Behandlung von Geschlechtsidentitätsstörungen (Geschlechtsdysphorie) im Kindes- und Jugendalter - Ausgangsoffene psychotherapeutische Begleitung oder frühzeitige Festlegung und Weichenstellung durch Einleitung einer hormonellen Therapie?
Autoren
Alexander Korte, Klaus M. Beier, Hartmut A.G. Bosinski
Abstract
Child and adolescent psychiatrists experience more and more patients who are uncertain or dissatisfied in regard to their birth sex; some wish to join the opposite sex. Within the framework of the recently revised DSM, DSM-5 (2013), this article discusses the diagnostic clas- sification Gender Dysphoria (GD), in particular the question of the persistence of GD and the therapeutic implications. It reviews at length the different approaches for treatment, especially the pros and cons of early hormonal therapy. The study is based on a selective Medline literature search, national and international guidelines, and the results of a debate among experts in multiple relevant disciplines. Strong evidence indicates that only a minority of children with GD manifest an irreversible transsexualism in adulthood. This indicates the use of age-differentiated therapy with an open outcome, a treatment approach which in the case of younger children primarily aims at strengthening the sense of concordance with their birth sex and which in principle uses developmental tasks beyond the gender identity issue for all age groups, and takes possible comorbid psychiatric disorders into account. For adolescents with transsexualism in statu nascendi a real-life test under psychotherapeutical supervision is indicated. The treatment with developmental- and body- altering hormones should be initiated only after the juvenile’s somato- and psychosexual development has been completed. The article also debates the medical ethics involved here.
Keywords
Gender identity disorder, Gender dysphoria, Transsexuality, Hormone treatment, Puberty suppression, GnRH, Analoga
Metadaten
Veröffentlicht in: Sexuologie. Zeitschrift für Sexualmedizin, Sexualtherapie und Sexualwissenschaft. Band 23 • Jahr 2016 • Heft 3-4, Seiten 117-132