Gender Dysphoria

Overview

Gender dysphoria is a feeling of discomfort or distress experienced by individuals whose gender identity differs from the sex assigned to them at birth or from their sex-related physical characteristics. It can affect adolescents and adults and may cause significant distress in social situations, work, or other areas of life. Symptoms can include a strong desire to be rid of or change genitalia or secondary sex characteristics, a strong desire to have the genitals and characteristics of another gender, and a strong belief of having the typical feelings and reactions of another gender. Gender dysphoria can cause complications such as difficulty in school or work, relationship problems, anxiety, depression, and other mental health issues. Accessing health services can be challenging due to fear of stigma and a lack of experienced care providers.

Understanding the disease

Symptoms

The symptoms of gender dysphoria include a marked difference between inner gender identity and assigned gender that lasts for at least six months, as shown by at least two of the following:

1. A difference between gender identity and genitals or secondary sex characteristics, such as breast size, voice, and facial hair.
2. In young adolescents, a difference between gender identity and anticipated secondary sex characteristics.
3. A strong desire to be rid of these genitals or secondary sex characteristics, or a desire to prevent the development of secondary sex characteristics.
4. A strong desire to have the genitals and secondary sex characteristics of another gender.
5. A strong desire to be or to be treated as another gender.
6. A strong belief of having the typical feelings and reactions of another gender. Gender dysphoria can lead to significant distress and affect an individual's functioning in various aspects of life, including social situations, work, and school. It may also result in relationship difficulties, anxiety, depression, self-harm, eating disorders, substance misuse, and other problems. Accessing health and mental health services can be challenging due to fear of stigma and a lack of experienced care providers.

Risk Factors

Risk factors for developing gender dysphoria include:

1. Genetics: Research suggests that gender dysphoria might have a genetic component, and some individuals might be more predisposed to it due to their genetic makeup.
2. Hormonal influences: Exposure to hormones during fetal development or during puberty might play a role in the development of gender dysphoria.
3. Environmental factors: Early experiences and socialization, including family dynamics and societal expectations, can contribute to the development of gender dysphoria.
4. Childhood gender nonconformity: Children who exhibit behaviors or preferences that differ from traditional gender roles might be at a higher risk of developing gender dysphoria later in life. It is essential to note that not all individuals experiencing gender dysphoria will have these risk factors, and some people might develop gender dysphoria without any known risk factors. Gender dysphoria is a complex condition with varying causes and individual experiences.

Development

Gender dysphoria can develop in individuals whose gender identity differs from their sex assigned at birth or sex-related physical characteristics. This feeling of discomfort or distress can occur in transgender and gender-diverse people at some point in their lives. However, it is important to note that some transgender and gender-diverse individuals may feel comfortable with their bodies, with or without medical intervention. Gender dysphoria typically causes a marked difference between a person's inner gender identity and their assigned gender, lasting for at least six months. This difference is illustrated by at least two of the following: a difference between gender identity and genitals or secondary sex characteristics, a strong desire to be rid of these genitals or secondary sex characteristics, a desire to prevent the development of secondary sex characteristics, a strong desire to have the genitals and secondary sex characteristics of another gender, and a strong desire to be or to be treated as another gender. Gender dysphoria can start in childhood, continue into adolescence and adulthood, or occur around the time of puberty or later in life. It may also cause significant distress that affects an individual's social functioning, school performance, work, and other areas of life. It is important to address the complications that may arise from gender dysphoria, such as relationship difficulties, anxiety, depression, self-harm, eating disorders, substance misuse, and other problems. Accessing health services and mental health services can be challenging due to fear of stigma and a lack of experienced care providers. In summary, gender dysphoria develops as a feeling of discomfort or distress in individuals whose gender identity does not align with their sex assigned at birth or sex-related physical characteristics.

