Gender Dysphoria

Question 1

Order of interventions for gender dysphoria

Answer 1

Should be done in order of reversibility, to ensure that the effects are congruent with the patient’s expectations.

• Fully reversible interventions: Living as the desired gender identity, pubertal suppression with leuprelide. Living in the community for at least 3 months at this level is recommended before progressing.
• Partially reversible interventions: Gonadal hormone administration. Living in the community for at least 12 months at this level is recommended before progressing.
• Irreversible interventions: Gender-affirming surgery

Question 2

Anatomical sex

Answer 2

Sex based on the appearance of genitals

In ambiguous cases, intersex is the preferred identifier.

Question 3

Androgen insensitivity syndrome

Answer 3

Type of intersex presentation in which the patient is chromosomally male, but does not respond to androgens, and therefore develops externally female genitalia and female secondary sex characteristics.

Most of these patients are not recognized as having AIS until they fail to undergo puberty.

Question 4

Chromosomal sex

Answer 4

Sex based on karyotype

It is also necessary to identify those with genetic mosaicism (45X/46XY with __% of the latter)

Question 5

Most common DDx for gender dysphoria

Answer 5

Simple noncomformity to societal stereotypes of sex role behavior without gender dysphoria

Question 6

One of the initial steps to workup of gender dysphoria should ALWAYS be. . .

Answer 6

. . . screening for other psychopathology

As these patients are at high risk for other psychiatric conditions, some of which may contribute to their current gender dysphoria.

The last thing you want is to treat their gender dysphoria irreversible, find out they have another psychiatric comorbidity, treat that, and find that they are now dysphoric again.