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Psychological Research

Cisgenderism in psychology: pathologising and misgendering children from 1999 to 2008

Y. Gavriel Ansara
and Peter Hegarty

Department of Psychology,

Faculty of Arts and Human Sciences,| University of Surrey, Guildford, UK

Abstract: We assessed whether recent psychological literature on children reflects or contrasts with the zeitgeist of American Psychological Association’s recent non-discrimination statement on ‘transgender’ and ‘gender variant’ individuals. Article records (N = 94) on childhood ‘gender identity’ and ‘expression’ published between 1999 and 2008 inclusive were evaluated for two kinds of cisgenderism, the ideology that invalidates or pathologises self-designated genders that contrast with external designations. Misgendering language contradicts children’s own gender assignations and was less frequent than pathologising language which constructs children’s own gender assigna- tions and expression as disordered. Articles on children’s gender identity/expression
are increasingly impactful within psychology. Cisgenderism is neither increasing nor decreasing overall. Mental health professionals are more cisgenderist than other authors. Articles by members of an ‘invisible college’ structured around the most prolific author in this area are more cisgenderist and impactful than other articles. We suggest how authors and editors can implement American Psychological Association policy and change scientific discourse about children’s genders.

Durso-Gates LGBT Homeless Youth Survey July 2012
Public Policy Fellow at the Williams Institute, UCLA School of Law;
Williams Distinguished Scholar at the Williams Institute, UCLA School of Law

This report by the The Palette Fund, True Colors Fund, and the Williams Institute presents data from The Lesbian,
Gay, Bisexual, and Transgender (LGBT) Homeless Youth Provider Survey, a web-based survey conducted from
October 2011 through March 2012. The survey was designed to assess the experiences of homeless youth
organizations in providing services to LGBT youth. It also assessed the prevalence of LGBT youth within the
homeless populations being served by these organizations. In total, 381 respondents completed at least part of
the survey, representing 354 agencies throughout the United States.

An Affirmative Intervention for Families
Gender Variant Children: Parental Ratings of
Child Mental Health
and Gender

Department of Psychology, College of Staten Island, City University of New York,
New York, USA

This is a report on parents who have children who exhibit gender
variant behaviors and who contacted an affirmative program in
the United States for assistance. All parents completed the Child
Behavior Checklist, the Gender Identity Questionnaire, and the
Genderism and Transphobia Scale, as well as telephone interviews.
The parents reported comparatively low levels of genderism and
transphobia. When compared to children at other gender identity
clinics in Canada and The Netherlands, parents rated their
children’s gender variance as no less extreme, but their children
were overall less pathological. Indeed, none of the measures in this
study could predict parents’ ratings of their child’s pathology. These
findings support the contention that this affirmative program served
children who were no less gender variant than in other programs,
but they were overall less distressed.

Family Acceptance in Adolescence and the Health
of LGBT Young Adults

Caitlin Ryan, PhD, ACSW, Stephen T. Russell, PhD, David Huebner, PhD, MPH, Rafael Diaz, PhD, MSW,
and Jorge Sanchez, BA

ISSUE: The role of family acceptance as a
protective factor for lesbian, gay, bisexual, and
transgender (LGBT) adolescents and young
adults has not been established.

METHODS: A quantitative measure with items
derived from prior qualitative work
retrospectively assessed family accepting
behaviors in response to LGBT adolescents’
sexual orientation and gender expression and
their relationship to mental health, substance
abuse, and sexual risk in young adults
(N = 245).

FINDINGS: Family acceptance predicts greater
self-esteem, social support, and general health
status; it also protects against depression,
substance abuse, and suicidal ideation and

CONCLUSIONS: Family acceptance of LGBT
adolescents is associated with positive young
adult mental and physical health. Interventions
that promote parental and caregiver acceptance
of LGBT adolescents are needed to reduce health

Gender-Nonconforming Lesbian, Gay, Bisexual, and Transgender Youth:
School Victimization and Young Adult Psychosocial Adjustment

Russell B. Toomey
University of Arizona,
Caitlin Ryan
and Rafael M. Diaz
San Francisco State University,
Noel A. Card
and Stephen T. Russell
University of Arizona

