermont

Reasons To Access Mental Health Care

• Support in coming out or social transition

• Sort out identities and feelings• Access to medical transition

services• Pressure from family or other

adults• Any and all of the same

reasons every one else may choose to access mental health care

Dominant Assumptions

• Trans youth might just be gay or questioning

• Trans youth will later regret any permanent changes made to their body

• Trans people identify with the opposite gender from an early age

• Trans people only seek therapy to be allowed to transition

• Trans people hate the body they are born with

• Trans people wish to fully transition including hormones and all available surgeries

Social Transition

• Allows the youth live as if physical transformation had already taken place, including:– Using a new name congruent with stated

gender identity – Switching gender pronouns– Changing clothing and hairstyle to be

congruent with stated gender identity– Adopting gender-specific behaviors

congruent with stated gender identity• Clinically referred to as the “Real Life Test”

or the “Real Life Experience” and requires that family, friends, school and other social contacts be informed about the wish for sex reassignment and the intention to undergo gender transition.

Gender Identity DisorderDSM-IV-TR Diagnostic Criteria

A. A strong and persistent cross-gender identification

B. Persistent discomfort with his or her sex or a sense of inappropriateness in the gender role of that sex. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics or belief that he or she was born the wrong sex.

C. The disturbance is not concurrent with a physical intersex condition.

D. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

Gender Identity DisorderDiagnosis and Intervention

• gather information on early development, current school functioning, peer relationships and family dynamics from family members

• ask about sexual behavior, experiences, fantasies and attractions

• Harry Benjamin Standards of Care require that the therapist work with the youth for a minimum of 6 months before writing a letter recommending hormones. The frequency of sessions is left up to the rapist, and sessions are expected to continue throughout and beyond medical transition.

Medical Transition - Hormones

• Therapists and physicians usually require a youth be 16 before seeking hormones

• In order to receive hormones, youth must: – Have a strong cross-gender identity

from an early age– Be psychologically relatively stable– Live in a supportive environment

• Parental consent required

Medical Transition - Surgery

• Therapists and physicians usually require a youth be 18 before seeking surgery, and must be satisfied with the effects of hormones

• 18 year old youth are required to have two full years of “Real Life Experience” before surgery may be considered

• 19 year old youth are treated as adults, and guidelines are slightly more flexible

Who Is Left Out?

• Youth who are questioning their gender identity

• Youth with a non-binary gender identity

• Youth who do not want to transition• Youth who want to transition

without doctors• Youth who have already

transitioned• Youth who want to transition but do

not have the require support systems

Barriers to Care

• Uneducated or unsupportive providers

• Problematic guidelines and diagnostic criteria

• Lack of familial support• Lack of resources – Time

– Transportation

– Insurance

• Negative previous experiences

What Can We Do?

• Always affirm the youth’s current gender identity

• Allow the youth to share what feels comfortable

• Help youth locate friendly providers, and the resources needed to access care

• Be available and supportive• Trust the youth’s choices• Educate others about the needs

of trans youth

Finding Friendly Providers

• Ask for referrals and suggestions from queer-friendly community members

• Utilize provider lists through resources like:– Vermont Diversity Health Project

– Vemonters Ending Transgender Oppression

– World Professional Association for Transgender Health

• Check in with individual providers

• Let Outright know who you find!