Gender dysphoria in children and adolescents

Abstract Gender Dysphoria (GD) is a complex and most probably multifactorially caused condition and it is increasingly a matter of interest in the media and scientific literature. In particular, it is expressed by a significant discomfort that is usually associated with the incongruence between natal sex and gender identity and it represents a dimensional phenomenon that can occur with different degrees of intensity. The most extreme form of GD is usually accompanied by a desire for gender reassignment (GR). GD can have an early onset, since preschool age, with extremely variable and hard to predict clinical outcomes. Etiopathogenic theories are still uncertain and no specific etiological factor determining atypical gender development has been found to date, but there seems to be an increasing evidence of a biologic and/or genetic component involved. Professionals that deal with this kind of issues need to be able to recognize gender variant youth in order to perform an early assessment, to support awareness and structuring of sexual identity dimensions, to prevent associated psychopathology (if present), and consequently to improve the quality of life. Despite international guidelines being available, treatment of gender dysphoric children and adolescents is still controversial and there is currently poor consensus on psychological and medical intervention. Specialized GD services appear to be important in order to prevent suffering and distress and ensure psychosocial wellbeing of gender variant children/adolescents and their families. Aim of this chapter is to deal with psychological, medical and ethic aspects related to GD in children and adolescents, and to provide an overview of current debates and clinical options available internationally.