Gender-Affirming Physical & Mental Healthcare Should be Standard: In Conversation with 2024 ADAA Conference Keynote Alex Keuroghlian, MD, MPH

A lot can happen in 10 years. For Alex Keuroghlian, MD, MPH (any pronoun), the last decade has certainly been a busy, productive and significant one, not only for the field of mental health but also for the professional development of the psychiatrist and his or her work in gender-affirming care for transgender and genderqueer people. diverse.

The associate chief of the Department of Psychiatry at Massachusetts General Hospital presented the keynote address at ADAA’s 2024 annual conference, which focused on sex and gender and depression and anxiety disorders in transgender and gender diverse populations. Ten years after Dr. Keuroghlian participated in the ADAA Professional Development Leadership Program (the CDLP award) in Chicago, the Harvard Medical School Associate Professor of Psychiatry took the ADAA stage in Boston to emphasize the importance of gender-affirming mental health care.

A decade of education, advocacy and hard work

From 2014 to 2024, Dr. Keuroghlian has worked tirelessly and passionately to highlight and promote the state of mental health of LGBTQIA+ youth and adults. At the time, he admits that he was not as active in ADAA as he would have liked, but he was delighted to be the keynote speaker in his hometown and in his professional environment.

“It was a full-circle moment, a decade later, to go from being a psychiatry resident to being asked to give the keynote address,” he told ADAA. “It was a great honor and special to see so many mentors and colleagues in the audience. And it was a momentous thing for me 10 years ago to receive that (CDLP) award and attend the conference at that time.”

Luckily for ADAA, Dr. Keuroghlian made time for the conference and interview, as busy and involved as he is in so many different initiatives, educational and advocacy organizations, and professional endeavors. As Director of the Education and Training Programs Division of the Fenway InstituteDr. Keuroghlian also dedicates time to ensuring that the public gets correct, scientific and evidence-based information in the field of mental health, particularly on gender-related issues.

“I spend a lot of time trying to contribute to public discourse through the media,” he explained. “It is important for academic medical centers, institutions, and their representatives to set the record straight with comprehensive perspectives that are rooted in clinical experience to counter many of the narratives that are not based in reality.”

The reality of transgender and gender diverse (mental) health

Being transgender is not a mental health problem, says Dr. Keuroghlian, in the same way that being cisgender is not a mental health problem. Rather, it is society and political agendas that create mental health problems in many circumstances, he explains. Human gender diversity has always existed throughout history, cultures and countries, he adds, noting that it was simply that medical innovations and discoveries such as the isolation of sex hormones and their synthesis or surgical advances finally came to allow things that did not exist. were possible or acceptable before. “Medical options were not a reality before and expectations are changing now,” Dr. Keuroghlian said.

“It is not a mental health issue for anyone, at any age, to be transgender or gender diverse. Gender identity emerges from the age of two. Already at three years old, a child can express it clearly, inflexibly and persistently.”

Studies Dr. Keuroghlian and his colleagues have conducted show that gender-affirming approaches to care improve mental health outcomes. When gender-affirming care is initiated in all aspects of health care and wellness, including social, psychological, medical, and surgical, mental health problems such as anxiety, depression, and substance use disorders improve. dramatically, the psychiatrist told ADAA. He added that, contrary to much misinformation, there is no medical or surgical intervention for young children and that puberty suppressant therapy, for example, is safe and already widely used for other medical needs.

“My talk (at the conference) was about how we can adapt existing evidence-based mental health interventions and practices using a ‘gender minority stress framework’ to improve quality of care and health outcomes for these populations “said Dr. Keuroghlian. “The gender minority stress framework explains why people may experience more anxiety and depression due to the chronic developmental stigma and discrimination they face throughout their lives.”

Practice gender-affirming care, not “watchful waiting”

Social gender affirmation before age 10 or even in adolescence is associated with as good mental health in adults as not being socially affirmed until adulthood, says Dr. Keuroghlian. He says there is no evidence to support the idea of ​​“watchful waiting,” the belief that children and adolescents cannot know what their gender identity is at such a young age.

“In the same way that we don’t tell a five-year-old cisgender boy or girl that they are confused about their gender, we shouldn’t say that to transgender and gender diverse children either,” the psychiatrist said. “And when it comes to teenagers, all children need to go through puberty, but a puberty that aligns with a person’s gender identity.”

The process for determining medical and psychological care, if needed, for transgender and gender diverse youth is a very careful, collective and thoughtful decision, Dr. Keuroghlian said. Even in a state like Massachusetts with some of the most progressive laws on gender identity, there is a process that includes expert doctors, professionals, and family members. It is not currently possible, he says, without all parents or guardians in the image agreeing.

Providing culturally sensitive and gender-affirming care, rather than specialized care that creates bottlenecks and restricts the number of professionals who can do the work, is especially important, says former 2014 CDLP winner and ADAA keynote speaker in 2024. In those 10 years, the Harvard psychiatrist has made great strides in gender-affirming mental health care and ADAA is confident that Dr. Keuroghlian will contribute and create more inclusive mental health care environments, safe and welcoming for the next decade.

“It is essential that every doctor, clinician, therapist, nurse practitioner, medical professional, etc., be confident and trained in this type of care,” he said. “We all have to do our part to improve, improve and modernize the health system to support gender-affirming care.”