For children with sex identity problem

1. EDUCATe TRANSGENDER children
MRS SINDHIYA RAJAKUMARI MSc (N)

2. OBJECTIVES
 To define transgender
 To identify the physical changes
 To discuss the psychosocial and psychosexual development
 To educate the transgender and children in gender variant
 To counsel about the gender changes
 To support psychologically through groups

3. Terminologies
 Transgender
A subset of gender-diverse youth whose gender identity does not match their
assigned sex and generally remains persistent, consistent, and insistent over time; the
term “transgender” also encompasses many other labels individuals may use to refer to
themselves.
 Gender identity;
A person’s deep internal sense of being female, male, a combination of both,
somewhere in between, or neither, resulting from a multifaceted interaction of biological
traits, environmental factors, self-understanding, and cultural expectations

4.  MTF; affirmed female; trans female
Terms that are used to describe individuals who were assigned male sex at birth
but who have a gender identity and/or expression that is asserted to be more feminine.
 FTM; affirmed male; trans male
Terms that are used to describe individuals who were assigned female sex at birth
but who have a gender identity and/or expression that is asserted to be more masculine.

5.  Transgender people are individuals whose gender identities
do not pertain to their biological sex, and thus they differ
from the stereotype of how men and women normally are.
Transgender people choose different terms to describe
themselves.
For example, a transgender woman is someone assigned male
at birth who identifies as female, she might describe herself
as a “transwoman”, “Male to Female” or “female”.
Someone assigned female at birth who identifies as male
is a transgender man. He might use the term “transman”,
“Female to Male” or simply “male” to describe his identity.
Introduction

6. Transgender population
 According to the Williams Institute 2022, 1.4 million adults identify as
transgender in the United States. About 0.7% of adults 18-24 identify as
transgender, and 0.5% of adults 65 and older identify as transgender.
 India’s 2011 Census was the first census in its history to incorporate the number
of ‘trans’ population of the country. The report estimated that 4.8 million Indians
identified as transgender.
 According to the 2014 summary revision electoral data, only 2,996 transgenders
had registered themselves as voters in 39 Parliamentary constituencies in Tami
Nadu though their actual population is much more than that.

7. Where does it starts?
 Developmentally; children start to experience gender identity around age 3, most as
either boys or girls.
 American society regards a “natural” relationship between sex and gender, and those
children who don’t identify with their birth gender are quickly pushed back into the
socially prescribed gender role.

8. Psychosocial and psychosexual development of
adolescent
12–18yrs Identity vs role confusion
Experiment with and
develop identity and roles
Erikson’s- Psychosocial development
Sigmund Freud’s -psychosexual development
The genital stage is the last stage of Freud's psychosexual theory of
personality development, and begins in puberty. It is a time of adolescent sexual
experimentation, the successful resolution of which is settling down in a loving one-
to-one relationship with another person.

9.  Transgender was termed ‘Gender Identity Disorder (GID) in 1980 with the 3rd edition
of the Psychological Association’s Diagnostic and Statistical Medical Manual of
Mental Disorders.
 GID was defined as: “An Incongruence between assigned sex and gender identity.”
 Unfortunately, children can be treated for GID
 Since children have no legal standing, they don’t have the means to refuse the brutal
aversion therapies designed at breaking the ‘disorder’.
 As result, these children usually become socially isolated, and depressed not because of
who they are, but because of the social misunderstandings.

10. Gender dysphoria
Although being transgender is not a mental illness, most transgender persons
experience dysphoria (dissatisfied) at various times in their lives. The dysphoria
experienced by transgender persons is likely attributable to having to live in a body
(and social role) that does not feel congruent with their sense of self in a society that
misunderstands and discriminates against them.
The gender dysphoria diagnosis in the fifth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) indicates that it may include
symptoms of depression, anxiety, fear, guilt, low self-esteem, shame and self-hatred.
For some transgender persons, these negative emotional experiences may lead to self-
harm, substance abuse and eating disorders.

