Gender dysphoria, gender reorientation, and the clinical management of transsexualism.
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Adaptation, Psychological↗
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Results for “Gender dysphoria”
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A review of clinical approaches to gender dysphoria.
Gender dysphoric patients are not infrequently encountered in the clinical practice of psychiatry. A comprehensive review of the world literature reveals that the systematic study of severe gender disorders--as exemplified by transsexualism--is relatively new, consisting of just over 25 years of collective experience. While the formal diagnosis of transsexualism is rare, this disorder represents the most severe form of the gender dysphoric conditions. Many nontranssexual patients with a variety of other psychiatric disorders present to psychiatrists desperately requesting somatic treatments (cross-gender hormones, sex reassignment surgery, and other cosmetic surgical procedures). A lengthy differential diagnosis needs to be considered, and a specialized approach to interviewing gender dysphoric patients is highly recommended. Available treatments and their efficacy are discussed. Large prospective controlled studies of treatments for gender dysphoria, such as sex reassignment surgery and psychotherapy, are lacking. Countertransference issues are noted to be particularly relevant in the care of gender dysphoric individuals.
Countertransference↗
Gender dysphoria and gender change in androgen insensitivity or micropenis.
This review article answers three questions relevant to the medical management and care of individuals born with complete androgen insensitivity syndrome (CAIS), partial androgen insensitivity syndrome (PAIS), or a micropenis: (1) Do any of these individuals reassign themselves from their initial gender assignment? (2) Do more reassign than the ones who do not? (3) Is there evidence of gender dysphoria in those who do not self-initiate reassignment? Reviewed were all articles on CAIS, PAIS, and micropenis cited in K. J. Zucker (1999) plus articles published through 2004. There were no documented cases of gender change in individuals with CAIS (N= 156 females) or micropenis (N= 89: 79 males, 10 females). Nine (9.1%) out of 99 individuals with PAIS changed gender. Thus, self-initiated gender reassignment was rare. Gender dysphoria also appears to be a rare occurrence. The best predictor of adult gender identity in CAIS, PAIS, and micropenis is initial gender assignment.
Adolescent↗
Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia.
This article reviews the literature on studies and case reports on gender identity and gender identity problems, gender dysphoria, and gender change in chromosomal females with congenital adrenal hyperplasia, raised male or female. The large majority (94.8%) of the patients raised female (N= 250) later developed a gender identity as girls and women and did not feel gender dysphoric. But 13 (5.2%) patients had serious problems with their gender identity. This percentage is higher than the prevalence of female-to-male transsexuals in the general population of chromosomal females. Among patients raised male, serious gender identity problems were reported in 4 (12.1%) out of 33 patients. From these observations, we conclude that the assignment to the female gender as a general policy for 46,XX patients with CAH appears justified, even in severely masculinized 46,XX newborns with CAH (Prader stage IV or V).
Adrenal Hyperplasia, Congenital↗
Introduction: gender dysphoria and gender change in persons with intersexuality.
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Disorders of Sex Development↗
Treatment of gender dysphoria (transsexualism).
Gender dysphoria, or transsexualism, is a condition involving incongruity between an individual's anatomic sex and personal sense of gender identity. Only in the last 15 years have Standards of Care been established and a professional organization developed to bring definition and consistency to the field (Harry Benjamin International Gender Dysphoria Association). A typical course of treatment lasts several years and includes psychological/psychiatric evaluations, completion of the "real life" test, administration of hormone therapy to create desired secondary sex characteristics, and finally sex reassignment surgery. As the field has developed and health-care professionals and the public have become more aware, increasing numbers of individuals are coming forward to seek evaluation and treatment. Published follow-up studies documenting long-term outcome are needed now. Current intervention techniques have progressed beyond the "experimental" stage and can be regarded as accepted medical practice.
Combined Modality Therapy↗
Varieties of autogynephilia and their relationship to gender dysphoria.
The relationship between gender dysphoria and autogynephilia (erotic arousal in men associated with the thought or image of themselves as women) was investigated. Subjects were 238 nonhomosexual male outpatients divided into three groups: 94 reporting they were most aroused sexually by images of themselves as nude women, 67 most aroused by images of themselves as women in underwear, and 77 most aroused by images of themselves as fully clothed women. These were compared on questionnaire measures of gender dysphoria and other psychosexual variables. The Nude group was significantly more gender dysphoric than the Clothed group, which, in turn, was significantly more gender dysphoric than the Underwear group. These results support the hypothesis that those nonhomosexual men most aroused sexually by the thought of having a woman's body are also those most interested in acquiring a woman's body through some permanent, physical transformation. A secondary finding was that the Nude group was the same age as the Underwear group and significantly younger than the Clothed group. This outcome makes it unlikely that erotic fantasies of having a woman's body are the end result of some progression that necessarily begins with erotic fantasies of wearing women's clothes.
