Gender Dysphoria

Question 1

Biological sex definition

Answer 1

a multidimensional biological trait that determines whether an organism produces male or female gametes. It’s based on a combination of factors, including anatomy, physiology and genetics. Determines at fertilisation

Question 2

Gender definition

Answer 2

Refers to sociocultural systems that include norms and expectations for male and female.

Question 3

Gender binary examples in the media

Answer 3

Olympics 2024 boxing case
Google 2017 google worker claimed men and women are biologically different

Question 4

Challenges to the gender binary: Hyde et al., 2019, History of gender understanding

Answer 4

1800’s psychological research and practice assumed there’s 2 genders
1930’s psychologists developed psychological masculinity-femineity (Terman and Miled, 1936)
Argues masculinity was necessary for good adjustment for men as was femineity for women (Pleck, 1981)

Question 5

Challenges to the gender binary: Hyde et al., 2019,Categories of gender

Answer 5

2 discrete categories into which all individuals can be stored, gender binary also assumes that: one’s category membership is biologically determines, apparent at birth, stable over time, salient and meaningful to the self and a powerful predictor of a host of psychological variables

Question 6

Challenges to the gender binary: Hyde et al., 2019: Sex organs are typically dimorphic

Answer 6

Individuals are almost always only born with either a male or a female reproductive system

Question 7

Challenges to the gender binary: Hyde et al., 2019:The brain, hormones are not dimorphic

Answer 7

A considerable overlap between men and women brain structure
Because sex differences in specific brain features can be different, and even opposite, under different environmental conditions. Sex-by-environment interactions vary across brain features.
Hormones are not fixed characteristics even though trait patterns

Question 8

Challenges to the gender binary: Hyde et al., 2019: Gendered behaviours and traits are not dimorphic

Answer 8

Joel et al., (2015) analysed a dataset of ten highly gender-stereotypical behaviours in U.S college students, (boxing, playing golf, watching talk shows and using cosmetics). Even for these highly gendered behaviours, which showed very large gender differences, less than 1% of the students exhibited only feminine or masculine features, whereas over 55% showed some combination of both.

Question 9

Development of gender schemas (Saygan & Uludaǧlı, 2021):

Answer 9

Toddlerhood children prefer to play with same-sex peers like many other mammalian species
Age 4 spend 3x more time with same sex peers, rises to 1/11 by age 6
Blakemore 2003 boys playing with dolls is seen more negatively than girls playing with trucks by both girls and boys
Boys are more likely to adopt the “expected” gender roles for themselves (Bussey and Bandura 1992, Ruble et al. 2006).
- Children who exhibit “atypical” behaviours regarding their gender and who are subjected to social pressure for this reason face serious problems such as introversion, chronic sadness, disappointment, and anxiety (Yunger et al., 2004)

Question 10

Development of Gender Schemas: Tobin et al 2010

Answer 10

GSSM suggests children are motivated to adhere to gender stereotypes (motivated to be similar to others of same gender) and norms as they develop their gender identity
Gender identity is important in the adoption of gender stereotypes
Strive for gender consistency between their stereotypes and efficacy for those types
Parents can massively influence their gendered behaviour

Question 11

Gender dysphoria definition

Answer 11

If a person experiences distress resulting from incongruence between gender identity and assigned gender this person is gender dysphoric. Gender dysphoric individuals may have DSD ,or congenital conditions in which the development of chromosomal, gonadal, or anatomical sex is atypical), but mostly have physical sex characteristics which are correspond with each other
Involves feelings of distress

Question 12

What is GD? Beek et al., (2015):

Answer 12

Individuals with gender incongruence do not necessarily experience a complete cross gender identity, and may not always need clinical attention.
There is a wide spectrum of gender identity labels, such as ‘third gender’. ‘pan-/poly-/or omnigendered’ or ‘gender fluid’, instead of ‘male’ and ‘female’ or even ‘transexual’
These individuals may not experience distress and they may or may not want to live as the ‘other gender’

Question 13

DSM-5 definition gender dysphoria

Answer 13

Incongruence between ones expressed gender and assigned gender. 2 of following: incongruence, desire to be rid of sex characteristics, desire for sex characteristics of other gender, desire to be of the other gender, desire to be treated as other gender, conviction one has the feelings of the other gender
Clinical distress, Specify if it exists with a disorders of sex development and of it’s post transitional.

Question 14

ICD-10 definition: Gender Dysphoria

Answer 14

F64 Gender identity disorders
F64.0 Transsexualism: a desire to live and be accepted as a member of the opposite sex, usually accompanied with discomfort to atomic sex and a wish for surgery
F64.1 Dual-role transvestism: wearing clothes of the opposite sex to enjoy the temporary membership, without a desire for a permanent change
F64.2 Gender identity disorder of childhood: persistent distress about assigned sex, desire to be other sex usually firsts manifests in childhood. Persistent preoccupation and with the dress and activities of the opposite sex.
F64.8 Other gender identity disorders
F64.9Gender identity disorder, unspecified

Question 15

GD prevalence: Shields et al.,

Answer 15

Random sample 2730 grade 6-8 students San Francisco 1.3% self identified as ‘transgender’ in response to the question ‘what is your gender identity’

Question 16

GD prevalence

Answer 16

Parent questionnaire 6-12 years old (n=1822) - less than 1% of parents of non-referred and 1.2% of non-referred girls endorsed this item as either ‘somewhat of sometimes true’ or ‘very true or often true’ on 0-2 point scale. Percentages were higher for referred boys and girls (2.7% and 4.7% respectively)
- Among 577 Canadian children referred between 1976 and 2011 to the male-to-female ratio was 4.49:1 which was significantly higher than the 2.02:1 ratio in the Netherlands. More common for males to transition than it is for females.

