人兽性交

Transgender individuals are those whose 鈥済ender identity鈥� 鈥� their personal sense of being male or female 鈥� does not match the sex they were assigned at birth. Some transgender people describe this as feeling as if they have been born into the 鈥渨rong body.鈥�

Changing one鈥檚 gender identity is not possible. Unfortunately, many transgender children go without appropriate care and endure such distress and anxiety over the mismatch of their physical bodies with their identities that they suffer from a condition known as gender dysphoria.

Juvenile justice professionals need to know that the failure to provide proper treatment for this condition not only can cause serious health problems for transgender children, it can lead to legal liability for detention facilities. Courts have uniformly held that gender dysphoria is a serious medical condition for which treatment is necessary. Failing to provide it can violate the Eighth Amendment鈥檚 ban on cruel and unusual punishment.

Medical treatment for transgender adolescents consists of an individualized protocol that can include

20% of youth in juvenile detention identify as LGBT or gender non-conforming compared with 7-9% in the general community.

Medical treatment for transgender adolescents consists of an individualized protocol that can include psychological, social, and physical interventions.

鈥� Psychological interventions can include psychotherapy focused on reducing distress related to gender dysphoria and any other psychosocial difficulties.

鈥� Social interventions can include a partial social transition (e.g., wearing clothing and having a hairstyle that reflects gender identity) or a complete social transition (e.g., also using a name and pronouns congruent with gender identity).

鈥� Physical interventions can include puberty suppression, hormone therapy, or surgery.

Many juvenile detention facilities do not provide appropriate treatment for gender dysphoria and/or may enforce 鈥渇reeze-frame鈥� policies. A freeze-frame policy prohibits the initiation of gender dysphoria treatment for individuals in custody and allows only the continuation of medical care received prior to detention 鈥� without individualized assessments and despite medical need.

Facilities or departments with freeze-frame policies are subject to legal challenges. The Georgia Department of Corrections (GDOC), for example, recently rescinded its policy after the Southern Poverty Law Center filed suit on behalf of a transgender inmate who was denied proper treatment.

Untreated gender dysphoria may lead to heightened risk of suicide, depression, anxiety, drug use, and school drop-out.

From a medical perspective, it is important for juvenile justice agencies to facilitate appropriate interventions for transgender adolescents, because they may have a relatively narrow window of time to curtail the development of secondary sex characteristics.

In addition, refusing timely medical interventions for adolescents might prolong gender dysphoria and contribute to an appearance that could provoke abuse and stigmatization, contributing to psychiatric distress.

Juvenile detention facilities must care for all youth.

Juvenile detention facilities should consider adopting and implementing the following model policy. This policy has been adapted from the 聽as well as the

Counseling, Mental Health, and Substance Abuse

鈥� Clinicians shall offer affirming counseling and information to 人兽性交I and gender non-conforming (GNC) youth who are experiencing distress related to their gender identity, gender expression, sexual orientation, or intersex condition.

鈥� All adolescents experience social and developmental challenges. Clinicians shall educate themselves about the additional barriers to mental health faced by 人兽性交I and GNC youth; aim to reduce these barriers with open, non-judgmental, and empathetic communication; and help youth to develop their strengths, coping skills, and resilience.

鈥� 人兽性交I and GNC youth frequently face stressors related to their gender identity, gender expression, sexual orientation, or intersex condition that other youth do not. Clinicians shall be aware that these stressors may lead to heightened risk of suicide, depression, anxiety, drug use, and school drop-out, and they shall be prepared to treat these issues.

鈥� When youth express a transgender identity or request hormone therapy, they shall be referred to a comprehensive youth gender identity clinic, a psychiatrist with experience diagnosing and treating gender dysphoria in adolescents, or a transgender- affirming psychiatrist who consults with experienced gender identity specialists (listed in order of preference). All efforts shall be made to obtain an appointment within two weeks of the request. All providers shall follow the World ProfessionalAssociation for Transgender Health (WPATH) Standards of Care for treating gender dysphoria.

鈥� Counseling sessions for youth shall include individual opportunities to discuss any gender identity questions or feelings that may arise as a result of having youth in program who are perceived to be 鈥渄ifferent.鈥�

鈥� Treatment for gender dysphoria shall not be withheld for the purpose of preserving fertility.

鈥� Staff shall not attempt to change a youth鈥檚 sexual orientation or gender identity, as this is contrary to accepted practice and has been shown to be potentially harmful.

Medical and Health

鈥� All youth shall have an initial health screening within an hour of their arrival in detention. During this screening, staff shall identify any medications that the youth is currently taking. If a youth indicates that he or she has been undergoing hormone therapy, whether supervised by a medical professional or not, the juvenile detention agency鈥檚 medical doctor shall arrange an appointment with a comprehensive youth gender identity clinic, a psychiatrist with experience diagnosing and treating gender dysphoria in adolescents, or a transgender-affirming psychiatrist who consults with experienced gender identity specialists (listed in order of preference). The medical doctor will make this arrangement within one business day of being notified about a youth鈥檚 hormone therapy in order to prevent the complications associated with abrupt disruption of treatment and to ensure optimum continuity of care.

鈥� Staff shall provide age-appropriate medical information and health services education for all youth that includes topics related to 人兽性交I and GNC health.

GNC: gender non-conforming

Gender Dysphoria: severe distress over gender assigned at birth

Gender Expression: the ways people outwardly manifest their masculinity, femininity, and androgyny

Gender Identity: personal sense of male, female or androgyny

LGBT: lesbian, gay, bisexual, and transgender

人兽性交QI: lesbian, gay, bisexual, transgender, queer or questioning, and intersex

Transgender: adjective for a person whose gender identity differs from the sex they were assigned at birth

WPATH: World Professional Association for Transgender Health