Gender dysphoria

Question 1

What is the definition of sex?

Answer 1

The genitalia assigned at birth

Question 2

What is gender identity?

Answer 2

A person’s sense of being female or male

Question 3

What is someone’s gender role?

Answer 3

Someone’s personality and appearance, societal expectation

Question 4

What is diversity of characteristics?

Answer 4

where the primary/secondary sex characteristics are ambiguous eg Klinefelter’s which XXY chromosomes causing a lack of testosterone

Question 5

What is gender dysphoria?

Answer 5

distress due to incongruence of gender and sex

Question 6

What is the defintion of transsexual?

Answer 6

seek to change primary or secondary sex characteristics

Question 7

What is the defintion of sexual orientation?

Answer 7

sex of whom the individual engages in sexual activities, is aroused by and fantasises about.

Question 8

What are male hormones?

Answer 8

Androgen

Question 9

What are female hormones?

Answer 9

oestrogen

Question 10

What are primary sex characteristics?

Answer 10

gonads and genitalia

Question 11

What are secondary sex characteristics?

Answer 11

post puberty eg redistribution of body fat, hair growth, menstrual cycle, height, voice deepening

Question 12

Describe the embryology of sex development?

Answer 12

External genitalia and gonads are present at 8 weeks
Masculinisation occurs due to the SRY gene (Y chromosome) which causes testes development due to testosterone and mullein inhibiting substance

Question 13

Describe the embryology of gender development?

Answer 13

Sexual differentiation of the brain occurs in the second half of pregnancy and is a combination of hormones and genetics.

Question 14

What is the aetiology of gender dysphoria?

Answer 14

Strong genetic component

ASD link

Question 15

What is general management for trans gender people?

Answer 15

Porterbrook clinic referral with around 80 weeks waiting time
Remember that with trans people need to be aware of screening eg may still have a cervix or prostate

Question 16

What manaagement can be done for trans males?

Answer 16

Psychotherapy/OT
Androgens +/- GNRH analogue
Speech and voice communications
Phalloplasty, urethroplasty and scrotoplasty
Bilateral mastectomy
Hysterectomy, vaginectomy and salpinoophectomy
Blockers to stop puberty

Question 17

What management can be done for trans females?

Answer 17

Hair removal 
Speech and voice communication 
Psychotherapy/OT 
Vaginoplasty, clitoroplasty, vulvaplasty and labiaplasty 
HRT for life 
Can use blockers to stop puberty 
Penectomy, orchidectomy