Past research documents that both adolescent gender nonconformity and the experience of school
victimization are associated with high rates of negative psychosocial adjustment. Using data from the
Family Acceptance Project’s young adult survey, we examined associations among retrospective reports
of adolescent gender nonconformity and adolescent school victimization due to perceived or actual
lesbian, gay, bisexual, or transgender (LGBT) status, along with current reports of life satisfaction and
depression. The participants included 245 LGBT young adults ranging in age from 21 to 25 years. Using
structural equation modeling, we found that victimization due to perceived or actual LGBT status fully
mediates the association between adolescent gender nonconformity and young adult psychosocial
adjustment (i.e., life satisfaction and depression). Implications are addressed, including specific strategies
that schools can implement to provide safer environments for gender-nonconforming LGBT students.

Psychiatric comorbidity in gender dysphoric

Annelou L.C. de Vries,

Theo A.H. Doreleijers,

Thomas D. Steensma,

Peggy T. Cohen-Kettenis
Departments of Child and Adolescent Psychiatry; and Medical Psychology, VU University Medical Center,
Amsterdam, The Netherlands

Background: This study examined psychiatric comorbidity in adolescents with a gender identity disorder
(GID). We focused on its relation to gender, type of GID diagnosis and eligibility for medical
interventions (puberty suppression and cross-sex hormones).
Methods: To ascertain DSM-IV diagnoses,
the Diagnostic Interview Schedule for Children (DISC) was administered to parents of 105 gender
dysphoric adolescents. Results: 67.6% had no concurrent psychiatric disorder. Anxiety disorders
occurred in 21%, mood disorders in 12.4% and disruptive disorders in 11.4% of the adolescents.
Compared with natal females (n = 52), natal males (n = 53) suffered more often from two or more
comorbid diagnoses (22.6% vs. 7.7%, p = .03), mood disorders (20.8% vs. 3.8%, p = .008) and social
anxiety disorder (15.1% vs. 3.8%, p = .049). Adolescents with GID considered to be ‘delayed eligible’ for
medical treatment were older [15.6 years (SD = 1.6) vs. 14.1 years (SD = 2.2), p = .001], their intelligence
was lower [91.6 (SD = 12.4) vs. 99.1 (SD = 12.8), p = .011] and a lower percentage was living with
both parents (23% vs. 64%, p < .001). Although the two groups did not differ in the prevalence of
psychiatric comorbidity, the respective odds ratios (‘delayed eligible’ adolescents vs. ‘immediately eligible’
adolescents) were >1.0 for all psychiatric diagnoses except specific phobia.
Conclusions: Despite
the suffering resulting from the incongruence between experienced and assigned gender at the start of
puberty, the majority of gender dysphoric adolescents do not have co-occurring psychiatric problems.
Delayed eligibility for medical interventions is associated with psychiatric comorbidity although other
factors are of importance as well.

Comparing adult and adolescent transsexuals: An MMPI-2 and MMPI-A study
Annelou L.C. de Vries ,

Baudewijntje P.C. Kreukels,
Thomas D. Steensma,
Theo A.H. Doreleijers,

Peggy T. Cohen-Kettenis
Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
b Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands

Sex, sexual orientation and age have been shown to be important in relation to psychological functioning in
transsexuals. However, only few studies to date took these factors into account and not earlier have
adolescent transsexuals participated. In this study the Minnesota Multiphasic Personality Inventory (MMPI-2
or MMPI-A, respectively) was administered to 293 adults (207 male to female transsexuals (MtFs), mean age
38.04 (range 18.56–65.62) and 86 female to male transsexuals (FtMs), mean age 33.26 (range 18.95–64.30))
and 83 adolescents (43 MtFs, mean age 15.70 (range 13.16–18.70) and 40 FtMs, mean age 15.64 (range
13.05–18.56)) with a gender identity disorder (GID). Of adult MtFs, 33% were categorized as “homosexuals”
and 66% as “non-homosexuals”. Of adult FtMs, 77% were categorized as “homosexuals” and 33% as “nonhomosexuals”.
Adult FtMs functioned significantly better than MtFs on three clinical scales. Contrary to what
is often assumed, no differences in psychological functioning were found in the adult transsexuals with
regard to sexual orientation, except on one clinical scale. Most remarkably, significantly more adults with
GID scored in the clinical range on two or more clinical scales than adolescents with GID. Therefore, early
medical intervention may be recommendable for adolescents with GID.

