Gender Dysphoria

Question 1

Broadly speaking, what does GD refer to

Answer 1

a sense of unease that an individual has due to a mismatch between their biological sex and their gender identity (how they see and describe themselves)

Question 2

Outline the biological, psychological and social etiological influencers of GD

Answer 2

Biological:
- interactional of sex hormones on prenatal brain development
- endocrine disruptions
- gender identity programmed in womb (1st physical and then psycho)

Psychological
- pre-natal stress
- Autism and schizophrenia risk factors

Social
- childhood maltreatment and adversities a big influence
*cast majority of transgender people suffered childhood sexual abuse

Question 3

What are the broad diagnostic criteria for for GD

Answer 3

• clinically significant distress due to tension between sex and GI (>6 months)

For kids:
- strong desire to be/insists they are other gender
- dislike own anatomy, desire other gender’s anatomy
- cross dressing/cross role playing

For adolescents/adults:
- desire to be other gender
- desire sex characteristics of other gender
- desire to get rid of own sex characteristics
- marked incongruence between sex and gender

*as associated with impairment of daily functioning

Question 4

What are 4 of the main comorbidities of GD

Answer 4

• depressive disorders
• substance abuse
• anxiety disorder
• suicidality/self-harm

Question 5

What are the two routes for transitioning in GD?

Answer 5

Social transition

Medical transition
- hormonal (suppression and then affirming)
- surgical treatment (can include fertility preservation)

Question 6

What are the requirements for medical transition routes?

Answer 6

Hormonal
- need team of medical professionals, and endocrinologist
- psychiatric assessment to eliminate other conditions

Surgery
- two recommendation letters from psychiatrists and a gender specialist
- have undergone hormonal therapy for at least 1 year

Question 7

What are some of the controversies surrounding GD?

Answer 7

1. Stigmatization of individuals
2. Is it a medical condition of a mental disorder?
3. Diagnosis in children is considered too broad

Question 8

What are some of the WPATH standards of care?

Answer 8

• need to address mental health symptoms (that incapacitate one’s ability to consent to GA care) prior to treatment
• no mandatory psychotherapy before medical treatment
• prohibits reparative and conversion therapy

Question 9

What are some issues faced by trans people?

Answer 9

• documentation change difficult and laborious
• workplace (bathrooms etc)
• limited funding, professional training and research

Question 10

What are the 4 treatment routes for GD?

Answer 10

• triadic therapy
• CBT
• psychotherapy
• eligibility and readiness assessment

Question 11

What hormones would be taken by men and women respectively to transition? And what effects would it have

Answer 11

Women:
- testosterone
- stop period, body and facial hair, fat distribution changes, muscle mass, increased libido, voice

Trans Men
- testosterone blockers, estrogen, progesterone
- fat distribution, breasts, reduce hair, decreased testicular size and erectile function