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The Gender Dysphoria Concept

Abstract

Formerly known as Gender Identity Disorder (GID), gender dysphoria is a discrepancy between gender and sex, which is characterized by feelings of identification with the opposite gender and discomfort with one’s biological sex. People with this medical condition desire to live as the opposite sex. Therefore, their behaviors, attitudes, and dressing styles resemble those of the opposite sex. Gender dysphoria is a rare condition whose prevalence is not well known because the majority of people with the condition fail to seek professional help.

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Common symptoms of the condition include isolation, depression, low self-esteem, anxiety disorder, and discomfort with one’s physical appearance. Through extensive research, several potential causes of the condition have been identified. They include neurology, genetics hormones, abnormal chromosomes, and rare conditions. Diagnosis of gender dysphoria is complex. Therefore, it involves the participation of different medical professionals that include neurologists, urologists, psychologists, psychiatrists, and endocrinologists. Management of gender dysphoria is most effective if diagnosis of the condition is done early and the best treatment plan implemented.

Introduction

Gender dysphoria is a condition that manifests in a mismatch between a person’s biological sex and gender identity. Biological sex and gender identity are natural occurrences for many people (Trombetta & Liguori, 2015). However, others experience problems connecting their biological sex to their gender identity. For instance, an individual might have the male genitalia, but embrace the identity of a woman. This mismatch is a major cause of distress and uncomfortable feelings. In the medical field, the confusion, distress, and discomfort that ensue due to the mismatch are referred to as gender dysphoria (Trombetta & Liguori, 2015). Gender dysphoria is a medical condition, and victims are often advised to seek treatment. In many cases, many people with the condition prefer to live in accordance with their gender identity rather than their biological sex (Tosh, 2016). For instance, a person with the male genitalia might behave and dress like a woman.

History

Gender dysphoria was included in the Diagnostic and Statistical manual (DSM-III) in 1980. The diagnosis manual included a diagnostic group referred to as “Gender Identity Disorders” that comprised several conditions associated with gender identity (Trombetta & Liguori, 2015). The American Psychiatric Association made that bold and controversial decision to ensure that people with gender variance got access to the same health care that other people enjoy (Vitale, 2010). The management of gender dysphoria is complex because of the involvement of different medical professionals. For instance, diagnosis is done by mental health care providers while treatment is usually done by endocrinologists (Tosh, 2016). Gender dysphoria is not a mental condition.

However, it is classified under mental disorders because of the mental anguish it causes (Trombetta & Liguori, 2015). The confusion created by discrepancies between gender and sex cause impairments in the normal social and occupational functioning. Since its first appearance in DSM-II, the definition of gender dysphoria has changed with each revision of the DSM. The term “gender dysphoria” replaced gender identity disorder in the DSM-5 (Tosh, 2016). The term is more appropriate because it annihilated the assumption that people with the condition had a disorder. It is a condition and not a disorder because its main characteristic is the presence of feelings of discomfort with one’s physical appearance (Yarhouse, 2015).

Signs and Symptoms

Research has established that this condition is noticeable early in life, and is characterized by certain behaviors and attitudes. For instance, a girl may refuse to dress as girls dress or take part in activities that are characteristic of girls (Giordano, 2013). Early childhood is a challenging time to determine whether a child has gender dysphoria or not because certain behaviors are part of the growing up process and disappear as the child grows older (Giordano, 2013). The main difference between normal childhood behavior and behaviors characteristic of gender dysphoria is that these behaviors persist during childhood and children carry them into adulthood.

In adults, the feeling of being trapped in a body that betrays one’s gender identity persists and causes a lot of pain mainly because of societal expectations (Tosh, 2016). In such cases, people with gender dysphoria live according to their anatomical sex in order to avoid the constant judgment and criticism from the society (Trombetta & Liguori, 2015). Another sign is the constant desire to change the physical signs that determine their biological sex and replace them with signs that match their gender identity. Other signs in children include social isolation, anxiety, loneliness, and depression (Giordano, 2013). In addition, disgust at one’s genitalia is a common occurrence. In adults, symptoms include stress, isolation, low self-esteem, suicide attempts, and depression (Vitale, 2010).

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Causes

The causes of gender dysphoria are unclear. However, scientists have suggested several potential causes including genetics, hormones, rare conditions, and exposure to estrogen drugs (Vitale, 2010). Improper functioning of hormones that trigger sex development during pregnancy could be a cause of gender differences. Androgen Insensitivity Syndrome (AIS) causes the release of excess female hormones that interfere with the normal process of sex development (Yarhouse, 2015). If the fetus is insensitive to the hormones, then gender dysphoria is likely to develop. Studies have established that Congenital Adrenal Hyperplasia (CAH) among other conditions predispose people to the risk of suffering gender dysphoria. CAH leads to excessive production of male hormones in a female fetus and the development of male organs. Intersex conditions lead to the birth of babies with male and female genitalia (Steiner, 2013). Other causes include chromosomal abnormalities and defects in normal human bonding during childhood (Giordano, 2013). The condition can also be caused by additional hormones in the mother’s system that originates from the administration of certain medication.