11. PHYSICAL APPERANCE
Body image can play a role in how people express their gender. Transgender
people generally have an even more uncomfortable or negative relationship with their
bodies than non-transgender people.
 Some create a literal armor to hide or alter their bodies or to create a different bodily
contour:
Some FTMs (or other people on the trans-masculine spectrum)—
• Bind their chests.
• Wear baggy or multiple layers of clothing to help flatten the appearance of their
chest.
• Wear self-made or store-bought penile prosthetics.
• Use prosthetics to allow them to urinate while standing.

12. • Some MTFs (or other people on the trans-feminine spectrum)—
• Use breast or hip forms to create a more feminine contour.
• Wear wigs.
• Dress in a highly stereotypical feminine way to create an outward
appearance of undeniable femaleness.

13. Transition Period
 The process by which a transgender individual strives to have physical
presentation more closely align with identity.
 Transition can occur in three ways:
-social transition through nonpermanent changes in clothing,
hairstyle, name and/or pronouns
-medical transition through the use of medicines such as hormone
"blockers" or cross hormones to promote gender‐based body changes
-surgical transition in which an individual's body is modified
through the addition or removal of gender‐related physical traits.

14. The World Professional Association for Transgender Health
(WPATH)
Standards of Care (currently SOC-7) provide state-of-the-art guidelines for the proper
treatment of transgender adults and children.
 Treatment involves an integration of medical interventions, social support and
community building, and mental health care.
 Treatment is integrative and collaborative with other professionals and is most effective
when it includes advocacy and education within family, school, work and community
contexts
 Medical interventions
 Medical interventions may include any or all of the following, depending on the age and
gender identity of the transgender person:
• Puberty blockers that suppress the physical signs of puberty, which transgender adolescents
often experience as distressing

15. • Hormone replacement therapy (testosterone for FTM and androgen blockers and
estrogen for MTF transgender persons)
• Gender confirmation surgeries, including top surgeries (mastectomy and male chest
contouring for FTM and breast augmentation for MTF transgender persons) and bottom
surgeries (phalloplasty, scrotoplasty, metoidioplasty with or without urethroplasty, and
hysterectomy for FTM, and orchiectomy, vaginoplasty and labiaplasty for MTF
transgender persons)
 Cosmetic surgeries may also be performed, such as tracheal shave and facial
feminization surgery to help feminize facial features in MTF persons. Electrolysis or
other hair-removal methods may also be considered by MTF transgender persons to
feel and appear more feminine.

16. Social support and community building
Social support is very important for reducing the sense of isolation that many
transgender persons experience. Many report that they first sought information and
support for themselves on the internet, describing how comforting it was to find out there
were other people like them.
 There are support groups for transgender men, women, children and teens, and for
parents of transgender children and teens.
 Such groups for transgender persons and their family members provide useful
information about medical, cosmetic and legal steps in the transition process. These
groups are also central to the community building that provides hope and support for
dealing with unaccepting environments and other challenges that transgender persons
may encounter. Fostering the development of support services and participating in
community-building efforts are among the ways that professional

17. Safe school environment
 School environments play a significant role in the social and emotional development of
children.
 Every child has a right to feel safe and respected at school, but for youth who identify
as TGD, this can be challenging.
 Nearly every aspect of school life may present safety concerns and require
negotiations regarding their gender expression, including name/pronoun use, use of
bathrooms and locker rooms, sports teams, dances and activities, overnight activities,
and even peer groups.
 Conflicts in any of these areas can quickly escalate beyond the school’s control to
larger debates among the community and even on a national stage.

