Gender dysphoria is a medical condition characterized by a disconnection between someone's assigned and perceived genders. Individuals with gender dysphoria usually identify themselves as transgendered or transsexual, depending on their ideological feelings about sex and gender. Some transgendered individuals also disagree with the categorization of gender dysphoria as a medical condition, as part of a larger exploration of gender identity and what “normal” gender is. It is also important to differentiate a transvestite (cross dresser) from someone with gender dysphoria; medically, a transvestite is someone who wears clothing belonging to the opposite gender, but is both happy and secure with his or her gender identity.(includes Drag Kings and Queens)
People of all ages can experience gender dysphoria, although most patients experience a sense of disconnection from a very young age. A little boy who longs to be a little girl throughout childhood may not seek treatment until he is much older, but the underlying feelings are still there. Adolescence is also a common time period for the emergence of symptoms, while, more rarely, some adults only start to question their gender when they are much older. The acceptance of gender dysphoria as a condition requiring compassionate treatment, rather than an abnormality, began in the mid twentieth century, but was not widespread until the 1980s.
Individuals with gender dysphoria who seek treatment usually start by seeing a psychologist to discuss their feelings. Working together with a psychologist, the patient decides how serious the problem is, and whether steps should be taken to bring his or her physical gender into alignment with the perceived gender. In most nations, a patient must be seeing a psychologist about the problem for a minimum of one year before taking the next step in treatment, to ensure that the patient truly has gender dysphoria, rather than a passing phase. In most cases, the next step begins with living life in the other gender part time; a man transitioning to a woman, for example, may start going to the store in dresses, and will also begin discussing the problem with the people in her life.
There are a number of treatments that can be used to transition between genders. The first is hormone treatment, which will physically alter the body. After a set period of hormone treatment, the patient may consider surgery to modify genitalia and the chest region. During hormone treatment, the patient usually begins to transition full time, dressing and behaving in ways which match his or her perceived gender, and sometimes taking voice training and other lessons to learn how to walk, talk, and “pass” as the new gender. At the end of the treatment, the transgendered individual will have fully transitioned into a new gender.
Gender identity disorder (GID) is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria (discontent with their biological sex and/or the gender they were assigned at birth). It describes the symptoms related to transsexualism, as well as less severe manifestations of gender dysphoria. GID is classified as a medical disorder by the ICD-10 CM and by the DSM-IV TR. It is likely that the new version of the DSM will replace this category with "Gender Dysphoria." Some authorities do not classify gender dysphoria as a mental illness, including the NHS which describes it as "a condition for which medical treatment is appropriate in some cases."
Gender identity disorder in children is considered clinically distinct from GID that appears in adolescence or adulthood, which has been reported by some as intensifying over time. As gender identity develops in children, so do sex-role stereotypes. Sex-role stereotypes are the beliefs, characteristics and behaviors of individual cultures that are deemed normal and appropriate for boys and girls to possess. These "norms" are influenced by family and friends, the mass-media, community and other socializing agents. Since many cultures strongly disapprove of cross-gender behavior, it often results in significant problems for affected persons and those in close relationships with them. In many cases, transgendered individuals report discomfort stemming from the feeling that their bodies are "wrong" or meant to be different.
Many transgendered people and researchers support the declassification of GID as a mental disorder for several reasons. Recent medical research on the brain structures of transgendered individuals have shown that some transgendered individuals have the physical brain structures that resemble their desired sex even before hormone treatment.In addition, recent studies are indicating more possible causes for gender dysphoria, stemming from genetic reasons and prenatal exposure to hormones, as well as other psychological and behavioral reasons. (See Causes of transsexualism).
One contemporary treatment for GID consists primarily of physical modifications to bring the body into harmony with one's perception of mental (psychological, emotional) gender identity, rather than vice versa.
In the United States, the American Psychiatric Association permits a diagnosis of gender identity disorder if the four diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4thEdition, Text-Revised (DSM-IV-TR) are met. The criteria are:
If the four criteria are met under the DSM-IV-TR, a diagnosis is made under ICD-9 code 302.85. See the classification and external resources sidebar at right for other diagnostic codes for gender identity disorder.
The International Classification of Diseases (ICD-10) list three diagnostic criteria:
Transsexualism (F64.0) has three criteria:
Uncertainty about gender identity which causes anxiety or stress is diagnosed as sexual maturation disorder.
The World Professional Association for Transgender Health (WPATH, formerly HBIGDA) Standards of Care (Version 7 from 2011) are considered by some as definitive treatment guidelines for providers. Other Standards exist (see those discussed in Standards of Care for the Health of Transsexual, Transgender, and G..., including the guidelines outlined in Gianna Israel and Donald Tarver's classic 1997 book "Transgender Care". Several health clinics in the United States (e.g. Tom Waddell in San Francisco, Callen Lorde in New York City, Mazzoni in Philadelphia) have developed “protocols” for transgender hormone therapy following a “harm reduction” model which increasing numbers of providers have adopted. Nick Gorton et al. suggest a flexible approach based on harm reduction, “Willingness to provide hormonal therapy based on assessment of individual patients needs, history and situation with an overriding goal of achieving the best outcome for patients rather than rigidly adhering to arbitrary rules has been successful.”
Formal gender clinics for individuals seeking medical sex reassignment began operating in the 1960s and 1970s, leading to long-term follow-up studies that began appearing in the research literature in the 1980s and 1990s. These studies have examined transsexuals who received clinical approval to undergo reassignment and proceeded to do so. The great majority of patients who met clinics' screening criteria reported being satisfied in the long-term with the results.
The question of whether to counsel young children to be happy with their biological sex, or to encourage them to continue to exhibit behaviors that do not conform to gender stereotypes — or to explore a transsexual transition — is controversial. Some clinicians report a significant proportion of young children with gender identity disorder no longer have such symptoms later in life.There is an active and growing movement among professionals who treat gender dysphoria in children to refer and prescribe hormones to delay the onset of puberty until a child is old enough to make an informed decision on whether hormonal gender reassignment leading to surgical gender reassignment will be in that person's best interest. It should be noted, however, that such blocking of growth hormones may cause significant detrimental musculo-skeletal problems if done for a prolonged period of time
People diagnosed with gender identity disorder (GID) may not regard their own cross-gender feelings and behaviors as a disorder, and may question what constitutes a normal gender identity or gender role. One argument is that gender characteristics are socially constructed and therefore naturally unrelated to biological sex. This perspective often notes that other cultures, particularly historical ones, valued gender roles that would presently suggest homosexuality or transgenderism as normal behavior.Individuals diagnosed with GID may also view "transgendering" as a means for deconstructing gender; however, not all transgender people wish to deconstruct gender or feel that they are doing so.
Those in the community who disagree with the diagnosis of GID also state that the treatment for this disorder consists primarily of physical modifications to bring the body into harmony with one's perception of mental (psychological, emotional) gender identity, rather than vice versa.
Some critics of the classification of GID as a mental disorder argue that transsexualism instead should be listed as a "birth defect" or "rare disease," citing in evidence research suggesting a physiological cause. This argument is supported by evidence that includes overall more feminine white matter and neuron patterns observed in male-to-female transsexual participants and overall longer instances of the androgen receptor gene. (Also see Causes of transsexualism) One rebuttal to this view is that these markers do not identify every individual who undergoes transition, and that using them to define transsexualism could falsely exclude some people from treatment.
Thank you Brigit!