MHM Magazine

Issue 6 | 2022 | MENTAL HEALTH MATTERS | 35 MHM options are. They have likely already embarked on their own research which tends to lead them down a rabbit hole of fear inducing information on risks and stories of those who regret their transitions later in life, often exposing parents’ prejudices. Not to mention their internal battle coming to terms with such immense changes in their child’s life, which can be experienced as a process of grieving. This can result in parents being very defensive, which places doctors in the difficult position of trying to get parents to engage with an open mind, whilst explaining the risks involved with the various options for medical transition. This article aims to provide doctors with some tips around approaching these interactions effectively. Firstly, try to ascertain what their perspectives and feelings are around their child’s transitioning journey. Should they express concerns, it helps to normalise their experience showing understanding and empathy. It’s likely a lot of their fears are due to uncertainty or misunderstanding, giving you an opportunity to clarify and educate them, which could diminish their resistance somewhat. Essentially, it’s not about telling parents not to be afraid or resistant, as it’s an inherent part of the informed consent process to be open and honest about the real risks involved. It’s more about balancing their concerns out with the benefits of supporting their child through their transitioning journey. It often helps for the teenager to participate in this conversation, so they can share the impact transitioning will have on their lives holistically. Most parents prioritise the health of their children and so are naturally resistant to consenting to their child undergoing any form of treatment that could have an adverse effect. However, it’s important to highlight the fact that health is not solely about physical wellbeing, but mental and emotional wellbeing too. While parents may only be concerned with the research regarding health risks, it’s important they’re made aware of the research regarding mental health risks for transgender teens who are not able to begin the transitioning journey. Transgender youth are at a particularly high risk for mental illnesses (e.g. depression and anxiety) and life-threatening behaviours, with more than a third having a history of self- injuring behaviours and a third reporting at least one suicide attempt Suicide amongst teenagers is already a major concern, with the risk of suicide amongst transgender youth who don’t receive the support they need being even greater. According to Prof Gerhard Grobler, psychiatrist and past president of the South African Society of Psychiatrists (SASOP, one of the reasons for such mental health risks is due to gender dysphoria - the experience of intense distress as a result of the sex assigned at birth not aligning with their gender identity – and not because identifying as transgender is a disorder in itself. Other factors that increase risk of mental health issues in transgender youth are stigma, discrimination, having to hide who they truly are, low self-esteem, bullying, social rejection, harassment and abuse. It’s for these reasons that receiving gender-affirming healthcare is so necessary and beneficial. Research has widely shown mental health risks are significantly reduced in those who receive medical, social and psychological support in transitioning to the gender identity they feel aligns with their authentic selves. Of course some parents’ resistance will persist, especially regarding medical interventions which have certain non-reversible effects. Many will attribute their child’s request to transition as a ‘phase’ and refuse any medical interventions due to predicting their child will regret the decision later and won’t be able to undo the changes. Should you find yourself faced with such resistance, it’s helpful to highlight that: • Navigating and establishing their identity isn’t something that happens overnight; they generally would have spent a significant amount of time considering this within themselves, which the parents may not have been aware of. • It’s important for parents to recognise their child’s expressed identity and show acceptance of who they are now. • All humans change throughout their lives – especially from adolescence into adulthood – yet this doesn’t mean that just because they don’t continue acting/dressing in the same way or having the same likes/dislikes, their current way of being is any less valid. • Just because some transgender individuals may not be 100% sure about their gender identity or shift their gender identity at later stages in their lives, this shouldn’t take away from the value of respecting and appreciating who they are at this time! Understandably, some parents will take issue with their child initiating certain medical gender affirming treatments that may be non-reversible in light of the lack of certainty, believing their child should wait until they’re sure about who they are. It’s at this point it’s essential