Prevalence

It is difficult to determine the prevalence of gender dysphoria because many people with the condition fail to seek professional help (Yarhouse, 2015). The condition is associated with prejudice and discrimination because it is considered an anomaly. Therefore, people with the condition keep it private. Gender dysphoria is rare and few cases have been reported. However, increased research into treatment methods and initiatives to create awareness have led to an increase in the number of people seeking professional help for problems related to gender dysphoria (Trombetta & Liguori, 2015). The Equality and Human Rights Commission conducted a survey in 2012 to find the extent of the problem. The results of the survey concluded that at least 1% of the 10,000 participants were gender variant in some way (Steiner, 2013). In the state of Massachusetts, statistics show that the rate of prevalence is 0.5% based on people who identify as transgender. Projections show that approximately 0.005% of males and 0.002% of females would have gender variations if current diagnostic criteria were applied.

Diagnosis

The diagnosis of gender dysphoria is a complex process that necessitates the participation of a multidisciplinary team of professionals that include psychiatrists, psychologists, counselors, urologists, neurologists, endocrinologists, and behavioral and occupational therapists (Vitale, 2010). According to the American Psychiatric Association, the diagnosis of gender dysphoria should be conducted only if at least two of the criteria outlined in the DSM-5 have been occurring for a period of six months. The Association changed the diagnosis of gender identity disorder to gender dysphoria after several complaints that described the former term as stigmatizing (Trombetta & Liguori, 2015). The DSM also has separate diagnosis guidelines for children and adults. The diagnosis process takes place in two phases. In the first phase, the diagnosis is conducted based on the provisions of the Statistical Manual for Mental Disorders IV while diagnosis in phase two involves assessment to determine whether the patient can live in accordance with the results of the diagnosis (Steiner, 2013). This phase also involves activities such as psychotherapy, hormonal therapy, and counseling.

Treatment

Treatment for dysphoria is usually individualized to fit the specific needs of patients. The main aim of treatment is the reduction or removal of feelings of distress or embarrassment that might be affecting a patient (Steiner, 2013). Variations in treatment include conducting surgery to change the patient’s physical appearance and administration of hormones to stimulate the development of certain organs. The most common treatment method is surgery to change physical appearance permanently. Surgery and administration of hormones create consistency between one’s biological sex and gender identity. Treatment for children and young people includes family therapy, individual child psychotherapy, parental counseling, and hormone therapy (Steiner, 2013). Treatment of this condition often involves a large team comprised of different members of the health care team.

Hormone therapy is done to children who show signs of gender dysphoria after puberty. They are administered with Gonadotrophin-Releasing Hormone (GnRH) analogues that help delay the development of certain physical changes. Treatment for adults includes peer support groups, hormone therapy, cross-sex hormone treatment, mental health support, speech and language therapy, and hair removal treatments (Steiner, 2013). Surgery is usually performed after a successful social gender role transition using the aforementioned treatment methods. Surgery options for trans-men include bilateral mastectomy, scrotoplasty, penile implant, phalloplasty, and salpingo-oophorectomy. For trans-women, surgery options include vulvoplasty, vaginoplasty, orchidectomy, penectomy, and breast implants (Steiner, 2013). Effective treatment is based on early diagnosis of the condition and the implementation of a proper treatment plan.

Conclusion

As mentioned in the foregoing discussion, gender dysphoria is a rare medical condition that is characterized by discrepancies in gender and sex. It causes discomfort and distress in victims because of the discrimination and prejudice that comes from the society. Advancements in technology have brought hope to people with gender dysphoria because more research studies are exploring different treatment options for the condition. Moreover, studies to combat the discrimination associated with the condition are being conducted. Therefore, there is hope for the acceptance of people with gender dysphoria in society. Signs and symptoms among children and adults are different. However, certain signs are hard to deal with at an individual level. They include discomfort with one’s physical appearance, stress, depression, and anxiety. Diagnosis involves the participation of different medical practitioners who help in identifying the various aspects of gender and sex mismatch in patients. Treatment depends on successful diagnosis. Examples of treatment remedies available include hormone therapy, surgery, counseling, therapy, and psychotherapy. Surgery is common in adults.

References

Giordano, S. (2013). Children with gender identity disorder: a clinical, ethical, and legal analysis. New York, NY: Routledge.

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Steiner, B. W. (2013). Gender dysphoria: development, research, management. New York, NY: Springer Science & Business Media.

Tosh, J. (2016). Psychology and gender dysphoria: feminist and transgender perspectives. New York, NY: Routledge.

Trombetta, C., & Liguori, G. (2015). Management of Gender Dysphoria: A Multidisciplinary Approach. New York, NY: Cengage Learning.

Vitale, A. M. (2010). The gendered self further commentary on the transsexual phenomenon. New York, NY: Lulu.com.

Yarhouse, M. A. (2015). Understanding gender dysphoria: navigating transgender issues in a changing culture. New York, NY: InterVarsity Press.

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