Puberty Suppression in Adolescents With Gender Identity Disorder: A Prospective Follow-Up Study
Annelou L.C. deVries, MD, et al
Dept. of Child and Adolescent Psychiatry, VU Medical Center, Amsterdam, The Netherlands

Introduction. Puberty suppression by means of gonadotropin-releasing hormone analogues (GnRHa) is used for
young transsexuals between 12 and 16 years of age. The purpose of this intervention is to relieve the suffering caused
by the development of secondary sex characteristics and to provide time to make a balanced decision regarding actual
gender reassignment.
Aim. To compare psychological functioning and gender dysphoria before and after puberty suppression in gender
dysphoric adolescents.
Methods. Of the first 70 eligible candidates who received puberty suppression between 2000 and 2008, psychological
functioning and gender dysphoria were assessed twice: at TO, when attending the gender identity clinic, before the
start of GnRHa; and at T1, shortly before the start of cross-sex hormone treatment.
Main Outcome Measures. Behavioral and emotional problems (Child Behavior Checklist and the Youth-Self
Report), depressive symptoms (Beck Depression Inventory), anxiety and anger (the Spielberger Trait Anxiety and
Utrecht Gender Dysphoria Scale), and body satisfaction (the Body Image Scale) were assessed.
Results. Behavioral and emotional problems and depressive symptoms decreased, while general functioning
improved signiflcantly during puberty suppression. Feelings of anxiety and anger did not change between TO and T1.
`VVhile changes over time were equal for both sexes, compared with natal males, natal females were older when they
started puberty suppression and showed more problem behavior at both TO and T1. Gender dysphoria and body
satisfaction did not change between TO and T1. No adolescent withdrew from puberty suppression, and all started
cross-sex hormone treatment, the flrst step of actual gender reassignment.
Conclusion. Puberty suppression may be considered a valuable contribution in the clinical management of gender
dysphoria in adolescents.

de Vries ALC, Steensma TD, Doreleijers TAH, and Cohen-Kettenis PT.

Aspects of Psychological Resilience among Transgender Youth
Arnold H. Grossman; Anthony R. D’augelli; John A. Franka
Department of Applied Psychology, New York University,

New York, New York, USA
College of
Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, USA

Fifty-five transgender youth described their gender development
and some of the stressful life experiences related to their gender
identity and gender expression. More than two-thirds of youth reported
past verbal abuse by their parents or peers related to their
gender identity and nonconformity, and approximately one-fifth
to one-third reported past physical abuse. The more gender nonconforming
the youth were, the more abuse they reported. Four
aspects of psychological resilience were examined: a sense of personal
mastery, self-esteem, perceived social support, and emotionoriented
coping. A regression model of the selected aspects of resilience
accounted for 40%–55% of the variance in relation to
depression, trauma symptoms, mental health symptoms, and internalizing
and externalizing problems. Emotion-oriented coping
was a significant predictor of negative mental health as determined
by each of the mental health variables.

Comparing Gender Expression,
Gender Nonconforrmty, and Parents’
Responses to Female-to-Male
and Male-to-Female Transgender Youth:
Implications for Counseling

Arnold H. Grossman, PhD
Anthony R. Dbtugelli, PhD
Nicholas P. Salter
Steven M. Hubbard

ABSTRACT. Twenty·four female-to-male (FTM} and 31 rnale-to-female (MTF) transgender youth reported on their gender development and expression, and parental responses to their gender noneonforrnity.
Both groups of youth felt different from others of their same birth sex at a mean age of seven and one-half years. The age that knew they were different was younger for the MTF than the FTM youth. The
MTF youth were called “sissy” at an earlier age than the FTM were
called “tomboy." Parents of FTM youth encouraged them to act in rnore
traditional gender typical ways at a younger age than the MTF. The M’l`F
youth considered themselves transgender two years earlier than the FTM
youth. More parents of MTF youth felt that their children needed counseling than the parents of the FTM youth. While the majority of both
groups reported past verbal victirnization, comparatively more MTF
youth reported being physically victimized implications of the developmental trajectories and experiences of transgender youth for school and
family counselors are discussed.