Assessment and Diagnosis

Triage

You should consider seeing a doctor if you or someone you know is experiencing gender dysphoria and it is causing significant distress that affects daily life, social situations, work, school, or other areas of life. Additionally, if the person is experiencing any of the following, they should seek medical advice:

1. If the person is experiencing anxiety, depression, self-harm, eating disorders, substance misuse, or other mental health issues related to gender dysphoria.
2. If they are facing relationship difficulties or struggles due to gender dysphoria.
3. If they are experiencing discrimination or stress related to accessing healthcare services or mental health support.
4. If the person is considering suicide or has suicidal thoughts. It is important to consult with a healthcare professional who is knowledgeable about gender dysphoria and can provide appropriate guidance and treatment options. Remember, seeking help for gender dysphoria is a step towards managing the condition and improving overall well-being.

Diagnosis

To diagnose gender dysphoria, a healthcare provider will typically conduct a behavioral health evaluation. This evaluation includes assessing the presence of gender dysphoria and the impact of prejudice and discrimination on the individual's mental health. The provider will also consider the degree of support from family, friends, and peers. Additionally, the mental health professional may use the criteria for gender dysphoria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. The individual must also have persistent, well-documented gender dysphoria, be capable of making a fully informed decision and consent to treatment, and meet other specific criteria, depending on their age and any underlying medical or mental health concerns. A pre-treatment medical evaluation, including a personal and family medical history, physical exam, lab tests, and assessment of tobacco use and drug/alcohol misuse, is also conducted to rule out or address potential medical conditions that may affect treatment.

Management and Treatment

Complications

Potential complications of gender dysphoria may include:

1. School dropout or unemployment due to impaired ability to function in social situations, at work or school, and in other areas of life.
2. Relationship difficulties and increased risk of anxiety, depression, self-harm, eating disorders, substance misuse, and other problems.
3. Experiencing discrimination, which can result in stress.
4. Difficulty in accessing health and mental health services due to fear of stigma and a lack of experienced care providers.
5. Increased risk of suicidal thoughts or attempts, particularly in adolescents and adults without gender-affirming treatment. It is important to note that not all individuals with gender dysphoria experience these complications, and that effective treatment and support can help mitigate these risks.

Treatment

Treatments for gender dysphoria aim to alleviate the distress and discomfort associated with the condition. Some common treatment options include:

1. Psychotherapy: Also known as talk therapy, psychotherapy can help individuals explore their feelings about their gender identity and address any mental health issues related to gender dysphoria.
2. Hormone therapy: Hormone therapy involves taking medications to alter hormone levels, which can help bring about physical changes that align with an individual's gender identity. Hormone therapy can also relieve symptoms of gender dysphoria.
3. Gender-affirming surgeries: These surgeries are designed to alter an individual's physical characteristics to align with their gender identity. Examples include breast augmentation, facial feminization or masculinization surgery, vaginoplasty, and phalloplasty.
4. Lifestyle changes: Supporting individuals in their gender identity and helping them integrate into their preferred gender role through clothing, hairstyle, and other presentation aspects can help alleviate gender dysphoria. It is essential to consult a healthcare professional experienced in treating gender dysphoria to determine the most appropriate treatment plan. The best course of action will be tailored to individual needs and circumstances.

Preparing for medical consultation

To prepare for an appointment for gender dysphoria, make a list of the following:

1. Persistent, well-documented gender dysphoria
2. Capacity to make a fully informed decision and consent to treatment
3. Legal age in your country or, if younger, following the standard of care for children and adolescents
4. If significant medical or mental concerns are present, they must be reasonably well controlled Before your appointment, you may also want to consider:

• A personal and family medical history
• A physical exam
• Lab tests
• Assessment of the need for age- and sex-appropriate screenings
• Identification and management of tobacco use and drug and alcohol misuse
• Testing for HIV and other sexually transmitted infections, along with treatment, if necessary
• Exploring individual, couples, family, and group therapy to address your gender identity, accept yourself, cope with minority stress, build a support network, and make decisions about your medical treatment options
• Evaluating your mood, mental health concerns, risk-taking behaviors, substance misuse, sexual health concerns, social support, goals, risks, and expectations for treatment, and trajectory of care
• Utilizing peer support groups, voice and communication therapy, hair removal or transplantation, genital tucking, breast binding, breast padding, packing, aesthetic services, and legal services as needed Remember to prioritize self-care, meditation, or prayer, and getting involved in your community through volunteering at LGBTQ organizations.