We noted the observation transgender youth are more likely “to have concurrent mental health and neurodiverse conditions including depression, anxiety, attention deficit disorders, and autism.” [1]. Pedantically, “neurodiverse” should be neurodivergent. Neurodiversity is the concept that divergent neurotypes exist as a valued part of natural human diversity with both strengths and challenges. Writing “disorders” adjacent to “neurodiverse” shows misunderstanding of the intended inherent demedicalisation.
The authors of this letter are neurodivergent, some of which identify as transgender. Without pretence, the mention of neurodivergence when speaking about transgender people is to imply that there is less capacity for making good choices about our bodies, evaluating risks and benefits. We can assure you as intelligent neurodivergent practising doctors, responsible for the care of others, that this is not the case. A divergent neurotype does not invalidate one’s gender identity. Moreover, the evidence is mounting that both divergences should be affirmed for better health outcomes [2, 3, 4].
Other letters have addressed some of the flaws within J Block’s article [5, 6]. It has been noted the article conflates affirming psychosocial gender identity with medical intervention [6]. The article also further conflates “puberty blockers'' and gender affirming hormonal intervention. The former is a reversible pause of puberty and the latter is where puberty is commenced aligned with identified gender. These are initiated separately, slowly and cautiously; regardless the existing evidence shows good outcomes in transgender youth [7]. It bears repeating that when reaching adulthood 0.3-0.6% regret gender affirming procedures [8, 9], with evidence that even this small figure is largely due to external environmental pressures [10].
For erudite commentary on transgender healthcare, we would alternatively suggest Abigail Thorn; she leverages lived experience as a transgender woman and her background in philosophy [11].
Samira Khan (pseudonym)
Specialty Trainee Doctor
London, UK
Matthew Sellen
Consultant Psychiatrist specialising in neurodivergence and gender divergence
Brisbane, Australia
Bethan Carey Jones
General Practice Registrar
Wales, UK
Sources
1. Becerra-Culqui TA et al. Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics. 2018. 141.
2. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender dysphoric/gender-incongruent persons: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2017. 102.
3. Turban JL, King D, Kobe J, et al. Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. 2022. PLoS One 17: e0261039.
4. Botha M, Gillespie-Lynch K: Come as You Are: Examining Autistic Identity Development and the Neurodiversity Movement through an Intersectional Lens. Human Development. 2022. 66.
7. Chen D, Berona J, Chan YM, Ehrensaft D, Garofalo R, Hidalgo MA, et al. Psychosocial Functioning in Transgender Youth after 2 Years of Hormones. N Engl J Med. 2023 Jan 19;388(3):240–50.
8. Jedrzejewski BY et al. Regret after Gender Affirming Surgery – A Multidisciplinary Approach to a Multifaceted Patient Experience. Plastic and Reconstructive Surgery. 2023. 23 (1).
9. Wiepjes CM et al. The Amsterdam cohort of gender dysphoria study (1972–2015): Trends in prevalence, treatment, and regrets. The Journal of Sexual Medicine. 2018. 15.
10. Turban JL et al. Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT Health. 2021. 8(4).
11. Thorn A. “I Emailed My Doctor 133 Times: The Crisis in the British Healthcare System”. YouTube. 2022. Available at: https://youtu.be/v1eWIshUzr8 [Accessed 02/03/23. Bibliography available in the recording’s description.]
Competing interests:
No competing interests
16 March 2023
Samira Khan
Specialty Trainee Doctor
Matthew Sellen (Consultant Psychiatrist specialising in neurodivergence and gender divergence Brisbane, Australia) , Bethan Carey Jones (General Practice Registrar Wales, UK)
Rapid Response:
Diversity in gender identity and neurotypes
Dear Editor,
We noted the observation transgender youth are more likely “to have concurrent mental health and neurodiverse conditions including depression, anxiety, attention deficit disorders, and autism.” [1]. Pedantically, “neurodiverse” should be neurodivergent. Neurodiversity is the concept that divergent neurotypes exist as a valued part of natural human diversity with both strengths and challenges. Writing “disorders” adjacent to “neurodiverse” shows misunderstanding of the intended inherent demedicalisation.
The authors of this letter are neurodivergent, some of which identify as transgender. Without pretence, the mention of neurodivergence when speaking about transgender people is to imply that there is less capacity for making good choices about our bodies, evaluating risks and benefits. We can assure you as intelligent neurodivergent practising doctors, responsible for the care of others, that this is not the case. A divergent neurotype does not invalidate one’s gender identity. Moreover, the evidence is mounting that both divergences should be affirmed for better health outcomes [2, 3, 4].
Other letters have addressed some of the flaws within J Block’s article [5, 6]. It has been noted the article conflates affirming psychosocial gender identity with medical intervention [6]. The article also further conflates “puberty blockers'' and gender affirming hormonal intervention. The former is a reversible pause of puberty and the latter is where puberty is commenced aligned with identified gender. These are initiated separately, slowly and cautiously; regardless the existing evidence shows good outcomes in transgender youth [7]. It bears repeating that when reaching adulthood 0.3-0.6% regret gender affirming procedures [8, 9], with evidence that even this small figure is largely due to external environmental pressures [10].
For erudite commentary on transgender healthcare, we would alternatively suggest Abigail Thorn; she leverages lived experience as a transgender woman and her background in philosophy [11].
Samira Khan (pseudonym)
Specialty Trainee Doctor
London, UK
Matthew Sellen
Consultant Psychiatrist specialising in neurodivergence and gender divergence
Brisbane, Australia
Bethan Carey Jones
General Practice Registrar
Wales, UK
Sources
1. Becerra-Culqui TA et al. Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics. 2018. 141.
2. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender dysphoric/gender-incongruent persons: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2017. 102.
3. Turban JL, King D, Kobe J, et al. Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. 2022. PLoS One 17: e0261039.
4. Botha M, Gillespie-Lynch K: Come as You Are: Examining Autistic Identity Development and the Neurodiversity Movement through an Intersectional Lens. Human Development. 2022. 66.
5. Huntington GR. Rapid response to: Gender dysphoria in young people is rising. https://www.bmj.com/content/380/bmj.p382/rr
6. Kristensen Z, Menkes DB. Rapid Response: Professional responses to gender dysphoria: reality checks needed. https://www.bmj.com/content/380/bmj.p382/rr-3
7. Chen D, Berona J, Chan YM, Ehrensaft D, Garofalo R, Hidalgo MA, et al. Psychosocial Functioning in Transgender Youth after 2 Years of Hormones. N Engl J Med. 2023 Jan 19;388(3):240–50.
8. Jedrzejewski BY et al. Regret after Gender Affirming Surgery – A Multidisciplinary Approach to a Multifaceted Patient Experience. Plastic and Reconstructive Surgery. 2023. 23 (1).
9. Wiepjes CM et al. The Amsterdam cohort of gender dysphoria study (1972–2015): Trends in prevalence, treatment, and regrets. The Journal of Sexual Medicine. 2018. 15.
10. Turban JL et al. Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT Health. 2021. 8(4).
11. Thorn A. “I Emailed My Doctor 133 Times: The Crisis in the British Healthcare System”. YouTube. 2022. Available at: https://youtu.be/v1eWIshUzr8 [Accessed 02/03/23. Bibliography available in the recording’s description.]
Competing interests: No competing interests