L’adolescence (12–18 ans) est une période de transition biologique, psychologique et sociale majeure dans laquelle la stabilité globale du sujet est façonnée dans un nouvel équilibre pérenne dans le temps. Les questions de genre à l’adolescence peuvent faire émerger des difficultés dans les représentations de l’individu de lui-même, du monde et impacter son quotidien. L’accompagnement de cette population représente un enjeu de santé publique majeur tant leur vulnérabilité psychiatrique est importante et globale. Cet enjeu concerne la santé présente et future de ces adolescent(e)s, pour leur insertion scolaire et universitaire, leurs projets futurs. L’étiologie des co-occurrences psychiatriques se relie à des facteurs internes, psycho-corporels en lien notamment avec la notion de dysphorie de genre (DSM-5 ) ou d’incongruence de genre (CIM 11) et externes socio-culturels, particulièrement pluriels. Cette revue de la littérature aborde certains aspects sanitaires et sociaux autour des questions de diversité de genre. Les divergences conceptuelles présentes aux cours du temps et des espaces manifestent toute la complexité d’une évolution de société empreinte de ces divers flux. Cette revue narrative s’appuie sur trois axes disciplinaires. En premier lieu, les évolutions socio-historiques contemporaines autour de la représentation du genre et de son expression. Puis les dynamiques identitaire et psychopathologique autour de la représentation de ce qu’est le sujet-individu et le dépassement des dualités paradigmatiques. Enfin, le positionnement médical, d’abord sous un prisme épidémiologique concernant la vulnérabilité psychiatrique de la population trans notamment adolescente ainsi que les mécanismes étiopathogéniques s’y rattachant. Ces présupposés théoriques et cliniques ont pour objectif de questionner la position soignante à l’égard des minorités de genre afin de pouvoir mettre en place des soins adaptés tant dans les spécificités techniques que dans les enjeux relationnels et transférentiels. En effet, il est essentiel que la structuration de l’offre de soin puisse se penser au plus proche des attentes et des besoins des adolescent(e)s et leurs familles. Cela se décline par un meilleur recours aux soins et un meilleur parcours de soins pour cette population présentant une vulnérabilité psychiatrique importante.

Adolescence (ages 12–18) is a major period of biological, psychological, and social transition, during which the individual's overall stability is reshaped into a new, lasting equilibrium over time. Gender-related issues during adolescence can give rise to difficulties in the individual's representations of themselves, the world, and can impact their daily life. Supporting this population represents a major public health challenge, given the high and global level of psychiatric vulnerability observed. The stakes are considerable for both the present and future health of these patients, as well as for their educational and academic integration, future life projects, and the significant economic cost involved. The etiology of psychiatric co-occurrence involves a particularly plural set of internal, psychocorporeal, and external sociocultural factors. Studying the representations held by patients, their relatives, and healthcare professionals aims to identify the expectations and needs of this at-risk population in order to structure a relevant healthcare offer capable of addressing mental health needs both in acute settings and in long-term care. This narrative review addresses health and social aspects of gender diversity. Conceptual divergences across time and space highlight the full complexity of a societal evolution shaped by multiple and intersecting dynamics. This narrative review is structured around three main areas. First, the contemporary socio-historical developments surrounding the representation of gender and its expression. The German physician Hirschfeld [1868–1935] was the first to accompany and advocate for a non-stigmatizing vision of sexual diversity in the Western world. He was the first to use the term “transvestite” in 1910, the term “transsexuality” in 1912; he founded the first “Institute of Sexology” in 1918, and opposed the criminalization of homosexuality alongside several other authors, including Freud, in 1927. In France, following the movements of 1968, mobilizations for homosexual rights also took shape, with Monique Wittig [1935–2003] as one of their prominent figures — notably through the co-founding of the Front homosexuel d’action révolutionnaire in 1971, of which Les Gazolines represented a trans sub-segment, and Les Gouines Rouges that same year, representing the first lesbian group in Paris. Monique Wittig championed all affirmations of gender and sexuality, combating heteronormativity, which she identified as a mechanism of social control. The recent 2025 recommendations from the HAS once again affirm the illegitimacy of standardized psychiatric follow-up within the care pathway for trans identity. Since 2016, it is no longer necessary to undergo surgery reflecting the “irreversible nature of the transformation,” nor to provide a medical certificate in order to change one's civil status. From a psychopathological standpoint, this literature review draws on a move away from binary categorization — both in terms of masculine/feminine, through the concept of de-coalescence (whose academic foundations took shape around Butler's 1990 work), and in terms of the normal/pathological binary as theorized by Canguilhem and Foucault. These movements, which challenge our representations of fixed binary categories, are part of a broader cultural shift in which dualities such as Body/Mind, Individual/Collective, and Nature/Culture no longer quite fit the contemporary conceptual framework. In his work The Society of Individuals , Elias emphasizes how these issues — widely present in discourse — are now particularly de-substantialized, and have evolved toward a dimensional, dynamic, and circular understanding of the self and the other; one that is arguably closer to Sartrean existentialism than to Descartes’ Cogito. In France, a study by Lagrange et al. examining the clinical profiles of 239 children and adolescents seen between 2012 and 2022 at a specialized gender identity clinic in Île-de-France at the Pitié-Salpêtrière Hospital identifies two groups: a prepubertal group and an adolescent group, accounting for 17% (AMAB/AFAB ratio 1:1) and 83% (AMAB/AFAB ratio 1:3) respectively. Two-thirds of them reported their sexual orientation as still in flux. Rates of depression (60%), suicidality (24% with a history of suicide attempts, one completed suicide during the study), bullying (38%), post-traumatic stress disorder (10%), and borderline personality disorder (10%) were markedly elevated compared to the general population. Then, the identity and psychopathological dynamics surrounding the representation of what constitutes the subject-individual. Finally, the medical positioning — first through an epidemiological lens regarding the psychiatric vulnerability of the trans population, particularly adolescents — as well as the etiopathogenic mechanisms associated with it. These theoretical and clinical premises aim to interrogate the clinical stance toward gender minorities, in order to establish appropriate care that addresses both the specific technical dimensions and the relational and transferential dimensions involved. The service is one of the first Maisons des Adolescents created in France, in 2004, and serves as a reference center for the care of adolescents and their families. In parallel, the service has a transcultural orientation and expertise that are integrated transversally into clinical practice, across individual and group interventions in all areas of activity and diversity. The medical and caregiving stance regarding prejudice is essential and goes hand in hand with a decentered approach, enabling optimal reception of patients and a deeper understanding of their psychological difficulties, regardless of cultural or social background. The first specialized clinics providing care for minors opened in France, in Paris, as early as 2013. A care network gradually developed in France through the coordination of various healthcare and community partners. In Paris, the reference platform Trajectoire Jeune Trans opened in 2022, with the involvement of the Assistance Publique des Hôpitaux de Paris, the Agence Régionale de la Santé, and the Interministerial Delegation for Combating Racism, Antisemitism, and Anti-LGBT Hatred. The gender questioning and transgender identity consultation was launched in September 2023, led by a multidisciplinary team with extensive experience in adolescent psychiatric care. This at-risk population, whose access to healthcare remains fragile, requires medical support to promote overall well-being — physical, psychological, and social. Preventive support for this population may help avert substantial public health costs in the coming years, notably through a care model that maintains and strengthens engagement with individuals at risk of psychological deterioration and social marginalization.