March 2, 2014

Do Coexisting Mental Conditions Prevent Gender Transition?

Asked recently on Tumblr:

Hi, I am asking a question as a friend of someone who identifies as transgender. I’m trying to do some research concerning what is needed for transition, but I’ve been having problems because most of the information I find concerns transgender individuals who do not have certain disabilities. I’m talking about autism, depression, OCD, anorexia etc. Do you have any resources concerning these?

It’s well established in the existing research that people with GD have higher-than-average instances of other mental conditions (depression is very common), so it’s likely that any GD mental health professional has helped transition such individuals before. In fact, the therapist probably operates under the WPATH Standards of Care, which advises that if someone has a therapeutically treatable mental disorder like depression, anorexia, or OCD, “Mental health professionals should screen for these and other mental health concerns and incorporate the identified concerns into the overall treatment plan” (p. 181). In other words, GD is not something a therapist treats in a vaacum, but as part of a comprehensive psychiatric regimen. So having these issues doesn’t severely alter possible transition; it just complicates it a bit.

This aligns with my personal experience. When I first sought out therapy I also had a depressive disorder that included thoughts of suicide. My therapist worked with my GD, but made it clear that I needed to be mentally healthy overall before completing transition. I sought out a seperate therapist to deal with the depression issues and to prescribe appropriate medication. Within eight months, I started HRT; and today my GD is not only being treated, but my depression is under control and I am leading a much happier life.

Autism spectrum disorder (ASD) is more complex than depression or OCD. It is not a single clinically treatable mental condition, but instead a series of related neurodevelopmental disorders (also sometimes called pervasive developmental disorders) that can cause social impairment, communication difficulties, and behavioral issues. Further complicating the question is that some adult patients with ASD are not considered to have the capacity to consent to medical treatment, which would mean that a legal guardian would need to approve of any transition.

As I also couldn’t find any clear resources about treating ASD with GD, I sent the question to my own therapist. She said that while ASD complicates diagnosis and treatment of GD, she did not generally view it as an impediment to transition. In fact, since GD causes mental distress and anxiety — both things which someone with ASD can struggle to express or deal with — treating the GD could possibly moderate ASD symptoms as well. Her view was that someone with both GD and ASD would be best served by finding a therapist who is familiar with both; but barring that, any good therapist would be sure to coordinate any GD counseling with the client’s ASD support system. This would be the same as the approach to therapeutically treatable mental disorders: work with the patient to help not just the GD, but overall mental health and quality of life.

I hope this gives you the information you were seeking, and that your friend finds the help they need.


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