gender identity formation in adolescence a review.26

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ntroductIon

Dr. Robert Stoller originally discussed and published identity in terms of gender – the psychic interior perception of genders – in 1968. He put up the theory that “Gender and sex are not always related.” Each individual may proceed in their own distinct manner. Despite the reality that gender experience and gender identity are relatively new concepts in contemporary society is older than all of mankind.

According to one’s deeply felt sense of sexual orientation, innate feeling of being a boy, a man, or a male; a girl, a woman, or a female; or an alternate gender, according to the American Psychological Association (APA) (2015) (e.g., transgender or nonbinary), perhaps or not match the character designated birth sexuality or their major or supplementary sex traits.^[1]

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earch

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trategy

The present comprehensive review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, addressing the importance of the medical practitioner’s role in identifying gender identity in adolescents. Electronic and manual data resources were consulted using the following databases: PubMed/MEDLINE,

Embase, ScienceDirect, Cochrane Library, and clinical trials site for studies published until March 2022. The results were filtered for studies in the English language. The words that were used for the search strategy on various databases were serum investigations [Figure 1]. The literature search on PubMed/

MEDLINE was based on the terms “Gender identity” (All Fields) AND “Medical practitioner” (MeSH Terms) OR

“Gender diversity” (All Fields) AND “Evolvement” (MeSH Term). The above-mentioned words (role of medical practitioners and gender identity) were used in the search strategy on the Cochrane Library, the database for systematic review.

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ender

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dentIty

Every person has an individual gender. Children between 3 and 5 years old, typically become conscious of their gender. The language used to express one’s gender identification is quickly evolving changing and contains dozens of other descriptions in addition to male, female, androgynous, pansexual, gay,

Gender Identity Formation in Adolescence: A Review of Gender Diversity

Nandini Bandil, Devamsh Arora, Rushikesh Shukla, Sourya Acharya, Shailja Singh

Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India

The goal of this article is to summarize what is now understood about pathways and influencing elements in adolescence’s gender identity formation. We provide a brief review of identity in terms of gender historically and discuss the emergence of general identities during adolescence, gender identities in the populace at large, and the emergence of gender diversity identities in young people. We are focusing in this article that the medical practitioner’s responsibility in managing gender identity for contribution.

Keywords: Emergence of general identities, gender identities, medical practitioner’s responsibility

Address for correspondence: Ms. Nandini Bandil, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Sawangi (Meghe), Wardha ‑ 442 001, Maharashtra, India.

E‑mail: [email protected]

Access this article online Quick Response Code:

Website:

www.journaldmims.com

DOI:

10.4103/jdmimsu.jdmimsu_549_22

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

For reprints contact: [email protected]

How to cite this article: Bandil N, Arora D, Shukla R, Acharya S, Singh S.

Gender identity formation in adolescence: A review of gender diversity.

J Datta Meghe Inst Med Sci Univ 2023;18:120-4.

Abstract

Submitted: 15‑Nov‑2022 Revised: 17‑Nov‑2022 Accepted: 09‑Dec‑2022 Published: 31‑Mar‑2023

Downloaded from http://journals.lww.com/dmms by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 09/27/2023

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bisexual, transgender, and bigender [Figure 2].^[2] The terms

“cisgender” and “transgender” are widely categorized gender identities. Cisgender refers to a gender identification that coincides with the sex that was assigned to a person at birth (i.e., the sex identified by genital inspection at birth or by genetic testing). A gender identification that is different according to the birth-assigned sex is referred to as transgender. The national institutes of health (NIH) refers to both communities of trans people and individuals who do not identify as trans, but not whose gender identity or expression deviates from conventional, cultural, or societal conventions as “gender minorities.”

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PProachof

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The identical Latin word “identitas,” is where the word

“identity” originates. The term, which refers to a person’s opinion of themselves, suggests some similarity with others in

a specific way. Each person is capable of possessing a variety of identities, such as nationality, ethnicity, and religion.^[3] The majority of the time, gender identity will change according to the physical attributes of gender. A newborn with male genitalia and XY chromosomes will typically be ascribed to the gender of male, exhibit characteristics of men, and identify as male.

However, under some circumstances, there is discordance between these gender-related characteristics. Congenital diseases known as disorders of sexual development (DSD) cause aberrant sexuality based on chromosomes, gonads, or anatomy development.^[4] For example, with DSD, possibly mismatched gonads and/or sex chromosomes the exterior male genitalia. Gender identity could not be correlated with the external genitalia, only the chromosomes and gonads. Despite the fact that the physical traits of each sex line up, people with gender dysphoria could the creation of a gender identity that does not coincide with their gonads and genitalia.

