The discursive and clinical production of trans youth: gender variant youth who seek puberty suppression

Abstract

This article focuses on therapeutic interventions with gender variant youth and, in particular, pubertal suppression. The aim is to address the question of which kinds of subjects are enabled, and which are made invisible, through discursive and clinical practices. The analysis demonstrates the conceptual value of drawing on discursive and queer theoretical approaches. The published work of selected clinicians is used as a way in to the complexities that various clinical understandings and approaches bring with them. A key focus is on problems inherent in the construction of gender variant youth as ‘persisting’ or ‘desisting’ in their cross-gender wishes. Psychologists working in this area have substantial challenges to face, such as the challenge of negotiating understandings about what is a ‘successful’ outcome and the complexity of reporting fluidity and uncertainty in the context of a scientific forum where ‘results’ are expected. This article addresses the challenge of engaging psychological, discursive and clinical practices in ways that enable empowered, viable, gender variant possibilities, rather than representing gender variant youth as incoherent subjects.

Keywords:

• gender variant youth
• queer
• gender identity disorder
• puberty suppression
• discourse

Acknowledgements

I am grateful to colleagues for comments on earlier drafts. Specific thanks to Karl Bryant, Peter Hegarty, Peggy Cohen-Kettenis, Bernadette Wren and Erik Carlquist. I also acknowledge the support of GEXcel: Centre of Gender Excellence, Linköping University, where I was a visiting scholar while working on this article.

Notes

1. The Endocrine Society is a US professional body (http://www.endo-society.org/) but this particular set of guidelines were written by a collaboration of Dutch and US endocrinologists.

2. Early studies (mostly on boys) suggested that 60–100% of children who were assessed to be gender dysphoric later were reported to be gay or bisexual adults (Green, 1987; Money & Russo, 1979; Zucker & Bradley, 1995).

3. This stands in contrast to research demonstrating that transgender people in general, and gender variant youth in particular, experience high levels of harassment and abuse (e.g. Gagne, Tewksbury, & McGaughey, 1997; Lombardi, Wilchins, Priesing, & Malouf, 2001; Ryan & Rivers, 2003). A UK study that surveyed 872 self-identified trans people found that 73% of the sample reported harassment, with many recalling such harassment and bullying taking place at school (Whittle, Turner, & Al-Alami, 2007). More clinically oriented publications on gender variant youth also note issues of teasing, ostracism and violence (Menvielle, Tuerk, & Perrin, 2005; Möller et al., 2009).

4. For a recent exposition of debates specifically centred on transsexual and transgender theorising and the consideration or neglect of transpeople's lived realities, see Elliot (2009).