Gender Dysphoria

Adolescents and adults
Must have lasted for at least 6 months and must include at least 2 of the following 6 criteria:
  • Marked incongruence between the patient’s experienced or expressed gender and his or her primary or secondary sex characteristics
  • Strong desire to be rid of his or her primary or secondary sex characteristics (or, in young adolescents, to prevent the development of the anticipated secondary characteristics)
  • Strong desire for the primary or secondary sex characteristics of the other gender
  • Strong desire to be of the other (or some alternative) gender
  • Strong desire to be treated as the other (or some alternative) gender
  • Strong conviction of having the typical feelings and reactions of the other (or some alternative) gender
The second requirement is that the condition be associated with clinically significant distress or impairment of social, occupational, or other important areas of functioning.

Specify whether the condition is occurring in conjunction with a disorder of sex development and, if so, should code that disorder as well.

Specifier
  • Post-transition: Individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is undergoing) at least one cross-sex medical procedure or treatment regimen, namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male, mastectomy, phalloplasty in a natal female).
Children
Must have lasted for at least 6 months and must include at least 6 of the following 8 criteria, with the first criterion being mandatory:
  • Strong desire to be of the other (or some alternative) gender or insistence that one already is
  • Strong preference for cross-dressing or simulating female attire (boys); strong preference for typical masculine clothing and resistance to typical feminine clothing (girls)
  • Strong preference for cross-gender roles in make-believe or fantasy play
  • Strong preference for the stereotypical toys, games, or pastimes of the other gender
  • Strong preference for playmates of the other gender
  • Strong rejection of typically masculine toys, games, and activities, with strong avoidance of rough play (boys); strong rejection of typically feminine toys, games, and activities (girls)
  • Strong dislike of one’s sexual anatomy
  • Strong desire for the primary or secondary sex characteristics that match one’s experienced gender
The second requirement is that the condition be associated with clinically significant distress or impairment of social, school, or other important areas of functioning. The clinician should specify whether the condition is occurring in conjunction with a disorder of sex development and, if so, should code that disorder as well.

Assessment & Treatment

Issues and therapies:
  • Consent to treatment concerns (minors)
  • Endocrine treatment (post-pubertal)
  • Gonadotrophin-releasing hormone (GnRH)
  • Cross-sex hormones
  • Preoperative 12 month experience
  • Psychotherapy/counseling
  • Hormone therapy
  • Speech therapy
Possible surgeries, procedures:
  • Genital surgery
  • Facial feminization surgery -- i.e. thyroid chondroplasty/tracheal shave, rhinoplasty, facial (jaw) bone reduction, blepharoplasty
  • Breast augmentation
  • Hair removal
  • Bi-lateral mastectomy, chest reconstruction

Position Papers

  • Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (World Professional Association for Transgender Health, 2011)
  • Good practice guidelines for the assessment and treatment of adults with gender dysphoria (Royal College of Psychiatrists, 2013)
  • Report of the APA Task Force on Treatment of Gender Identity Disorder  (Byne et al, 2011) 

Articles

  • International Journal of Transgenderism
  • The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding (IOM, 2010) -- free
  • WPATH's Transgender Health Bibliography

Resources

  • "Learning Trans"
  • PFLAG's Welcoming our Trans Family and Friends educational document
  • Interview with Dr. Norman Spack, Co-Founder/Co-Director of Boston Children's GeMS - Gender Management Service on Gender Dysphoria Treatment - video posted by TransParent
  • TransMedicine Discussion ListServ
  • Trans-Health Journal Club
  • UCSF Center of Excellence for Transgender Health
  • WPATH's "Find A Provider" tool


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Organizations:
  • World Professional Association for Transgender Health (WPATH)
  • FTM International
  • Gender Identity Research and Education Society (GIRES)
  • International Foundation for Gender Education
  • Renaissance Transgender Association
  • Gender Identity Project (NYC)
  • Ingersoll Gender Center (Seattle)
  • Johns Hopkins Center for Sexual Health & Medicine (Baltimore)
  • American Civil Liberties Union's LGBT Get Equal Project
  • Program in Human Sexuality Transgender Services (Univ. of Minnesota)
  • Gender Center of Colorado

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