Transgender Youth:
Invisible and Vulnerable

Arnold H. Grossman, PhD
New York University
Anthony R. D’Augelli, PhD
The Pennsylvania State University

SUMMARY. This study used three focus groups to explore factors that
affect the experiences of youth (ages 15 to 21) who identify as transgender.
The focus groups were designed to probe transgender youths’
experiences of vulnerability in the areas of health and mental health.
This involved their exposure to risks, discrimination, marginalization,
and their access to supportive resources. Three themes emerged from an
analysis of the groups’ conversations. The themes centered on gender
identity and gender presentation, sexuality and sexual orientation, and
vulnerability and health issues. Most youth reported feeling they were
transgender at puberty, and they experienced negative reactions to their
gender atypical behaviors, as well as confusion between their gender identity and sexual orientation. Youth noted four problems related to
their vulnerability in health-related areas: the lack of safe environments,
poor access to physical health services, inadequate resources to address
their mental health concerns, and a lack of continuity of caregiving by
their families and communities.

Early Childhood Development – Your Options – How Do
I Know If My Child Is Transgender?

By Stephanie Brill and Caitlin Ryan, PhD, ACSW

What Is transgender?
Can a Child Be Transgender?
What Makes a Child Transgender?
Why Can’t My Child Be “Normal”?
How Should I Respond?
How Can I know If It’s a Phase?
Where Do I Get Help, Support, and More Information?
Resources for Families & Providers

Family Rejection as a Predictor of Negative Health Outcomes in White and
Latino Lesbian, Gay, and Bisexual Young Adults

Caitlin Ryan, David Huebner, Rafael M. Diaz and Jorge Sanchez

OBJECTIVE. We examined specific family rejecting reactions to sexual orientation and
gender expression during adolescence as predictors of current health problems in a
sample of lesbian, gay, and bisexual young adults.
METHODS. On the basis of previously collected in-depth interviews, we developed quantitative
scales to assess retrospectively in young adults the frequency of parental and caregiver
reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey
instrument also included measures of 9 negative health indicators, including mental health,
substance abuse, and sexual risk. The survey was administered to a sample of 224 white and
Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited
through diverse venues and organizations. Participants completed self-report questionnaires
by using either computer-assisted or pencil-and-paper surveys.
RESULTS. Higher rates of family rejection were significantly associated with poorer health
outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who
reported higher levels of family rejection during adolescence were 8.4 times more likely
to report having attempted suicide, 5.9 times more likely to report high levels of
depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report
having engaged in unprotected sexual intercourse compared with peers from families
that reported no or low levels of family rejection. Latino men reported the highest
number of negative family reactions to their sexual orientation in adolescence.
CONCLUSIONS. This study establishes a clear link between specific parental and caregiver
rejecting behaviors and negative health problems in young lesbian, gay, and bisexual
adults. Providers who serve this population should assess and help educate families about the impact of rejecting
behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support
can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual

The positive aspects of
a transgender

Ellen D.B. Rigglea,

Sharon Scales Rostosky,
LaWanda E.McCants

and David

Research to date has primarily focused on health risks, psychopathologies and negative
life experiences with little attention to the positive aspects of identifying as
transgender. An online survey collected data on self-reports of the positive aspects
of a transgender identity (n = 61). Qualitative thematic analysis revealed eight positive
identity themes: congruency of self; enhanced interpersonal relationships; personal
growth and resiliency; increased empathy; a unique perspective on both sexes; living
beyond the sex binary; increased activism; and connection to the GLBTQ communities.
These findings are compared to previous research on the positive aspects of
gay, lesbian and bisexual identities. The implications of these findings for providing
strength-based therapeutic approaches and training counsellors to be culturally
competent with transgender-identified clients are discussed.