[Adolescents with Gender Incongruence - Special Case Constellations]. / Jugendliche mit Geschlechtsinkongruenz ­ besondere Fallkonstellationen.

Adolescents with Gender Incongruence - Special Case Constellations Abstract: Adolescents with gender incongruence and gender identity variants have a high rate of accompanying mental disorders, such as depression, autism spectrum disorders, or eating disorders. Yet, the interaction between gender incongruence, gender dysphoric distress, and accompanying mental disorders is complex and varies considerably from case to case. We need an individualized approach and careful professional assessment to help those affected and their guardians make informed decisions regarding possible treatment steps in complex case constellations. Maintaining careful process support and planning of the treatment steps can help to resolve blocked development processes in adolescents with gender incongruence and accompanying psychological disorders or in young people with unstable gender identity development.

[The Sorrows of the Old from the Gender of the Young: A Commentary on Korte, A. & Tschuschke, V. (2023). Media's Stranglehold on Storm and Stress ­ The Sorrows of Generation Z about Sex and Gender]. / Die Leiden der Alten am Geschlecht der Jungen.

When Old People Suffer Because of the Sex of the Young: A Commentary on Korte, A. & Tschuschke, V. (2023). The Media's Stranglehold on Sturm und Drang - The Sorrows of Generation Z Regarding Sex and Gender Abstract: In their article "Sturm und Drang im Würgegriff der Medien - Die Leiden der jungen Generation am eigenen Geschlecht" in the Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (volume 51, issue 5), our colleagues Korte and Tschuschke address the question of the extent to which the increase in gender identity deviations among adolescents "also results from upheavals the cultural landscape and, above all, in media technology." The authors look critically at the planned German "Self-Determination Law," the social transition of children and adolescents, the so-called puberty blockade, and hormone therapy in adolescents and justify their preference for a gender-critical over a transaffirmative therapy approach. Although the article introduces some interesting hypotheses from the perspective of cultural studies and philosophy (among others), it may contribute to uncertainty among colleagues in treating trans*people because of its trans-critical tone. This stems from linguistic devices, misleading and erroneous quotations, and incomplete or incorrect descriptions of facts. This contribution therefore takes a critical look at the article by Korte and Tschuschke, using critical linguistic analysis and examining the facts, data, and sources cited by the authors. It encourages our colleagues to engage in a joint, participatory, trans*respectful treatment process with gender-dysphoric children and adolescents while exploring the sizeable intermediate area between "gender-critical" and "transaffirmative" attitudes, which the authors Korte and Tschuschke barely touch on in their article.

[Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria]. / Beyond NICE: Aktualisierte systematische Übersicht zur Evidenzlage der Pubertätsblockade und Hormongabe bei Minderjährigen mit Geschlechtsdysphorie.

Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria Abstract: Objective: The suppression of physiological puberty using puberty-blocking pharmacological agents (PB) and prescribing cross-sex hormones (CSH) to minors with gender dysphoria (GD) is a current matter of discussion, and in some cases, PB and CSH are used in clinical practice for this particular population. Two systematic reviews (one on PB, one on CSH treatment) by the British National Institute for Clinical Excellence (NICE) from 2020 indicated no clear clinical benefit of such treatments regarding critical outcome variables. In particular, these two systematic NICE reviews on the use of PB and CSH in minors with GD detected no clear improvements of GD symptoms. Moreover, the overall scientific quality of the available evidence, as discussed within the above-mentioned two NICE reviews, was classified as "very low certainty" regarding modified GRADE criteria. Method: The present systematic review presents an updated literature search on this particular topic (use of PB and CSH in minors with GD) following NICE principles and PICO criteria for all relevant new original research studies published since the release of the two above-mentioned NICE reviews (updated literature search period was July 2020-August 2023). Results: The newly conducted literature search revealed no newly published original studies targeting NICE-defined critical and important outcomes and the related use of PB in minors with GD following PICO criteria. For CSH treatment, we found two new studies that met PICO criteria, but these particular two studies had low participant numbers, yielded no significant additional clear evidence for specific and clearly beneficial effects of CSH in minors with GD, and could be classified as "low certainty" tfollowing modified GRADE criteria. Conclusions: The currently available studies on the use of PB and CSH in minors with GD have significant conceptual and methodological flaws. The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn't suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD. Psychotherapeutic interventions to address and reduce the experienced burden can become relevant in children and adolescents with GD. If the decision to use PB and/or CSH is made on an individual case-by-case basis and after a complete and thorough mental health assessment, potential treatment of possibly co-occurring mental health problems as well as after a thoroughly conducted and carefully executed individual risk-benefit evaluation, doing so as part of clinical studies or research projects, as currently done in England, can be of value in terms of generation of new research data. The electronic supplement (ESM) 1 is an adapted and abreviated English version of this work.

[Media's Stranglehold on Storm and Stress - The Sorrows of Generation Z about Sex and Gender]. / Sturm und Drang im Würgegriff der Medien ­ Die Leiden der jungen Generation am eigenen Geschlecht.

Media's Stranglehold on Storm and Stress - The Sorrows of Generation Z about Sex and Gender Abstract: The feeling of not belonging to one's birth sex is not new; one can trace this phenomenon back even to ancient mythology. Although it has always been rare, there has recently been a sharp increase in gender identity deviations among adolescents. This text addresses this problem by asking to what extent this development also results from upheavals in the cultural landscape and, above all, in media technology. Do they cause young people to believe they are in the "wrong gender" and, in extreme cases, to strive for transition? We present the most salient cornerstones of the planned German self-determination law (Self-ID), most of which, however, are unlikely to do justice to the underlying problem. The text concludes by describing several unanswered questions concerning this matter and by attempting to propose first answers. The advantages of a gender-exploratory over the trans affirmative therapy approach are summarized.

