Psychology of Gender

Q: When do children develop an awareness of gender?

Most children develop an awareness of their own sex between the ages of two and four. A minority experience gender variance or dysphoria during this phase. In the vast majority of these children, the dysphoria disappears spontaneously around puberty. The classical developmental psychology of Kohlberg and Bem describes this development between the ages of two and seven.

Q: Why do people with gender dysphoria experience mental health problems more often?

Three factors interact: comorbid problems (autism, anxiety, depression, trauma) that often precede the dysphoria, the dysphoria itself, and minority stress. It is scientifically inaccurate to attribute the problems entirely to external discrimination; levels remain high even in trans-positive countries.

Q: What is the difference between affirmative care and exploratory therapy?

Affirmative care takes self-declared identity as its starting point and steers toward medical support. Exploratory therapy takes a broader look at comorbid problems, social influence, and identity development, without affirming or denying anything a priori. The international scientific movement is clearly moving toward exploration as the first-line approach.

Q: Is exploratory therapy the same as conversion therapy?

No. Conversion therapy attempts to change sexual orientation or identity through coercion and aversion. Exploratory psychotherapy openly and respectfully examines what may underlie experienced dysphoria, without a predetermined outcome. The UK, Sweden, and Finland have explicitly endorsed this distinction. Exploratory therapy can help many adolescents without irreversible interventions.

The psychology of gender examines how people develop gender-related feelings, how identity, body, and social role interact, and which psychological factors contribute to gender dysphoria. The field is currently marked by a polarization between the affirmative model—which takes self-declared gender identity as its starting point—and the more traditional exploratory approach, which leaves room for underlying factors. In recent years, the scientific balance has clearly shifted toward exploration and caution.

Development of Gender Feelings in Children

Classical developmental psychology (Kohlberg, Bem) describes how children between the ages of two and seven develop an awareness of their body and sex. A minority of children experience gender variance or dysphoria during this phase. The best-documented finding is that the vast majority of these children come to accept their bodies around puberty without medical intervention—usually alongside the development of a homosexual or bisexual orientation. See desistance.

Comorbidity: the Rule, Not the Exception

Among adolescents presenting for gender care, psychiatric comorbidity is extremely high. Autism spectrum disorder occurs in 15 to 35%—several times more often than in the general population. Anxiety disorders, depression, eating disorders, trauma, and self-harming behavior are also disproportionately prevalent. In many individual cases, it is difficult to determine whether dysphoria is the primary problem or manifests as a result of underlying issues—and that is precisely why thorough psychological exploration is necessary, rather than automatic affirmation. An overview of the figures on autism in gender clinics can be found at genderautisme.nl.

Affirmative Model versus Exploratory Approach

The affirmative model assumes that self-declared gender identity should be accepted as truth and, upon request, medically supported. Critics—including clinical psychologists, child and adolescent psychiatrists, and the authors of the Cass Review (2024)—point out that this model discourages exploratory psychotherapy and therefore fails to do justice to vulnerable adolescents with underlying problems. The exploratory approach examines a broad range of factors (trauma, internalized homophobia, autism, family dynamics, social influences) without affirming or denying anything a priori. Sweden, Finland, Norway, Denmark, and the UK have now established psychotherapy as the first-line treatment.

Minority Stress Is an Incomplete Explanation

Meyer's “minority stress” model is often used to attribute the high levels of mental health problems among trans people entirely to external discrimination. This model is empirically supported but incomplete: even in highly trans-positive environments (the Netherlands, Sweden), mental health problems and suicide risk remain substantially higher than in the general population. Gender dysphoria itself, comorbid problems, and negative outcomes of medical pathways likely contribute just as much.

The Suicide Claim Examined Critically

The statement “would you rather have a dead daughter or a living son” is regularly used to pressure minors into rapid medical transition. The Cass Review explicitly found that the empirical basis for this framing is weak, that suicidality among dysphoric young people is comparable to that in other vulnerable adolescent groups, and that using suicide threats as an argument is ethically problematic.

Psychotherapy as a Responsible First-Line Approach

Psychotherapy—exploratory, focused on comorbid problems and social context—can help many adolescent patients without irreversible interventions. It is not “conversion therapy,” an accusation that has unjustly been used in recent years to discourage critical psychological care. The UK, Finland, and Sweden have explicitly highlighted this distinction: exploration is not an attempt to cure someone of being trans; it is good medicine. Why automatic affirmation falls short as care is explained at genspect.nl. An interpretation from the depth psychology of Carl Jung can be found in the article on the eternal boy and gender ideology.

When do children develop an awareness of gender?

Why do people with gender dysphoria experience mental health problems more often?

What is the difference between affirmative care and exploratory therapy?

Is exploratory therapy the same as conversion therapy?