Adult↗
The aging gender dysphoria (transsexual) patient.
Ten aging gender dysphoria patients (eight men and two women, average age 52 years) were the subjects of this study. All had presented to the Gender Identity Clinic at Case Western Reserve University requesting sex-reassignment surgery. A psychiatric-psychological profile of the patients, their sexual functioning, problems with aging, diagnostic issues, and follow-up are discussed. The aging gender dysphoric patient presents in acute crisis, that is, exhibiting marked depression, increased suicidal ideation and behavior, and urgent perception of time. Diagnostic and treatment recommendations for aging gender dysphoria patients and their depressions are provided. Furthermore, guidelines are suggested for differentiating the aging transvestite with transsexual symptoms and the aging transsexual for whom sex-reassignment surgery may be indicated. Specific treatment strategies for an aging population, including sexual surgery, are also discussed.
Aging↗
Is gender dysphoria dysphoric? Elevated depression and anxiety in gender dysphoric and nondysphoric homosexual and bisexual men in an HIV sample. HNRC Group.
Few if any studies before the AIDS epidemic suggested that male homosexuals may on average have higher levels of depression than male heterosexuals. However, several samples of homosexual and bisexual men in HIV studies suggest that depression and anxiety are high in these populations, and that this psychiatric morbidity began before the AIDS epidemic. We tested the hypothesis that high childhood gender nonconformity (CGN) is associated with depression and anxiety, and so might account for differences in these variables among samples of homosexuals. A total of 254 homosexual or bisexual male subjects were assessed for depression, anxiety, and associated symptoms using various self-report and interview measures, as well as for CGN (using the Freund Feminine Gender Identity scale, FGI). For comparison purposes only, we also evaluated the subjects for the DSM-III diagnosis of Ego-Dystonic Homosexuality. Highly gender nonconforming men (high FGI scores) were more likely to have current symptoms of anxiety and depression by self-report, and to have had a lifetime history of depression by clinical interview. This association was more often due to FGI items dealing with childhood than adulthood. When the FGI was broken into subscales by a prior factor analysis, stepwise regression suggested that the subscale measuring core gender identity nonconformity (so-called "gender dysphoria") was more reliably associated with depression and anxiety than were the factors measuring nonconformity in the areas of masculine and feminine gender roles, or genitoerotic (sexual) roles. This subscale was also the only FGI measure correlating with Ego-Dystonic Homosexuality. AIDS (CDC stage and HIV serostatus) and age did not account for these findings. We conclude that the often-reported higher levels of depression, anxiety, and associated symptoms among homosexual and bisexual men in AIDS studies are more common in the subgroup of such men who are gender dysphoric. Theoretical and clinical implications of these data are discussed.
Adult↗
Unveiling the mystique of gender dysphoria syndrome.
There are common myths surrounding the condition of gender dysphoria and individuals seeking therapy. The diagnosis of gender dysphoria syndrome is applied to individuals who feel ill at ease with their biological body and either seek hormonal reassignment therapy or hormonal therapy and sex reassignment surgery. The author discusses standards of care, diagnostic criteria, physiological and psychological changes incurred through hormonal therapy are introduced as well as surgical techniques. By assisting individuals with gender dysphoria syndrome to enhance the integration of their new gender role into their self-identity, nurses are in an excellent position to facilitate improvements in their overall health status as well.
Female↗
The Southeast Asian interpretation of gender dysphoria: an illustrative case report.
In the West gender dysphoria is commonly attributed to a biological abnormality, parental influences favoring assumption of a gender opposite to the subject's anatomical sex, or a combination of these factors. In Southeast Asia (among Hindus and Buddhists), numerous cases of gender dysphoria occur. They generally receive less attention than they do in the West and evoke relatively little concern on the part of the persons affected and the members of their families. The condition is attribwted to residues of a previous life as a member of the opposite sex. Some persons with gender identity confusion claim to remember details of previous lives. A case illustrating such claims (without verifiable details) is presented.
Adjustment Disorders↗
The concept of autogynephilia and the typology of male gender dysphoria.
This study tested the hypothesis that all gender-dysphoric males who are not sexually aroused by men (homosexual) are instead sexually aroused by the thought or image of themselves as women (autogynephilic). Subjects were 212 adult male-to-female transsexuals. These were divided into four groups; one homosexual and three nonhomosexual. The three nonhomosexual groups were heterosexual, bisexual, and analloerotic (unattracted to male or female partners, but not necessarily devoid of all erotic behavior). A Core Autogynephilia Scale was developed to assess a subject's propensity to be sexually aroused by the fantasy of being a woman. The four transsexual groups were compared on this measure (and on several others), using Newman-Keuls multiple-range tests at p less than .05. As predicted, all three nonhomosexual groups were more likely than the homosexual group to report sexual stimulation by cross-gender fantasy. This finding supports the hypothesis that the major types of nonhomosexual gender dysphoria constitute variant forms of one underlying disorder, which may be characterized as autogynephilic gender dysphoria.
