{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T23:58:50Z","timestamp":1773273530107,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"s4","license":[{"start":{"date-parts":[[2014,9,17]],"date-time":"2014-09-17T00:00:00Z","timestamp":1410912000000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hastings Center Report"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:italic>Transgender issues and transgender rights have become increasingly a matter of media attention and public policy debates. Reflecting changes in psychiatric perspectives, the diagnosis of \u201ctrans\u2010sexualism\u201d first appeared in the International Statistical Classification of Diseases and Related Health Problems in 1975 and shortly thereafter, in 1980, in the Diagnostic and Statistical Manual of Mental Disorders. Since that time, international standards of care have been developed, and today those standards are followed by clinicians across diverse cultures. In many instances, treatment of older adolescents and adults is covered by national health care systems and, in some cases, by private health insurance. Most recently, the Medicare ban on coverage for gender reassignment surgery was lifted in 2014<\/jats:italic>.<\/jats:p><jats:p><jats:italic>In contrast to the relative lack of controversy about treating adolescents and adults, there is no expert clinical consensus regarding the treatment of prepubescent children who meet diagnostic criteria for what was referred to in both DSM\u2010IV\u2010TR and ICD\u201010 as gender identity disorder in children and now in DSM\u20105 as gender dysphoria. One reason for the differing attitudes has to do with the pervasive nature of gender dysphoria in older adolescents and adults: it rarely desists, and so the treatment of choice is gender or sex reassignment. On the subject of treating children, however, as the World Professional Association for Transgender Health notes in their latest Standards of Care, gender dysphoria in childhood does not inevitably continue into adulthood, and only 6 to 23 percent of boys and 12 to 27 percent of girls treated in gender clinics showed persistence of their gender dysphoria into adulthood. Further, most of the boys\u2019 gender dysphoria desisted, and in adulthood, they identified as gay rather than as transgender<\/jats:italic>.<\/jats:p><jats:p><jats:italic>In an effort to clarify best treatment practices for transgender individuals, a recent American Psychiatric Association Task Force on the Treatment of Gender Identity outlined three differing approaches to treating prepubescent gender dysphoric children<\/jats:italic>.<\/jats:p>","DOI":"10.1002\/hast.365","type":"journal-article","created":{"date-parts":[[2014,10,7]],"date-time":"2014-10-07T10:59:26Z","timestamp":1412679566000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Ethical Issues Raised by the Treatment of Gender\u2010Variant Prepubescent Children"],"prefix":"10.1002","volume":"44","author":[{"given":"Jack","family":"Drescher","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Pula","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,9,17]]},"reference":[{"key":"e_1_2_5_1_1","first-page":"A12","article-title":"California: Rights Guaranteed for Transgender Students","author":"Lovett I.","year":"2013","journal-title":"New York Times"},{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1300\/J514v19n01_07"},{"issue":"3","key":"e_1_2_5_2_2","first-page":"71","article-title":"Gender Dissonance: Diagnostic Reform of Gender Identity Disorder for Adults","volume":"17","author":"Winters K.","year":"2005","journal-title":"Journal of Psychology & Human Sexuality"},{"key":"e_1_2_5_3_1","volume-title":"Standards of Care for the Health of Transsexual, Transgender and Gender Non\u2010Conforming People","author":"World Professional Association for Transgender Health","year":"2011"},{"key":"e_1_2_5_4_1","article-title":"Ban Lifted on Medicare Coverage for Sex Change Surgery","author":"Cha A. E.","year":"2014","journal-title":"Washington Post"},{"key":"e_1_2_5_5_1","unstructured":"At the time of this writing a proposed name change forICD\u201011is \u201cgender incongruence of children.\u201d"},{"key":"e_1_2_5_6_1","unstructured":"This was formerly known as the Harry Benjamin International Gender Dysphoria Association."},{"key":"e_1_2_5_7_1","unstructured":"See World Professional Association for Transgender Health \u201cStandards of Care for the Health of Transsexual Transgender and Gender Non\u2010Conforming People \u201d 11."},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-012-9975-x"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurenf.2008.06.003"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/00918369.2012.653309"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/00918369.2012.653300"},{"key":"e_1_2_5_11_1","unstructured":"All three clinics mentioned here offer puberty suppression to children when clinically indicated either to \u201cbuy time\u201d in case they desist after puberty or to prevent development of secondary sex characteristics in those who persist. However the approach here acts under the assumption that they are better able to distinguish desisters from persisters."},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/00918369.2012.653303"},{"key":"e_1_2_5_13_1","unstructured":"Further illustrating the controversies some clinicians (including Ehrensaft) eschew the use of psychiatric diagnoses when evaluating and treating these children. Consequently the nonmedical term \u201cgender variance\u201d is an alternative nonpathologizing way of describing them."},{"key":"e_1_2_5_14_1","volume-title":"Treating Transgender Children and Adolescents: An Interdisciplinary Discussion","author":"Drescher J.","year":"2013"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2013.03.016"},{"key":"e_1_2_5_16_1","unstructured":"\u201cCisgender\u201d is used in the transgender community to describe those who are not transgender."},{"key":"e_1_2_5_17_1","volume-title":"The Principles of Medical Ethics: With Annotations Especially Applicable to Psychiatry","author":"American Psychiatric Association","year":"2009"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-200303000-00005"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/00918369.2012.653309"},{"key":"e_1_2_5_20_1","unstructured":"K. E.Bryant \u201cThe Politics of Pathology and the Making of Gender Identity Disorder \u201d PhD diss. University of California Santa Barbara 2007."},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359104510378303"},{"key":"e_1_2_5_22_1","unstructured":"A similar question can be raised about the treatment of adult trans individuals. Does the present system of \u201cgate keeping\u201d before allowing medical and surgical treatment exist for the benefit of those wishing to transition or to protect those individuals who after transition might express regrets?"},{"key":"e_1_2_5_23_1","unstructured":"Ehrensaft \u201cFrom Gender Identity Disorder to Gender Identity Creativity: True Gender Self Child Therapy \u201d 354."},{"key":"e_1_2_5_24_1","volume-title":"The Health of Lesbian, Gay, Bisexual and Transgender People: Building a Foundation for Better Understanding","author":"Institute of Medicine, Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities","year":"2011"}],"container-title":["Hastings Center Report"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhast.365","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hast.365","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T00:50:00Z","timestamp":1694479800000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hast.365"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,9]]},"references-count":26,"journal-issue":{"issue":"s4","published-print":{"date-parts":[[2014,9]]}},"alternative-id":["10.1002\/hast.365"],"URL":"https:\/\/doi.org\/10.1002\/hast.365","archive":["Portico"],"relation":{},"ISSN":["0093-0334","1552-146X"],"issn-type":[{"value":"0093-0334","type":"print"},{"value":"1552-146X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,9]]},"assertion":[{"value":"2014-09-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}