Treatment

Typically, three principal targets are set for intervention with GID in children. First, the children are unhappy being the sex to which they were born; second, they are experiencing substantial peer group alienation; third, there is conflict with one or both parents in consequence of their atypical behaviour. A principal intervention strategy is helping the child understand that the world of gender is not necessarily black and white, but that greys exist as well. Boys can understand that not all boys need to be good athletes or rough-and-tumblers, and that boys can be sensitive and creative.

Girls do not have to be boys to participate in rough-and-tumble play and sports. Children do not need to conform arbitrarily to all sex-typed attributes to remain in their birth sex role. To the extent this can be internalized, the path to transsexualism may be blocked.

The peer group of children with GID can be expanded to include children of both sexes. Parents may have to make substantial efforts, particularly with cross-gendered boys, to find other boys of their son's age who will enjoy non-athletic non-rough-and-tumble companionship, perhaps engaging in board games or computer games together. Similarly, girls with GID who are very athletically motivated may find other girls who are also athletically inclined, and not just boys to play with. Children who develop comfort in socializing with both boys and girls may experience enhancement of same-sex identification.

Cross-gendered boys are notably alienated from their fathers and intervention can promote their relationship by finding mutually enjoyable activities. This may serve as a source of same-sex identification in the child, will enhance the quality of the parent-child relationship, and will be a positive outcome irrespective of its influence on later sexual identity.

Very few adult transsexuals had entered into any treatment intervention to address GID during childhood. Children with GID referred for evaluation or treatment may, as a product of that concern by parents, and/or professional intervention, have that route to transsexualism diverted. However, there is little empirical support for intervention directed at emerging sexual orientation. There is no evidence that a specific type of 'treatment' in childhood has any effect on outcome on that dimension of gender identity.(22)

Parents should understand that if they are concerned about the ultimate sexual orientation of their child, that is a long time ahead—for the immediate period the child is unhappy being who he or she is, is experiencing conflict with the peer group, and may be having difficulties at home with at least one parent. These are immediate concerns and should be addressed.

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