Abstract
In the past two decades, children and their parents have increasingly been seeking advice and interventions for gender dysphoria from specialist gender and health services. Health professionals, though, are faced with dilemmas in determining appropriate and ethical treatment for children with gender dysphoria because they may be unable to predict whether the child’s gender identity will remain stable after puberty. To compound the difficulties of their decision making and clinical observations, HPs hold varied ideologies about gender. Expert opinion, therefore, about diagnosis and treatment is influenced by normative assumptions and prevailing societal beliefs about gender. This study aimed to synthesise and critically interpret the literature on the indicators that anticipate the continuity of childhood gender dysphoria after puberty. A further aim was to provide guidance to health professionals to inform their treatment of children with gender dysphoria. To address these aims, the critical interpretive synthesis method was selected to provide a framework for a literature synthesis that could also offer a critical appraisal of that literature. This synthesis of the literature sources (n=20) offered four constructs: (1) the intensity of gender dysphoria, (2) the child’s assertion of their gender identity, (3) the stability of gender identity, and (4) gender is multifarious. In the theoretical framework, the concept of multifariousness showed that gender identity development is an amorphous process that occurs across the lifespan. By anticipating possible detransition as a part of the gender identification later in life, health professionals adopt an affirmative approach while remaining cautious about those treatments that cannot be reversed. In an ethical encounter that supports gender diversity, they can support the young person, their family, and the school community to understand, first, that persistence of an affirmed gender is not guaranteed and, second, that gender stability should not be prioritised. Eight guidelines for clinical practice are therefore suggested. Keywords: childhood gender dysphoria, continuance of gender dysphoria, critical interpretive synthesis, desistance of gender dysphoria, detransition, persistence of gender dysphoria, transgender children.
M.A. (Psychology)