Autonomy and Developmental Trajectories of Transgender Adolescents
This blog post is an adaptation of an essay written for the course ‘Personality and Individual Differences’ given by dr. B. F. Jeronimus to Bachelor Psychology students.
Establishing one’s identity and how to present it to the world can cause conflicts and struggles for every adolescent, but having to fight to present yourself as who you are is a struggle that especially transgender individuals have to face. In this blog post, I want to explore the connection that can be made between transgender identity development, its link with personality psychology and societal issues.
An approach to transgender understanding
Charlotte Tate suggests defining gender as a “self-categorization process that exists within personality science” (Tate, 2014, pp. 1-2) which offers an interesting perspective on gender identity. It also gives way for new evidence in the ongoing debate on legal restrictions regarding gender reassignment treatments, especially the minimum age needed to pursue treatment.
Transgender individuals can be broadly defined as people who identify with a gender different from the one they were assigned at birth (National Center for Transgender Equality, 2016). Although they are reaching more recognition in society, there are still many hardships trans people have to endure. Only one of them is that they have to partake in an endless fight to make their appearance match the way they perceive themselves. Sadly, one example of enduring discrimination is the legislative actions introduced this year in multiple states in the U.S. as well as other countries such as Poland (ABC News, 2021) that restrict the rights of transgender individuals.
Transgender individuals can be broadly defined as people who identify with a gender different from the one they were assigned at birth (National Center for Transgender Equality, 2016).
As an example, the state of Arkansas introduced a bill titled the “Arkansas Safe Adolescents From Experimentation (SAFE) Act”, which prohibits healthcare professionals from providing any kind of gender transition procedures to minors under 18, either surgical, in the form of puberty-blocking drugs, or any other way (State of Arkansas, 2021). This means that adolescents would be forced by law to continue to present themselves in a way that is conflicting with their self-image and not true to their identity and personality – even when having talked to medical professionals or being diagnosed with, for instance, gender dysphoria (American Psychiatric Association, 2020).
What does the research say about transgender development and transition?
There is a limited number of studies on the percentage of individuals who regret taking gender reassigning measures or even decide to ‘detransition’, but the rates seem to be generally low. For example, Richards and Doyle found the rate of regret in pursuing treatment at 0.99% in a gender clinic in the UK (Richards & Doyle, 2019). So even though the possibility of adolescents regretting their decision to transition cannot be eliminated, it does not seem justified to use this argument to restrict treatment in a generalized way. In this sense, due to the relevance of the decision of gender reassigning, it is a process that should take place with the support, information, guidance, and accompaniment of a multidisciplinary health care team.
It is possible to make an analogy between personality traits and identity development to emphasize the relevance of validating individual gender identity trajectories. Personality traits can fluctuate in everyday life and over the developmental trajectories, but they are seen as relatively stable over time (Rantanen et al., 2007; Jayawickreme et al., 2019). The process of establishing an own identity might be a difficult process, especially in people deviating from the norm – but as with personality traits, once identity is developed throughout adolescence, it will remain relatively stable over the lifetime (Klimstra et al., 2010). Now, going back to gender identity, similar dynamics can be found: Gülgötz et al. (2019) show that transgender children age 3-12 already exhibited robust identification with their current gender and gender-typed behavior like toy preferences, therefore showing a persistent pattern of development in accordance with their current gender and similar to cisgender children.
“It is possible to make an analogy between personality traits and identity development to emphasize the relevance of validating individual gender identity trajectories”.
In this sense, trait stability reinforces the argument of giving adolescents the autonomy to hold control over a trait that influences their daily interactions with their environment as much as gender – especially since the consequences of taking this autonomy away from transgender individuals may be detrimental for their mental health and well-being. As an example, a study by Biggs (2020), which is available on the website of the US National Institute of Health, shows evidence for a significant inverse relation between puberty suppression during adolescence and lifetime suicidal ideation for people who wish for puberty suppression treatment.
Based on the arguments presented, the availability of treatment for trans adolescents is a public health need. In the future, more research on transgender youth will be able to show more intricate connections between treatment availability and improvement in mental health (Vrouenraets et al., 2015). At the same time, further research will help to prevent regretting decisions for irreversible gender reassignment treatments by providing deeper knowledge on this matter. Since the evidence suggests significant positive effects for transgender people who wish for and can receive treatment and also generally low rates of regret and ‘detransitioning’, adolescents who are faced with the struggle of gender expression would be granted the autonomy of making decisions about their own presentation, considering the singularities of each individual case, the access to information, professional guidance and support.
ABC News (2021). Poland’s ‘LGBT-free zones’ could lead to hate crimes and violence, rights group warns. https://www.abc.net.au/news/2021-02-11/hate-crime-violence-feared-in-polish-lgbt-free-zones/13142918
American Psychiatric Association (2020). What is Gender Dysphoria? https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria
Biggs, M. (2020). Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria. Arch Sex Behav 49, 2227–2229. https://doi.org/10.1007/s10508-020-01743-6
Gülgöz, S., Glazier, J. J., Enright, E. A., Alonso, D. J., Durwood, L. J., Fast, A. A., Lowe, R., Ji, C., Heer, J., Martin, C. L., & Olson, K. R. (2019). Similarity in transgender and cisgender children’s gender development. PNAS Proceedings of the National Academy of Sciences of the United States of America, 116(49), 24480–24485. https://doi.org/10.1073/pnas.1909367116
Jayawickreme, E., Zachry, C. E., & Fleeson, W. (2019). Whole Trait Theory: An integrative approach to examining personality structure and process. Personality and Individual Differences, 136, 2–11. https://doi.org/10.1016/j.paid.2018.06.045
Klimstra, T. A., Hale, W. W., III, Raaijmakers, Q. A. W., Branje, S. J. T., & Meeus, W. H. J. (2010). Identity formation in adolescence: Change or stability? Journal of Youth and Adolescence, 39(2), 150–162. https://doi.org/10.1007/s10964-009-9401-4
National Center for Transgender Equality (2016, July 9). Understanding Transgender People: The Basics.
Rantanen, J., Metsäpelto, R.-L., Feldt, T., Pulkkinen, L., & Kokko, K. (2007). Long-term stability in the Big Five personality traits in adulthood. Scandinavian Journal of Psychology, 48(6), 511–518. https://doi.org/10.1111/j.1467-9450.2007.00609.x
Richards, C., & Doyle, J. (2019). Detransition rates in a large national gender identity clinic in the UK. Counselling Psychology Review, 34(1), 60–66.
State of Arkansas, 93rd General Assembly (2021). An Act to Create the Arkansas Save Adolescents From Experimentation (SAFE) Act; and for Other Purposes. https://www.arkleg.state.ar.us/Bills/FTPDocument?path=%2FBills%2F2021R%2FPublic%2FHB1570.pdf
Tate, C. (2014). Gender identity as a personality process. In B. L. Miller (Ed.). Gender identity: Disorders, developmental perspectives and social implications (pp. 1-22). Hauppauge, NY: Nova Science Publishers.
Vrouenraets, L. J. J. J., Fredriks, A. M., Hannema, S. E., Cohen-Kettenis, P. T., & de Vries, M. C. (2015). Early medical treatment of children and adolescents with gender dysphoria: An empirical ethical study. Journal of Adolescent Health, 57(4), 367–373. https://doi.org/10.1016/j.jadohealth.2015.04.004
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