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An early adopter of document discrepancies between DSD patients, sexuality, and gender identity was Ellis.^[5] Ten years later, Money, a contemporary sexologist who worked with children that had DSD, this area of research should be expanded upon. To avoid confusion, he suggested drawing a separate line between the concepts of “sex” and “sexual preference,”

especially in the context of DSD.^[6] Do the characteristics of the complete androgen insensitivity syndrome, which includes excessive amounts of testosterone, undescended testicles, and genitalia, indicate that a 46, XY person belongs to the masculine or female sex? Money also popularized GI/R refers to the gender identity and role dual idea. He believed that identification of gender was the hidden expression of gender Figure 1: Search strategy using the PRISMA method. PRISMA: Preferred reporting items for systematic reviews and meta‑analyses

Figure 2: Gender identities

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roles and that gender role was the outward identification with a particular gender.

Research has not only looked into gender identity in clinical settings. In addition, cognitive developmental psychologists employed the idea. For a few decades, they largely paid attention to the cognitive aspects of gender identification.^[7-9]

For instance,^[7] described gender identity as “the notion of the self as a man or woman.”^[8] The “cognitive self-categorization as male or female” was used to define gender identity.

People who do not regard their gender as being their own are referred to as transsexuals or as having a disorder of gender identification in clinical psychology and psychiatry.^[10,11]

Clinically, they were and still are classified in accordance with standards established by the APA and WHO. It is asserted that not all individuals with gender difficulties fully identify as a different gender and do not always require clinical care.^[12,13]

A wide range of gender identity descriptors, such as “gender fluid,” “third gender,” “pan-/poly-/or omnigendered,” and

“shemale,” as opposed to male and female or even transsexual, were demonstrated by.^[14] These people might be distressed or not, and they might or might not wish to live as “the other gender.”^[15] Some patients just prefer specific procedures, such as hormone replacement treatment and gender reassignment surgery, from traditional gender reassignment. For instance, in one circumstance, men want to be chemically or surgically castrated (in certain instances with an additional penectomy), but they do not want to transition to the female gender since they self-identify e as eunuchs instead. They are known as

“male-to-eunuch” people.^[16,17]

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tIology

The exact reason for the emergence of a gender identity issue has not yet been identified. Inherited characteristics (see Bailey and Pillard) for male homosexuals,^[18] have been recommended. However, it is unknown how much these elements play a part in how gender identity develops difficulties in youngsters, necessitating more research. The masculinization of the brain by androgens during a crucial stage of fetal life has been linked to hormonal influences on the brain during the development of the fetus. Particular familial configurations linked to difficulties with gender identification in boys and girls have been described by.^[19] He implies that there is an excessively intimate contact the mother and a distant relative the boys or boys’ father. He suggests a depressed mother who is absent but who does not forbid the kid from helping the mother, instead pleading with the child to assist the mother in overcoming her dejection throughout the infant’s first few months of life.

Very early maternal effects that have a deleterious impact on the child’s early growth have been described by.^[20]

Inability to grieve the loss of a parent or another significant early attachment source has been related by^[21] to the development of gender identity issues in a few kids.

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ay

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Isexual

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ransgender

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ealth

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IsParItIes

Civil rights for lesbians, gay men, and bisexuals (LGBs) have sparked a lot of sociopolitical debate in recent years.

These discussions have led to significant gains for LGB people worldwide, including the legalization of same-sex relationships and the increase of partner benefits and safeguards for LGB people who are the targets of hate crimes.

Compared to their heterosexual friends, many LGB people also experience physical health disadvantages on a daily basis. Despite the fact that these health problems affect both individual well-being and global public health severely and occur more frequently than suicide or homicide, their causes are still mostly unknown.^[22] Approximately 9 million adults (or 3.8% of the US population) self-identify as Lesbian, Gay, Bisexual, or Transgender (LGBT) at this time, whereas a higher percentage (between 4% and 6% of males and 11% and 12% of women) report engaging in same-sex sexual conduct.^[23] LGBT people frequently have worse physical and mental health than people with heterosexual sexual orientation.

A growing amount of research shows that persons who identify as LGB are at exposure to a variety of physical health issues, from the poor general status of health to increased prevalence of particular diseases. The results show that compared to heterosexuals, sexual minorities typically assess their own health as being in bad condition, experience more acute bodily signs and long-term medical issues, are less able to engage in daily physical activity due to their health, and have the prevalence and age at commencement of impairments are higher like needing a walking aid.^[24-27]

Sexual minorities have elevated rates of particular issues of health in addition to these broad indicators of poor health.

