This is a study of an adolescent female who began to feel gender dysphoric at age 10 and was given testosterone at age 13. Parents were supportive of transition. Stopped T after 30 days, age 14 had emergency evaluation for suicidal ideation. https://www.cureus.com/articles/20779-gender-dysphoria-and-suicidal-ideation-clinical-observations-from-a-psychiatric-emergency-service

We are told: "(GD) among adolescents is not uncommon" when only a decade ago it was extremely rare. For this adolescent girl there was no prior medical history, until age 10 onset of "depressed mood, body dysmorphia, and gender dysphoria."

By age 14 symptoms had substantially worsened: "the patient reported persistent depression, social isolation, worthlessness, and suicidal ideation" and "expressed dissatisfaction with height, weight, and appearance, stating, “I am so short. I am so ugly. I am a joke""

"It has been found that among transgender youth, a significantly greater proportion of those who had attempted suicide expressed weight-related body dissatisfaction than those who had not. They also had a higher rate of negative assessment by others of appearance."

"More recently, another study confirmed a significant correlation between suicidality and a desire for weight change among adolescents with gender dysphoria. There has long been a natural association between body dissatisfaction and gender dysphoria"

This case highlights the "importance of assessing the degree and characterization of body dissatisfaction as they may contribute to suicidal risk" and "There is a need for further assessment of the safety and efficacy of the interventions."

In this case: "gender-affirming therapy also seemed to be associated, by his own description, with increased sadness, confusion, and frustration" and "Another salient point to consider from this case is the early administration of cross-sex hormone therapy."

Conclusion: "Gender dysphoric patients are at significant risk for psychiatric comorbidities and suicidal ideation and attempts. It is crucial that primary care providers be aware of and diligently evaluate these risks, regardless of treatment status."

"A collaborative, multi-disciplinary approach can help care for this vulnerable population and avoid tragic outcomes." This case leaves us with questions about how helpful it is for adolescents to be encouraged to interpret their distress at puberty as 'gender dysphoria.'

Is this a useful model of understanding their body hatred for adolescent girls who don't meet today's extreme beauty ideals and are encouraged to believe that their greatest value lies in how thin and how 'hot' they are and how many Likes they get on Instagram?

Self-diagnosis as trans sets in stone a pathway where other (unfortunately not uncommon) mental health problems of adolescence are discounted. Is gender affirmation plus hormones an appropriate substitution for careful therapeutic exploration and mental health support?

In this case it made things much worse. Littman's study indicated worsening mental health after 'coming out' as trans in 47% of cases. What qualifications do trans lobby groups have for pushing affirmation and earlier hormone use as the only legitimate pathway for these girls?

And on what evidence do they base their claim that suicidal ideation is a result only of discrimination, of not being 'supported' by everyone 'affirming' that these girls are really boys, and of being denied access to a medical pathway?

And finally, how helpful is it for this generation of adolescent girls to be taught in schools the material of transgender lobby groups, which leads them to believe they are right to feel disgust with their bodies because their bodies really are 'wrong'?

And how helpful is it for this generation of teenage girls that everyone around them affirms this? What chance do these girls stand of getting to the real root of their distress when the adults have already discounted all other possibilities?