[Practical Guideline on Dealing with Transgender Patients in Child and Adolescent Psychiatric Inpatient Settings]. / Handreichung zum Umgang mit Transgender-Patientinnen und -Patienten im voll- und teilstationären Setting.

Practical Guideline on Dealing with Transgender Patients in Child and Adolescent Psychiatric Inpatient Settings Abstract: The guideline provided by the Federal Association of Leading Medical Directors for Child and Adolescent Psychiatry offers a framework for dealing with transgender patients in child and adolescent psychiatric clinics. It addresses the clinical challenges arising from the significant increase in transgender patients and the paradigm shift in the medical field. The guideline includes recommendations for dealing with transgender patients in various settings. Key treatment principles comprise adopting a destigmatizing approach, using preferred names and pronouns, accommodating individual room assignments, and considering relevant comorbidities. Only experienced medical doctors and psychotherapists should carry out diagnosis and treatment. The goals for supporting adolescents with gender dysphoria include promoting self-acceptance, addressing negative emotions, facilitating social integration, and fostering identity development.

[Experiences of Children with Gender Dysphoria/Gender Incongruence and their Parents with the Health Care System in Germany]. / Erfahrungen von Kindern mit Geschlechtsdysphorie/ Geschlechtsinkongruenz und ihren Eltern mit dem Gesundheitswesen in Deutschland.

The aim of the study is to describe experiences within the health care system of children and adolescents with gender dysphoria/gender incongruence (GD/GI) as well as their parents in Germany.The findings are intended to improve health care of children and adolescents with GD/GI and their families and have been incorporated into the development of the new S3 Guidelines "Gender Incongruence and Gender Dysphoria in Childhood and Adolescence: Diagnosis and Treatment". A total of 78 people, 35 children, adolescents, and young adults (6- 21 years) with GD/GI as well as 33mothers and 10 fathers, were interviewed. Seventeen semistructured individual interviews and five focus groups were conducted. Many of the participants reported waiting times of several months or years as well as inadequately trained doctors and therapists. A trans*identity, especially amongst smaller children and their parents, was often dismissed by health care providers, as a temporary phenomenon or an imagination of the child or the parents. Trans*ident children, adolescents and young adults as well as their parents were rarely perceived as experts in their own right. Recommendations for an affirmative care of trans* children and adolescents are formulated.

[Gender identities in transition]. / Geschlechtsidentitäten im Wandel.

Gender identities in transition Abstract. In recent years, the healthcare system has been confronted with an increasing number of children and adolescents with gender nonconformity, gender incongruence, and gender dysphoria. Medical professionals are still debating how to interpret this phenomenon and how best to meet the healthcare needs of this diverse group of young people. Meanwhile, the transgender and gender nonconforming youths themselves face enormous challenges in finding appropriate support and treatment in the mental healthcare system. This article reviews the available epidemiological data, the paradigm shift in the social, legal, and medical systems, the developments in diagnostic classifications (DSM-5, ICD-11) as well as important aspects of the AWMF S3 guideline for adults with gender incongruence and gender dysphoria. In addition, it describes the complexity of working with transgender, gender nonconforming, and gender-questioning youth in the context of the current discourse and the underlying ethical dilemmas. In conclusion, this article outlines the challenges facing child and adolescent psychiatry and psychotherapy in this complex environment.

[Trans-Identity in Minors: Basic Ethical Principles for Individual Decision-Making in Healthcare]. / Trans-Identität bei Kindern und Jugendlichen: Medizinethische Grundsätze für individuelle Behandlungsentscheidungen.

Trans-Identity in Minors: Basic Ethical Principles for Individual Decision-Making in Healthcare The treatment of minors with gender incongruence has been the subject of controversial discussion for some time. In 2020, the German Ethics Council adopted the ad-hoc recommendation "Trans-identity in children and adolescents: Therapeutic Controversies - Ethical Orientations" with the aim of sensitising to the relevant ethically problematic aspects and of setting out orienting guidelines for medical and psychotherapeutic support and treatment. According to the Ethics Council, every person has the constitutional right to lead a life in accordance with one's own gender identity and to be respected in this identity. Healthcare professionals must assess the consequences of treatment as well as the consequences of refraining to provide treatment. All interactions with the child must be designed in such a way that the child can participate in decision-making and is ultimately enabled to give full informed consent. Stigmatisation and discriminatory pathologisation of gender incongruence must be avoided.

[Therapeutic Models for Children and Adolescents with Gender Dysphoria: Overview with Focus on Austrian Treatment Reality]. / Versorgungsmodelle für Kinder und Jugendliche mit Geschlechtsdysphorie: Überblick unter Berücksichtigung der österreichischen Behandlungsrealität.

Therapeutic Models for Children and Adolescents with Gender Dysphoria: Overview with Focus on Austrian Treatment Reality Young people whose experienced gender differs from their aligned sex are increasingly visible in public life as well as in the medical care system. For those children and adolescents, who can experience a high degree of suffering because of the discrepancy between aligned sex and desired gender, treatment guidelines have been developed. In this short narrative review, classification options, epidemiological data, health-care data and treatment guidelines are presented with an emphasis on the Austrian health care system.