Gender incongruence

Question 1

What is gender incongruence of adolescence or adulthood?

Answer 1

Characterised by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex, which often leads to a desire to be accepted as a person of the experienced gender

Question 2

What is gender incongruence of childhood?

Answer 2

Characterised by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex in pre-pubertal children, has to be present for more than 2 years

Question 3

What is thought to be the cause of gender incongruence?

Answer 3

Likely to be a balance of a number of genetic, hormonal and environmental factors, but the cause is essentially unknown

Question 4

What are some predictive factors which affect progress of treatment?

Answer 4

• Mental illness and psychological vunerability
• Absence/poor partner or family support
• Poor social function (including employment)
• Preconceived ideas associated with unrealistic expectations
• Age > 30 years
• Earlier period of life adaptation to biological sex including marriage and parenthood
• Morphological characteristics (e.g. large hands) which are incompatible with ‘passing with good credibility’ in the new gender, and ambivalence with regard to surgical processes

Question 5

What are some possible co-existing mental health problems with gender incongruence?

Answer 5

• Anxiety and depression
• Suicidal ideation or attempt
• Often associated with stigma
• Protective factors - pride in identity and support
• Alcohol, drug and other substance misuse has been reported as high

Question 6

What are some management options for gender incongruence?

Answer 6

• Several studies have shown positive benefit with psychotherapy prior to surgery, and subsequent satisfaction
  
  • Aim is to help the patient set realistic objectives
  • Many patients do not require this but it should be offered as part of the package of care
• Consider hormones when a trans person has made a full social gender role transition
  
  • Fully assessed by more than one gender specialist
• Surgical options include genital surgery and chest reconstructive surgery
• Postoperative psychotherapy may be linked with favourable outcome