Turn off the lights to take a shower, cover the mirrors in the apartment with towels or stop going to the beach on holiday. How great the disgust for one's own body can be is unimaginable for many people. Yet some feel that their penis, vagina or breasts do not match their identity. This was the case, for example, with Jakob Lorenz, whose real name was different. He was born when, let's call her, Anna, he spent a carefree childhood with many friends. He always tried to distinguish himself from girls of the same age. This was not a problem for a long time. But then came puberty and with it depression.
Jacob's story is exemplary. Although officially, feeling like a boy, but having a girl's body is no longer considered a pathological disorder (see "Transgender according to ICD-11"). But if you are gender incongruent, the inner knowledge does not match your own body or how others see you – a daily challenge. It can help to adapt the body to one's own feeling. However, in order to make the best personal decisions, there are a few things to consider.
How many children are born is unclear. In Sweden, 2.8 percent of adults have given the desire to live or be treated as a person of a different sex. Another 2.3 percent of the respondents said they would feel like someone of the opposite sex. The numbers should be transferable to Germany. According to a different estimate, the prevalence here is below 0.05 percent of the total population.
Theme Week »Transgender«
Humanity is diverse. LGBTQIA* brings together various terms for sexual orientations and gender identities: lesbian, gay, bi, trans, queer, inter, asexual – that * leaves room for more. Every year in June, the community celebrates itself in different ways. To kick off the "Pride Month", the week from May 30 to June 3, 2022 will be dedicated to the topic of "transgender" with the following content:
The essential texts on the subject of "Sex and Gender - there are more than two genders" can be found here on our collection page.
Wanting to belong to the opposite sex can be pronounced early
It is also controversial what can be the first sign of gender -typical behavior. »We have now come away from the idea of the gender -typical toys as a diagnostically pioneering observation. Why shouldn't girls play with cars and boys with dolls? «Asks the youth psychiatrist Georg Romer, who heads a transgender consultation at the University Hospital Münster. However, it is typical if the children have a pronounced desire to belong to the opposite sex and be treated accordingly. Often they look for a neutral or gender to the other first name with which they want to be addressed.
Whether you are a boy, girl, non-binary or something else, only the person himself knows. Although many children show gender-nonconforming experience and behavior, only a quarter of these people meet the diagnostic criteria for gender incongruence later in adolescence. Only from the age of 16 there is empirically seen an almost 100 percent diagnostic certainty.
In adolescence, suffering began
The problems of transpersonen often begin in puberty. As with Jakob Lorenz. When he was eleven, his body began to change, became more feminine. "I retired, my friendships no longer maintained and started to hate my body," says the 18-year-old today. With every physical change he was worse. He was twelve years old, he says when he met someone on the Internet who was trans. Suddenly everything made sense, childhood, the rejection of your own genitals. »With the knowledge of being trans, I suffered even more. I slipped into a depressive phase and saw no perspective at all, «says Jakob.
If such suffering is present, clinicians speak of gender dysphoria. In these cases, psychosocial support, counselling and, if necessary, psychotherapy can help to master life. Not only that: treatment can help prevent mental disorders. It has been proven that gender dysphoria increases the risk of "depression, suicidal thoughts, suicidal acts, anxiety disorders, substance abuse, personality disorders, dissociative disorders, Asperger's autism and eating disorders," as stated in a guideline led by the German Society for Sexual Research.
The international statistical classification of diseases and related health problems (ICD) serves as an overview of diagnoses worldwide. In 2022 the eleventh edition came into force, ICD-11 for short. It contains significant changes for transpersons:
Important to know: The ICD-11 is not yet used in Germany. It must first be translated, modified and integrated into the existing structures here on land. Doctors are currently working with the ICD-10-GM version 2022 – GM stands for "German Modification". It is unclear how long it will take for the ICD-11 to be used in Germany. But it will be more about several years than months.
With the ICD-11, indications for somatic treatments in trans*persons should continue to be medically justified if, for example, it is assumed that the quality of life of those affected is permanently affected without this.
"It is an important signal that gender incongruence is no longer understood as a mental disorder," says adolescent psychiatrist Georg Romer. Because being trans is therefore no longer a disease by medical definition. This could help trans people to be recognized in their gender identity and should counteract prejudice.
Gender dysphoria is characterized by a strong, persistent cross-gender identification. It can be accompanied by anxiety, depression, irritability. Also, sufferers often have a desire to live as a different gender from the one assigned at birth.
In Germany, an S3 guideline for diagnostics, advice and treatment regulates how to deal with gender incongruity, gender dysphoria and trans health. It dates from 2019, but already takes into account the desired changes to the ICD. A revision is planned for 2023.
Jakob read stories on the Internet about other teenagers whose parents showed no understanding of their children's trans identity. So he was afraid to reveal himself to his parents. Outwardly, he began to change, cut his hair short and wore rather gender-neutral clothes. »After half a year and several attempts to come out, the message reached my parents,« says Jakob. They had reacted very sympathetically, bought books on the subject and called him by his desired name. In a familiar circle, Anna had become Jacob.
First the every day of trans-day test, then hormone therapy
The young man was lucky. Around a third of the transcinders and young people are criticized in their families because of their gender -compliant behavior and appearance. At least this is the result of a scientific overview of psychologists Jannik Franzen and Arn Sauer from 2010. According to another study, children and young people experience more violence from their environment, the more clearly they occur.
