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Gender Dysphoria



It is important to note the difference between gender and sex. Sex is considered to be determined by genes, hormones, and physical genitalia, whereas gender is defined as categories of male or female defined by cultural role expectations. Gender identity is the personal understanding of oneself as male or female. It is a category of social identity and refers to an individual's identification as male, female, or, occasionally, some category other than male or female. Gender identity is one's own internal sense of self and their gender, whether that is man, woman, neither or both. This brings us to the question- What is Gender Dysphoria? When the biological sex and gender identity do not match which leads to distress and impairment is called Gender Dysphoria. Gender dysphoria refers to psychological distress that results from an incongruence between one's sex assigned at birth and one's gender identity. DSM V defines Gender dysphoria as a general descriptive term refers to an individual's affective/ cognitive discontent with the assigned gender but is more specifically defined when used as a diagnostic category.

Gender identity typically develops by age 3 or 4. Among children, Gender Dysphoria is apparent in repeated statements that the child wants to be the opposite sex or is the opposite sex. Among adults with Gender Dysphoria, lifetime prevalence of comorbid disorders range from 14% for current disorders to 71% for lifetime disorders. Clinically referred adults with gender dysphoria may have coexisting mental health problems, most commonly anxiety and depressive disorders (Beidel et al., 2017) .


Causes

Gender Dysphoria is a combination of biological, psychological, and social factors. On the biological side, a hormonal condition that may contribute to the development of Gender Dysphoria is congenital adrenal hyperplasia (CAH). Boys and girls with CAH are missing an enzyme necessary to make the hormones cortisol and aldosterone. As a result, the girls not only develop some masculine physical characteristics, but they have more masculine personality traits as well. Similarly, the boys are born looking female, raised as girls, and generally found to be psychologically hyper-feminine in later life. Psychosocial theories have examined the role of family, particularly parent–child relationships. Psychoanalysts propose that parental rejection may play a role in the onset of Gender Dysphoria. For example, if parents really wanted a girl but had a boy instead they may reject their son. That rejection may cause the boy to try to please the parent by behaving like a girl.


Treatment

Therapy can help persons who experience gender dysphoria explore their gender identity and establish the gender role that feels appropriate for them, alleviating distress. Individualized care should be provided, nevertheless. What may benefit one person may not benefit another. Changes in gender expression and role, hormone therapy, surgery, and behavioural therapy are a few possible treatment options (Mayo Clinic Staff, 2022).


Medical treatment

Medical treatment of gender dysphoria might include:

  • Hormone therapy, such as feminizing hormone therapy or masculinizing hormone therapy

  • Surgery, such as feminizing surgery or masculinizing surgery to change the chest, external genitalia, internal genitalia, facial features and body contour

Some persons desire the greatest degree of feminization or masculinization through hormone therapy. The use of hormones to reduce secondary sex traits like breasts and facial hair may help some people with gender dysphoria (Mayo Clinic Staff, 2022).

Sex reassignment surgery focuses on helping adults live as their chosen gender identity, maximizing their psychological and social adjustment. Essentially, the idea of sex reassignment is to facilitate the client’s wish to live as a member of a biological sex different from one assigned at birth, thereby eliminating the symptoms of Gender Dysphoria.

The intervention has three phases: living as the desired gender, using hormone therapy, and undergoing sex reassignment surgery. In the first stage, the person lives in the new gender role for at least two years. The second step is hormone therapy. The third and final phase is the surgery. Across different studies, more than 95% of patients reported satisfaction with sex reassignment surgery.


Behavioral health treatment

Your psychological well-being, quality of life, and sense of fulfilment are the main goals of this treatment. Your gender identity won't change as a result of behavioural therapy. Instead, counselling can assist you in exploring gender issues and identifying strategies for reducing gender dysphoria. In order to succeed in relationships, education, and the workplace, mental health treatment aims to make you feel comfortable with how you express your gender identity. Any other issues with mental health can be addressed in therapy (Mayo Clinic Staff, 2022).

Other steps

Other ways to ease gender dysphoria might include use of:

  • Peer support groups

  • Voice and communication therapy to develop vocal characteristics matching your experienced or expressed gender

  • Hair removal or transplantation

  • Genital tucking

  • Breast binding

  • Breast padding

  • Packing

  • Aesthetic services, such as makeup application or wardrobe consultation

  • Legal services, such as advanced directives, living wills or legal documentation

  • Social and community services to deal with workplace issues, minority stress or parenting issues


References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.).


Beidel, B., Cynthia, M., & Stanley, M. A. (2017). Abnormal Psychology. Pearson Education.


Hansell, J. H., & Damour, L. K. (2007). Abnormal psychology. Wiley Global Education.

Mayo Clinic Staff (2022) Gender dysphoria, Mayo Clinic. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/diagnosis-treatment/drc-20475262.




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