Gender Identity and Transgender Health Flashcards
Sex
Chromosomal
Phenotypic/genital anatomic (natal/sex assigned at birth)
Gender Identity
A person’s intrinsic sense of being male (a boy or a man), female (a girl or a woman), or an alternative gender (e.g., …transgender, genderqueer, eunuch)
refers to a person’s deeply felt, internal, intrinsic sense of their own gender
Gender role or expression:
characteristics in personality, appearance, and behavior that in a given culture and historical period are designated as masculine or feminine (that is, more typical of the male or female social role)
GENDER:
Depending on the context, gender may referencegender identity, gender expression, and/or social genderrole, including understandings and expectations culturallytied to people who were assigned male or female at birth
Gender identities other than those of men and women (whocan be either cisgender or transgender) include transgender,nonbinary, genderqueer, gender neutral, agender, genderfluid, and “third” gender, among others
Transgender
TRANSGENDER or trans are umbrella terms used to describe people whose gender identities and/or gender expressions are not what is typically expected for the sex to which they were assigned at birth
Transsexual is an older, more specific term, still in use by people who find that it fits
LGBT+
Non-binary
Emerging population in this place and time
Cultural and historical precedents
May be a permanent identity or a more liminal state
Very limited longitudinal data, but individual good clinical outcomes
Gender dysphoria
“distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics)”
describes a state of distress ordiscomfort that may be experienced because a person’s gender identity differs from that which is physically and/orsocially attributed to their sex assigned at birth
diagnostic term in the DSM-5 denotingan incongruence between the sex assigned at birth andexperienced gender accompanied by distress
Not all transgender and gender diverse people experience gender dysphoria
Gender Identity - eitology
Etiology is multifactorial, though may be straightforward for the individual
Life experience is variable: Some people are aware of gender difference very young, others not fully until middle or older adulthood
Traditionally this was thought of as an emotionally or dynamically based phenomenon—no longer so
There are clues in heredity, biochemistry, CNS microanatomy, from people with differences in sex development, from different cultures and worldviews—and from other species
> Tanner II (SMR II)
transition requests less likely to change than earlier
CNS, Genetic factors
CNS: Many subtle findings, including in the bed nuclei of the stria terminalis (BSTc) and third interstitial nucleus of the anterior hypothalamus
Prenatal hormonal milieu: Differences in Sex Development (DSD)
Complete androgen insensitivity = XY women, gender transition requests uncommon
Partial AIS = XY, variable genital appearance; most raised as girls, some as boys
Congenital adrenal hyperplasia = XX, usually raised as girls; 4-15% “GID.”
At least some transmasculine people show significant pre-transition masculinization (though this is by no means universally true. Some people who transition appear very feminine prior to beginning androgen supplementation)
Gender Plasticity
Variable but present, particularly during the first year of life
“John/Joan” failure: circ accident at 8 months, MTF surgery at 22 months, male identical twin.
Other cases more successful: penis ablating accident at 2 months, reassignment completed by 7 months, followed til age 26.
> In adulthood she identified as a bixsexual woman, sought surgery to improve her vagina for sexual participation
Clinical Care
Though there are “clues,” there is currently no reliable “test” for (trans)gender identity.
The decision to transition gender, or to live outside cultural gender norms, is an individual one.
Patients/parents sometimes want “explanations,” sometimes just want to live authentically, and receive medical treatment to reinforce this. Hormonal and surgical treatments can “bring the outside into line with the inside” and enable some degree of comfort in public and private life.
The general goal of psychotherapeutic, endocrine or surgical therapy for persons with gender identity disorders is
lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfilment
How do people transition?
Modifying social presentation, appearance, body, pronoun to attain a level of comfort. Many options
Transgender may be the identity, or transition may be a bridge.
Non-binary people face similar challenges.
Occasional “retransition” experiences occur.