Question 17

GD prevalence (deGraaf et al., 2018; Thompson et al., 2022)

Answer 17

GD diagnosis has been increasing
Historically more birth-assigned males were presenting to GIDs in childhood and adolescence
In a more recent study adolescent referrals to GIDS favoured birth-assigned females. de Graaf (2018) study on a UK sample of 4506 young people, aged between 1 and 18 years who were referred. 84% were adolescents, sex ratio in children favoured birth-assigned males in adolescents referrals favoured birth assigned females.

Question 18

History of GD

Answer 18

Used to be known as ‘transsexuals’ (WHO, 1992) or individuals with a ‘gender identity disorder’ (GID) (APA, 2000)
changed to ‘gender dysphoria’ (APA, 2013)
Hirschfield was the first to refer gender dysphoric individuals for surgery (hormone treatment only became available in the 1950’s)
Many medical professional criticised use of hormones and surgery as saw GD as neurotic pr psychotic need ‘reality testing’

Question 19

Christine Jorgensen

Answer 19

transgender woman and activist in the US 20th century. One of the first US citizens to publicly disclose her gender transition from male to female through gender-affirming surgery and hormone replacement therapy.

Question 20

Treatment

Answer 20

In a pre-post intervention studies, GA treatment resulted in a significant reduction of GD in 80% of cases (95% CI= 68% from eight studies), and in 78% of cases co-existing psychopathology (e.g., depression, anxiety disorders, substance abuse, suicidality) decreased as well (95% CI= 56%–94% from seven studies)

Question 20

Treatment: Meijer et al., (2017)

Answer 20

GA treatment should be an ethical right of all individuals with GD due to its effectiveness
Issues with clinicians reluctance due to reports that surgery may lead to psychiatric illness
Co-morbidity of GD e.g., with SZ less likely to gain the approval since it may be due to their SZ that is causing these thoughts

Question 21

GD and mental health

Answer 21

Metanalysis by Thompson et al., 2022:
Depression: 30%-78%
Anxiety: 21%- 63%
ADHD:6%-16%
ASD: 2%-26%
Eating disorders: 12%-15%
Suicidal ideation: 12%-74%
Self harm: 21%-55%
Psychotic symptoms: 12%-13%
Bipolar disorder: 5%
- Between 31% and 37% had been previously or were currently being prescribed psychoactive medication
PTSD: 23%

Question 22

GD and Mental Health: The Youth self report measure

Answer 22

de Vries et al reported 41% of participants scoring within the clinical range for Total problems: much higher than in non-referred boys (9%) and girls (8%); Becker- Hebly et al (2020) found YSR scores were significantly worse than published German population norms in adolescents baseline assessment; and Fisher et al (2017) found their Italian sample of 46 GD adolescents scored higher than non-referred adolescents on Total and Internalising problems

Question 23

GD and culture: South Asia

Answer 23

In South Asia communities recognize nonbinary third gender known as hijra-depicted in East Bengal, in present day Bangladesh in the early 1860’s

Question 24

GD and culture: Thailand, Cambodia and Laos

Answer 24

Kathoey is a term used in Thailand, Cambodia and Laos to describe people who were male but identify as female or effeminate (having or showing qualities that are considered more suited to women than to men). The term is often translated as “Ladyboy” in English, but it is not the same as the Western term for “trans-”

Question 25

GD and culture: Samoa

Answer 25

In Samoa, the term fa’afafine refers to a third gender that is accepted and celebrated in Samoan culture. Fa’afafine translates to “in the way of a woman” and is used to describe people who are born biologically male but identify as a third gender and embody both masculine and feminine traits

Question 26

Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria (Littman, 2018)

Answer 26

Purpose of this study was to collect data about parents’ observations, experiences and perspectives about their (AYA) children showing signs of apparent sudden or rapid onset of gender dysphoria that begun during or after puberty, and to develop hypotheses about factors that may contribute to it’s onset among this demographic group
Recruitment took place online with targeted recruitment through three websites (4thwavenow (’turf), transgender trend, and youthtranscriticalprofessionals) websites that are critical of people that are gender diverse, 256ppts

Question 27

Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria (Littman, 2018) findings

Answer 27

Per parent report, 41% of the AYAs had expressed a non-heterosexual sexual orientation before identifying as transgender.
62.5% had been diagnosed with at least one mental health disorder or neurodevelopmental disability prior to the onset
36.8% of the friendship groups described, majority of the members became transgender-identified
declines in the AYA’s mental health (47.2%) and in parent-child relationships (57.3%) since the AYA “came out”

Question 28

Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria (Littman, 2018) findings. Expressed behaviours

Answer 28

Distrust of non-transgender people- (22.7%); stopping spending time with non-transgender friends (25%); trying to isolate themselves from their families (49.4%), and only trusting information about gender dysphoria from transgender sources (46.6%)
- 86.7% reported along with the sudden or rapid onset of gender dysphoria, their child either had an increase in their social media use, belonged to a friend group in which one or multiple friends became transgender-identified during a similar time frame, or both

Question 29

Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria (Littman, 2018) Controversies

Answer 29

very negative focused, transgenderism is catching sparked in the media if you allow your children to be friends with other children that are experiencing gender exploration then they will start doing that as well, a ‘scare tactic’ to keep parents away from those other children and to keep them away from those forms of social media.