Even if, according to his experience, most parents of young trans people support their child, family conflicts can occur, says adolescent psychiatrist Romer: "For some parents, it initially feels as if they are losing a child." But with support, for example through family therapy, they could learn to internally re-adopt their child again. "It gets bad when the parents reject the identity of their child," says Romer. If you ignore the desire to address the child with a new name, or also prevent a transition. "If the parents cannot follow the path of a transition emotionally, then a young person can break down," warns Georg Romer. This rejection is existential, which also affects gender identity. "It won't work that way in the long run. In the worst case, the young person will eventually become suicidal or the relationship between the child and the parents will break down, " says Georg Romer.
Although the parents supported Jakob, there were always hurtful comments from friends and acquaintances. “Above all, the adults from my parents' circle of friends blamed us. They thought I had a difficult phase and that I only want attention, «says Jakob.
Neither he nor his parents were deterred. Jacob wanted a transition, starting with hormone treatment. So they looked for a psychotherapist who could perform the everyday test. "In order to be granted hormone treatment, I had to live in my social sex for one and a half years," says Lorenz. After a few months of waiting, the time had come, they had a therapy place. "Almost two years passed before it was finally determined that hormone therapy was what I needed," says the young man. He continued: "That was the worst time. It was horrible to watch my body go in the wrong direction. Add to that the long waiting times and the lack of prospects.«
Six months after he came out to his parents, he made it public step by step, Jakob says. At school, with the extended family, with acquaintances. It was particularly painful at this time to continue to be addressed with the female pronoun and first name. "I always cringed inside. I had the feeling that the world didn't see me as I actually am," says Jakob.
On the side of the federal government's rainbow portal, you can enter your postcode and find advice, self -help groups and interest associations. It is possible to search for offers for children and young people.
A tip from the authors of the portal: in order to recognize a good doctor or a good consultant, you can take the following test. Does the person use the name you told her? Does she make an effort to talk about you with the correct pronoun (for example, "he" or "she") or your first name? Do you feel taken seriously?
On the page you can also learn more about your own sexual orientation - how do I know if I am gay or lesbian, bi or very different? She also provides advice on the coming-out and explains what rights and possibilities of transformers have.
On the Internet there are many offers from trans people and professionals. This is a selection for trans and interpersonal people as well as their relatives and friends:
Puberty blockers can make the change easier
Georg Romer knows the impatience that plagues many trans youth. But he emphasizes how important it can be to have completed the social role change in a stable manner before starting hormone treatment. He always advises: "If your body goes through all these changes, for example, your voice becomes deeper, you grow a beard, then you will be very busy with yourself." Then the entire environment, from grandma to classmates to distant acquaintances, should be prepared for it. Puberty blockers, which delay or slow down the onset of puberty, can have a relieving effect in such cases. "In this way, the pressure is relieved, the young people can test themselves and practice the change of roles in the school and environment without the development of maturity progressing irreversibly," explains Romer.
However, the greatest social acceptance cannot alleviate the main suffering of those affected, says Romer. "Those affected usually feel a constant inner stress due to the feeling of being stuck in the wrong body. Psychotherapy does not help against this.«
At the age of 15, Jakob Lorenz was able to begin hormone therapy, as he says. “From then on, my mental health has improved a lot. When I could see physical changes, things went better immediately, «says Lorenz. At 16 he had his breasts removed. “It was a huge load that I fell off. I felt so much better, I felt that I was a new person! «, Says Jakob Lorenz.
For Lorenz, hormone treatment was a salvation. But this does not have to apply to everyone. Whether adolescents should specifically take estrogen or testosterone or even undergo gender reassignment surgery is intensively discussed. In 2020, the German Ethics Council stated in a statement on this topic: On the one hand, the ability to reflect and make decisions only develops in adolescence, on the other hand, the physical development that takes place during puberty creates time pressure. It goes on to say that, in this situation, both the treatment options envisaged and their omission can have serious and sometimes irreversible consequences. "That's why many physicians are afraid of making the wrong decision. But waiting is not a neutral option," says adolescent psychiatrist Romer.
Hormone treatment can protect against depression
The only possible way, according to his assessment: to have long conversations, with the adolescent person alone and together with the educators. Listen carefully. How strong is the identification with the opposite sex? Has she already shown herself in kindergarten? Or only at puberty?
In the latter case, Romer would take more time, wait longer. "Of course, there can also be other reasons behind the self -hatred," says Romer. Therefore, he recommends taking all steps carefully. First try socially, to out. After each step, the affected person should ask: I feel better now?
Trans people often have mental health problems in adulthood, such as depression or anxiety disorders. They also commit suicide attempts more often than the average population, according to statistics. Early hormone treatment can prevent this in some cases. According to current knowledge, there were significantly fewer suicide attempts in those subjects who had already received hormones in adolescence. Another study showed that the subjective well-being of young people after appropriate treatment and surgery was similar or even better than that of young adults of the same age from the general population.
Over the years, Romer and his team have accompanied about 500 young people on their way. "In the end, it is very nice to see that the psychological stresses usually dissolve when the transition was successful. Then the young people blossom," he says.
