Gender Dysphoria In Young People: A Model Of Chronic Stress

Abstract

Background: Gender Dysphoria (GD) refers to the distress that may accompany gender incongruence, often heightened at onset of puberty, with the development of secondary sex characteristics. Children and adolescents may be especially vulnerable to severe stressors, including GD, with potentially irreversible effects if these exposures occur during critical periods of development and brain maturation. Summary: We describe the evidence for GD as a chronic stressor, drawing parallels to other established models of stress, activating both innate psychological and biological stress responses. As well as being an inherently distressing experience, a person who experiences GD may also experience minority stress. Minority stress has been demonstrated in young people who experience GD with higher rates of social rejection and internalised stigma and shame. The biological stress response in young people with GD is illustrated through the activation of the Hypothalamic-Pituitary-Adrenal axis, autonomic nervous system, and pro-inflammatory response. The number of young people who report experiencing GD has increased exponentially worldwide in the past decade demanding a change in clinic infrastructure. Paediatric Endocrinologists and specialists in Mental Health work together to both support psychosocial wellbeing and offer individualised treatment to align phenotype with gender identity with the aim of alleviating the distress of GD. Medical interventions may include puberty suppression and gender affirming hormones. Ongoing monitoring is required prior to initiation and during treatment to ensure that the goals of treatment are being achieved. Key Messages: GD has similarities to other examples of chronic stress, with some evidence of both a psychological and biological stress response, but this has yet to be fully evaluated in longitudinal studies of young people with GD. GD, as a chronic stressor, may in part be responsible for reported poorer physical and mental health outcomes in young people. Uncertainties remain on the benefit of treatment in young people with GD highlighting the need for specific measures of GD and stress to be used in both clinical monitoring and future research.