18. Mental health care
 Professional counselors can be helpful to transgender persons by providing informed,
competent and compassionate mental health care.
 According to WPATH SOC-7, minimum qualifications to provide mental health care to
transgender persons include a master’s degree in a clinical behavioral science field; training
and competence in the DSM-5; documented supervised training and competence in
counseling/psychotherapy; and continuing education in the treatment of gender identity issues
and WPATH SOC.
 Other commonly expressed concerns involve:
• Disclosure to others (coming out)
• The timing and extent of transition

19. Families of transgender persons
 Although family members vary in their degree and pace of acceptance, most struggle
adjusting to the change in their identity as a family.
 Counselors can also serve as a resource for information about gender identity and the
coming out process, and they can assist parents and their transgender children in
determining when and how to inform grandparents, extended family members, friends,
school personnel and church personnel.

20. The AAP works toward all children and adolescents
The AAP works toward all children and adolescents, regardless of gender identity or
expression, receiving care to promote optimal physical, mental, and social well-being.
Any discrimination based on gender identity or expression, real or perceived, is
damaging to the socioemotional health of children, families, and society.
 In particular, the AAP recommends the following:
1. that youth who identify as TGD have access to comprehensive, gender-affirming, and
developmentally appropriate health care that is provided in a safe and inclusive
clinical space;
2. that family-based therapy and support be available to recognize and respond to the
emotional and mental health needs of parents, caregivers, and siblings of youth who
identify as TGD;

21. 3.that electronic health records, billing systems, patient-centered notification systems, and
clinical research be designed to respect the asserted gender identity of each patient while
maintaining confidentiality and avoiding duplicate charts;
4. that insurance plans offer coverage for health care that is specific to the needs of youth
who identify as TGD, including coverage for medical, psychological, and, when
indicated, surgical gender-affirming interventions;
5.that provider education, including medical school, residency, and continuing education,
integrate core competencies on the emotional and physical health needs and best practices
for the care of youth who identify as TGD and their families;
6.that pediatricians have a role in advocating for, educating, and developing liaison
relationships with school districts and other community organizations to promote
acceptance and inclusion of all children without fear of harassment, exclusion, or bullying
because of gender expression;

22. 7.that pediatricians have a role in advocating for policies and laws that protect youth who
identify as TGD from discrimination and violence;
8.that the health care workforce protects diversity by offering equal employment
opportunities and workplace protections, regardless of gender identity or expression; and
9.that the medical field and federal government prioritize research that is dedicated to
improving the quality of evidence-based care for youth who identify as TGD.

24. Interlink between the transgender social welfare
scheme and Maslow’s hierarchy of needs:
The entire social welfare scheme launched by govt. will satisfied the lower order
needs transgender which will boost them to achieve the higher-order needs. To fulfill all
the lower needs (D-needs) are the big issues and challenges for government. The entire
program should must consider the Maslow’s hierarchy needs

25. Maslow grouped the five needs into two categories -Higher-order needs (B-needs) and
Lower-order needs (D-needs) the physiological and the safety needs constituted the lower-order
needs. These lower-order needs are mainly satisfied externally. The social, esteem, and self-
actualization needs constituted the higher-order needs. These higher-order needs are generally
satisfied internally within an individual.

26. India's first transgender police officer appointed in
Tamil Nadu fighting gender bias and many glass
ceilings, K Prithika Yashini has become the first
transgender to be appointed as a police officer in
Tamil Nadu.
Joyita Mondal the woman who became the first
transgender judgein India

27. Aishwarya Rupranat Pradhan - India's First Transgender
CivilServant
Anjali Ameer, The First Transsexual to Play the Lead Role
in An Indian Movie. Born in an orthodox Muslim family in
Kerala's Kozhikode

28. Conclusion
Through, the transgender community was given high position in Mughal period and
facing many problems and obstacles in & after British era. But at present to safe guard and
empower transgender communities there are many policies and Schemes implemented by the
government after the intervention of Supreme Court of India. After 2014 transgender
community of India get a legal status and recognized as third gender. Thus, we can foresee a
better future for upliftment of transgender community with the change of government policies
and mind set of people.

29. • International Journal of Applied Research 2020; 6(5):
284-288.
• American Academy of Child and Adolescent Psychiatry
(AACAP)
American Counselling Association (ACA)