For instance, LGB one’s and those who being in a same-sex relationship causes more identifies to be made of asthma than heterosexual individuals or those who report being in a different-sex relationship.^[28] In addition, compared to their heterosexual counterparts, self-identified LGB people report greater neuralgia,^[29,30] long-standing illnesses, allergies, osteoarthritis, and severe gastrointestinal issues.^[26]

While the aforementioned findings generally show that physical health disparities according to sexual orientation exist, supplementary research has found that some LGB subpopulations are particularly affected. For instance, compared to heterosexuals, lesbian, and bisexual women frequently outline having the worse general physical condition.^[29,31] In addition, bisexual women, in particular, who identify as a sexual minority, report having greater incidences of asthma, urinary tract infections, and hepatitis B and C.^[32]

One early study found a link between elevated risk of invasive breast cancer and substitute indicators of female sexual orientation.^[33] Lesbian and bisexual women who identify as such also report an increased risk for and diagnosis of certain malignancies.^[34-36]

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reatMent

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PtIons as

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ontrIbutIon In

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ender

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eassIgnMent

Depending on the patient’s preferences, gender reassignment requires medical experts from a variety of specialties, including general care surgery, endocrinology, social services, psychology, and psychiatric. For the majority of patients, although gender reassignment is safe and helpful, insufficient follow-up limits the results of research and research design.

However, not all transgender people will want to undergo all of the various medical and surgical procedures or even all of them.^[37]

Hormone replacement therapy is the foundation of pharmaceutical medication. Prior until recently, an adult had to go through a period of “actual life experience,” during which individuals would live as their preferred gender for an extended time (often three months or more) with the necessary adjustments to social, legal, and health papers.

Transgender therapy of hormones, or “cross-sex hormone therapy,” is the practice of prescribing estrogen for trans women and testosterone for trans males.^[38] In some circumstances, it can also be essential to use a hormone analog which release gonadotropin to inhibit the generation of endogenous sex hormones. An inhibitor of five alpha reductase may be recommended for trans women to stop androgenic pattern baldness. According to the most recent research, hormone therapy for transgender patients are safe as long as proper monitoring is carried out and the procedure is not linked to an increased risk of cancer or mortality.^[39,40]

There could be a role for speech and language therapists as an adjunct to medicine, persons who identify as nonbinary or trans women may also want to have their face and body hair removed. Local clinical commissioning groups take each surgical procedure into consideration on a case-by-case basis, including thyroid chondroplasty and breast augmentation.^[37]

Before any surgery, gametes should be collected and frozen because the excision of gonadal tissues is a component of several operations. Blocking therapy of hormones, such as gonadotropin-releasing hormone analogs, may be utilized between the ages of 12 and 16 years to postpone maturational alterations while a decision about preferred gender is made.^[37]

Children and teenagers are not candidates for medical or surgical gender reassignment under the age of 16 years, but this does not prevent hormonal and surgical gender reassignment.

Given the debate surrounding the gender identity age is defined, this is probably a topic that will come up in future ethical discussions.

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eneral

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ractItIoner

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oleIn

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General practitioners should play a crucial part in the treatment of transgender patients, according to General Medical Council recommendations released in 2016. This includes providing

counseling or making the proper referral (which can be done without making an interim reference to general psychiatry by general practitioners), but in some circumstances, it also includes prescribing the start and maintenance of hormone therapy. General practitioners are encouraged to start therapy if instructed if a professional does it, write medications for maintenance, and ensure that all blood tests for screening and monitoring are performed as per the guidance. To improve access, decrease wait times for specialist appointments, and increase the capacity of specialty services to serve both nonspecialist physicians and patients, NHS commissioners must make investments to increase the capacity of specialty clinics on a local and national level. It will also be necessary to give nonspecialist physicians, such as general practitioners, proper training to increase the NHS’s ability to manage this population of patients.

Additional responsibilities for general practitioners include ensuring a successful postoperative recovery and maximizing health before gender reassignment surgery (e.g., quitting smoking, losing weight, and improving diabetic control) while keeping an eye out for any complications and rehabilitation.

c

onclusIon

In addition to male, female, pansexual, gay, bisexual, transgender, and androgynous gender identity encompasses hundreds of other terms. A neonate that has male genitalia and XY chromosomes is usually assigned to the male gender, shows features that are commonly associated with men, and identifies as a man. The care of people who identify as transgender should heavily involve general practitioners. Medical professionals from a range of specialties, including general social services, endocrinology, surgery, psychology, and psychiatry, are needed for gender reassignment.

Financial support and sponsorship Nil.

Conflicts of interest

There are no conflicts of interest.

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eferences

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