Factor Analysis, Statistical↗
Partial versus complete autogynephilia and gender dysphoria.
Autogynephilia (sexual arousal in men produced by the thought or image of themselves as women) is often associated with gender dysphoria (the desire to belong to the opposite sex). Previous research has shown that autogynephiles who are principally aroused by images of themselves as nude women are more gender dysphoric than those principally aroused by images of themselves as partially or fully dressed women. This study tested the hypothesis that the feature of the nude self-image most responsible for its correlation with gender dysphoria is the imagined vulva. The subjects were 220 nonhomosexual male outpatients who reported sexual arousal while imagining themselves with one or more features of the female anatomy. Autogynephilia and gender dysphoria were assessed with questionnaires. The findings confirmed that men who are sexually aroused at the thought of having a vulva are more likely to want to be women.
Adolescent↗
Pseudotranssexualism: iatrogenic gender dysphoria.
Individuals who wish sexual reassignment can be classified according to clinical entities. It is essential to recognize which clinical entities promote gender dysphoria. A complication arising in the intensive psychotherapy of a woman unhappy with her biologic sex is presented. A 32-year-old homosexual woman entered treatment with a female therapist for depression. Despite occasional fantasies of impregnating her therapist, the patient at first demonstrated no gender dysphoria. When her therapist actually did become pregnant, however, the patient began consciously to wish that she herself were male and stigmatized her homosexuality. During a two-week separation in treatment, the patient actively sought sexual reassignment. The role of eroticized transference is discussed to explain the emergency of gender dysphoria.
Adult↗
The classification and labeling of nonhomosexual gender dysphorias.
This report suggests systematic strategies for the descriptive classification of nonhomosexual gender identity disorders, based on clinical observations and research findings. The classification of biological males is considered first. A review of cross-gender taxonomies shows that previous observers have identified and labeled a homosexual type far more consistently than any other category of male gender dysphoric. It is suggested that the apparent difficulty in differentiating reliably among the nonhomosexual types results from the sharing of many overlapping characteristics by the various groups. This is supported by a review of informal, mostly clinical, observations and by the findings of three studies designed to test the hypothesis that the nonhomosexual gender dysphorias, together with transvestism, constitute a family of related disorders in men. It is concluded that the main varieties of nonhomosexual gender dysphoria are more similar to each other than any of them is to the homosexual type. Two recommendations, based on the foregoing review, are offered for the classification of male gender dysphorics in research studies. When the number of subjects is small, they may be classified simply as homosexual or nonhomosexual. When the number is larger, the nonhomosexual cases may be classified as heterosexual, bisexual, or analloerotic (unattracted to male or female partners, but not necessarily devoid of sexual drive or activities).
Female↗
Heterosexual and homosexual gender dysphoria.
This study investigated why more males than females complain of dissatisfaction with their anatomical sex (gender dysphoria). New referrals to a university gender identity clinic were dichotomously classified as heterosexual or homosexual. There were 73 heterosexual and 52 homosexual males; 1 heterosexual and 71 homosexual females. The average heterosexual male was 8 years older at inception than the homosexual groups. The heterosexual males reported that their first cross-gender wishes occurred around the time they first cross-dressed, whereas the homosexual groups reported that cross-gender wishes preceded cross-dressing by 3-4 years. Some history of fetishistic arousal was acknowledged by over 80% of the heterosexual males, compared to fewer than 10% of homosexual males and no homosexual females. The results suggest that males are not differentially susceptible to gender dysphoria per se, but rather that they are differentially susceptible to one of the predisposing conditions, namely, fetishistic transvestism.
Female↗
Gender dysphoria update.
Concepts of sexuality and gender identity are undergoing re-examination in society. Recent media attention has intensified interest in the area, although reliable information is sometimes lacking. Gender dysphoria, and its extreme form, transsexualism, frequently brings sufferers into contact with psychiatric, social, and mental health professionals, and surgical caregivers. Treatment of these patients often represents a challenge on many levels. Some guidelines for this care are outlined.
Female↗
Transsexualism or the gender dysphoria syndromes.
Professional, patient and media forces tend to oversimplify the complexity of the gender dysphoria syndrome. Because sex reassignment surgery may be helpful to some patients with the syndrome and harmful to others, mental health professionals need to competently perform differential diagnoses of both the gender disorder and the associated psychopathologies. This frequently involves distinctions between subtle forms of psychosis, character pathologies of varying severity, and major developmental problems. Surgery should not be considered the only, or the best, treatment for the syndrome. Contrary to popular belief, psychotherapy can help many patients, especially those with secondary gender dysphoria.
Adult↗