Gender Dysphoria

Signs, Causes, and Treatments

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What is Gender Dysphoria?

Gender Dysphoria refers to the discrepancy between a person's gender identity and their biological sex (Nolen-Hoeksema, 2014, p.388). This is usually diagnosed in adulthood, but can also be diagnosed in childhood, although it is rarer (Nolen-Hoeksema, 2014, p.388). Children who are diagnosed with gender dysphoria often reject the gender assigned to them at birth. Additionally, they seek activities typical of the opposite sex, and may begin to cross dress.


Adults who are diagnosed with gender dysphoria are sometimes referred to as transexual or transgender. Individuals with gender dysphoria can be homosexual, heterosexual, or asexual. It is not uncommon for someone with gender dyshproia to undergo surgical sex reassignment surgery to change their anatomy. This is usually preceded by a number of other changes; including, adoption of gender-related behaviors that fit their gender identity and cross dressing. Those who do not have access to surgical treatment may find it difficult to live with anatomy that does not match their gender identity. As a result, some develop alcohol and substance abuse issues. Furthermore, they may become depressed due to low self-esteem and the negative stigma that is associated with gender dysphoria.


It is important to know that being diagnosed with gender dysphoria is the first step to helping you find your authentic self. If you find that you are uncomfortable with your biological sex, and more closely identify with the opposite sex, you might meet the criteria for gender dysphoria. It is important to understand that professionals are available to help you through the process of self discovering when it comes to your gender identity.


This fact sheet from the Canadian Psycholcial Assosication offers some valuable information about gender dysphoria:


http://www.cpa.ca/docs/File/Publications/FactSheets/PsychologyWorksFactSheet_GenderDysphoriaInAdolescentsAndAdults.pdf

Myths: Fact and Fiction

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Myth: Transgender People are Confused

Being non-confroming or gender diverse is not equal to confusion. A person can identify in such a way that is different from the majority of the population and know exactly who they are. Different does not equal confused. A person who identifies as transgender is aware of their gender identity. However, this might be confusing for their families and loved ones.

Myth: Being Diagnosed with Gender Dysphoria Means a Person is Gay

Gender and sexual orientation are separate things. A person with gender dysphoria can be homosexual, heterosexual, or asexual. Sexual orientation is not included in the diagnosis of Gender dysphoria.

Myth: Children are Too Young to Know They are Transgender

Think about when non-transgender people become aware of their gender. Almost everyone knows from an early age which gender they identify with. The same is true for transgender children.

Causes

Theories

Gender dysphoria is a complex process that is thought to be influenced by both genetic and psychological factors (Klink & Den Heijer). Researchers have pointed to the role of hormones in the development of gender identity, specifically prenatal exposure to androgens (Veale, Clark, & Lomax, 2010). Furthermore, cell distribution in certain parts of the brain have been implicated in the development of gender dysphoria (Nolen-Hoeksema, 2014, p.390).


Psychological factors also play a role in the development of gender dysphoria. For example, a study of boys with gender dysphoria found that their parents were more encouraging of cross-gender behaviors than parents of boys without gender dysphoria (Nolen-Hoeksema, 2014, p.390). However, it is important to understand that the research points to genetic and hormonal causes rather than psychological factors in the development of gender identity. However, psychological and environmental factors play a role in influencing behavior, thoughts, and feelings around gender identity.


If you believe that you might have gender dysphoria it is important to resist placing blame on anyone or thing. Humanity is full of rich diversity. A professional can help you realize your personal richness and how to live fully with your identity.

Treatment Options

Counseling

The first step on your journey is to locate a therapist and receive a psychological evaluation to determine if you meet the criteria for the diagnosis. If so, psychotherapy has been proven to be an immensely helpful treatment in helping people navigate and clarify their gender identity and treatment plan (Nolen-Hoeksema, 2014, p.391). In some cases counseling is required before other treatments can be pursued (e.g. hormone therapy, sex reassignment surgery). Moreover, psychotherapy can help you manage your feelings if you chose to transition.

Hormone Therapy

Hormone therapy is a medical treatment option for those who wish to present physical creatures that are aligned with their gender identity. This comes in the form of estrogen (for male-to-female) and testosterone for (female-to-male) transitions (Manieri et. al., 2008). A psychological assessment is usually required before a medical professional will administer treatment. Additionally, hormone therapy can be given to those who chose not to get sex reassignment surgery (Nolen-Hoeksema, 2014, p.391).

Sex Reassignment Surgery

Sex reassignment surgery is done to change the anatomy to match an person's gender identity. Surgery is almost always preceded by hormone therapy and full-time real-lfe experience. The latter refers to when a person lives full-time in their identified gender. Only after a minimum of two years will a person be eligible for the surgery (Nolen-Hoeksema, 2014, p.391). For male-to-female reassignment the penis is removed and a vagina is constructed in its place. For female-to-male reassignments a penis is created, but is considerably more complex (Nolen-Hoeksema, 2014, p.391).


Working with a qualified professional will help you determine which treatment option(s) best fits your situation.

Finding a Qualified Provider

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The first step in seeking help is to identify a professional who specializes in treating individuals with gender dysphoria. Not all psychological professionals are equipped to manage the care of a person with gender dysphotia, which is why it is important to identify a therapist who is adequately qualified. For example, medical doctors (MD) are not necessarily trained with the necessary skills to provide therapeutic treatment for gender dysphoria. A highly qualified professional will have a PhD or Psy.D in the field of clinical psychology, more specifically with a concentration in gender studies. A Master's level therapist who has experience in counseling people with gender dysphoria is also a good option.


A good place to start your search is the World Professional Association of Transgender Health. There stated mission is a "Our professional, supporting, and student members engage in clinical and academic research to develop evidence-based medicine and strive to promote a high quality of care for transsexual, transgender, and gender-nonconforming individuals internationally" ("WPATH", n.d.). The following link will take you to the website, where you can use the search feature to find a qualified therapist.


http://www.wpath.org/uploaded_files/140/custom/find_a_provider.cfm?CFID=2650714&CFTOKEN=5c71db439980d50b-63D3C3DC-C560-4480-50F608CAD5761140


Here is a list of questions that you might consider asking a potential therapist to determine if he or she is qualified to help you in your journey.



  1. How many gender patients do you have?
  2. How many TS people have you recommended for surgery?
  3. How long have you been working with gender patients?
  4. What is your educational background?
  5. What books on transgender issues most influenced you?
  6. Have you written any books or articles on the subject?
  7. What got you interested in working with transgender people?
  8. What is your basic philosophy about how to treat this condition?
  9. Do you follow the Harry Benjamin Standards of Care?
  10. What is your hourly rate?

References

Veale, J. F., Clarke, D. E., & Lomax, T. C. (2010). Biological and psychosocial correlates of adult gender-variant identities: A review. Personality & Individual Differences, 48(4), 357-366. doi:10.1016/j.paid.2009.09.018


Nolen-Hoeksema, S. (2014). Abnormal Psychology (6th ed.). New York, NY: McGraw-Hill


Manieri, C., Godano, A., Lanfranco, F., Di Bisceglie, C., Ghigo, E., Maggi, M., & ... Jannini, E. (2008). Hormone treatment in gender dysphoria. Sexologies, 17(4), 265. doi:10.1016/j.sexol.2008.08.005


Find a provider. (n.d.). World Professional Association of Transgender Health. Retrieved from http://www.wpath.org/uploaded_files/140/custom/find_a_provider.cfm?CFID=2650714&CFTOKEN=5c71db439980d50b-63D3C3DC-C560-4480-50F608CAD5761140