Gender Dysphoria is simply defined as a condition where a person experiences a mismatch between their biological sex and gender identity. In other words, they feel like and identify with the opposite sex. Not being able to identify with traditional rigid societal binary male or female roles understandably creates turmoil in their lives. The fallout from this is that they face relationship difficulties within their families and with their peers. That rejection can lead to poor self-esteem, depression, substance use, disorders and suicide. Gender dysphoria (GD) occurs in about two per cent of high school children in the USA, although finding exact figures on the prevalence of GD seems to be a challenge. One Dutch study found that 4.6 per cent assigned male at birth and 3.2 per cent assigned females at birth identified themselves as being ambivalent about sexual identity. Demands for the service of care has risen dramatically and has provoked great conflict, especially in the USA.

Delaying treatment has consequences. A study in USA done by the National Centre for Transgender Equality and National Gay and Lesbian Task Force reported significant family rejection is 57 per cent, 41 per cent reported attempting suicide, 78 per cent reported harassment, 35 per cent reported physical assault and 12 per cent sexual violence. A landmark 2018 study published in the Journal of Adolescent Health found transgender youth who are able to use their preferred names and pronouns reported a 65 per cent decrease in suicide attempts. It is no wonder that many feel the urgency to live a normal live as the gender that they feel they are! If you live in Saskatchewan, it is difficult to obtain timely consultations with those providing Gender Affirming Care involving medication to suppress puberty, providing estrogen or testosterone to promote secondary sex characteristics and finally gender surgery to remove breasts and adjust genitals.

Developing fetuses have a lot of finely orchestrated hormone-related development taking place at an early age. It takes an infinitely small amount of disruption to have major effects. A rare medical condition called congenital adrenal hyperplasia or androgen insensitivity is a syndrome in which fetuses have the genetic makeup of a man but because the tissues do not respond to the male hormones, they develop the emotional and physical traits of a woman, although they do not develop pubic or armpit hair. Their testes remain in their abdomen. GD is associated with other neurological conditions such as schizophrenia and autism. MRIs show that there is faulty neurological development of links with the hypothalamus and that neural structures may have a variation in size associated with the other sex. There are some genetic alterations associated with this as well. Much more research is necessary to further define these associations. Amid the throes of boredom during COVID restrictions, I took an online class from the University of Arizona —”Environmental Health: An Integrative Approach.” It was interesting and frightening. The course discussed toxic effects of chemicals in our environment. There is clear evidence that chemicals used in everyday life like phthalates in plastics and polychlorinated biphenyls are hormone disrupters!

WHAT CAUSES GD?

• Phthalates can lead to higher testosterone levels which in turn increases the risk of autismdisorders. Phthalates are found in solvents, soft plastics, cosmetics, fabrics, paints, lubricants, children’s toys and child care articles, food products, indoor air, dust, water and foods. Canada has restricted its use in some products.

 • More chemicals are PCBs and BPA that are used in plastics and non-stick coverings on frying pans, pharmaceutical estrogens, DES, ethinyl estradiol and phytoestrogens are found in plants.

• Other chemicals with these properties are dioxin and furans. Fungicide vinclozolin, DDT metabolites, phthalates in plastics and more also react with androgen receptors. These clearly have gender-related effects. Exposure to even tiny amounts of these substances at the tender age of seven weeks gestation can affect brain structures, enzyme levels, receptor levels in tissues and hormone levels in the blood. These effects have been well studied in birds, frogs, seals, polar bears, marine mollusks and dozens more animals. Many studies have shown polluted water can cause ambiguous genitalia in vulnerable species.

This whole area certainly needs more study! Many professional organizations have developed guidelines for assessing and treating this condition. Political agendas, however, are forming and playing a role in making these difficult lives a little harder, removing the safety zone that they have experienced in school. Just for a moment, I ask you to put yourself in the shoes of a transgender. Through no fault of your own, your body has been influenced to make you “different” — outside of society’s norms. You may face ridicule, prejudice and emotional rejection. You can’t even safely use a public washroom! As a society, we are not nurturing them as God’s great people that they are. What can we do to give them a fighting chance in this complicated world? Think about it.

-Dr Vicki Holmes