title: [Actuals of the treatment for gender identity disorder at puberty: introducing the suppression of secondary sexual characteristics from psychotherapy].
abstract: We have treated young patients who feel gender dysphoria to help them accept their feelings of disconnection. We tell them that such feelings of disconnection are never strange, so they do not have to be suppressed, and can be expressed. To do that, the most important thing is that their parents firmly accept the situation, whereas they are the ones who also feel the most anxious. We need to provide psychological support carefully. The first major hurdle for children who have gender dysphoria is elementary school, even if parents are accepting. In elementary school, even children can distinguish beween male and female, and there are many situations where there is separation by gender in school events, so it is difficult to realize the expression of disconnection without school support. Therefore, understanding by school teachers is needed. When a school shows understanding, parental anxiety is alleviated. When a teacher provides firm support, children around them are more likely to accept the situation. Accordingly, support for children who have gender dysphoria consists of three pillars. The first of these is to help children accept their feelings of gender dysphoria and feel that they can be expressed. The second is to help their parents accept gender dysphoria and create an environment where it can be expressed. The third is to encourage schools to actively create such an environment. To deal with concrete problems which children face by providing these approaches promptly assists in promoting the social growth of children. Even if children feeling gender dysphoria have active school lives with such support, they face the following major hurdle : the secondary sexual characteristics. It has been reported in not only foreign countries but also Japan that there are many children who become mentally unbalanced and enter a maladaptive state, such as truancy and self-injury, on secondary sexual development. In the West, it has been reported that suppressive therapy for the secondary sexual characteristics with a GnRH agonist (gonadotropin-releasing hormone agonist) is effective, although it has been little used in Japan, and a mentally balanced state has been maintained in cases we have been involved with. We consider it important to provide support which enables children who have gender dysphoria to overcome this crisis while extensively providing medical treatment.
authors.affiliation: Department of Neuropsychiatry, Osaka Medical College.
authors.forename: Jun
authors.initials: J
authors.lastname: Koh
mesh_terms: D000293:Adolescent; D002648:Child; D002653:Child Behavior Disorders / Q000628:therapy*; D005178:Faculty; D005783:Gender Identity; D006801:Humans; D007564:Japan; D010290:Parents / Q000523:psychology; D011613:Psychotherapy; D011627:Puberty / Q000502:physiology / Q000523:psychology*; D012725:Sexual Behavior / Q000523:psychology*