Subspecialty consultation is required for any patient with suspected or confirmed gender dysphoria. Treatment is complex and should only be undertaken as part of a package of care provided by a multidisciplinary team with extensive experience in this area.
In children and adolescents, disorders of gender identity are particularly complicated, may have higher comorbidity, and may change form as patients mature, making specialist assessment particularly important. This topic covers the management of gender dysphoria in adults only.
Gender dysphoria is not commonly pronounced enough to prompt patients to seek medical intervention. Dual role transvestism is the most common manifestation.
Most clinics treat patients with hormones only when they are adults and have already changed their social gender role (or, occasionally, have a definite and agreed time when they will do so).
Most clinics will not undertake bilateral mastectomy unless there has been a change of social gender role from female to another, demonstrably stable, social gender role, usually male.
No clinic will undertake genital surgery unless there has been agreement from 2 appropriately trained professionals and the patient has been living with demonstrated success in their new gender role for at least 1 year.
Gender non-conformity is when a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex.
[1]
Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, v7. Int J Transgend. 2012;13(4):165-232.
https://s3.amazonaws.com/amo_hub_content/Association140/files/Standards%20of%20Care%20V7%20-%202011%20WPATH%20(2)(1).pdf
Gender dysphoria is present when there is a distressing dissonance between a person's biological sex and associated social gender role, as assigned at birth, and that person's sense of their own gender.
[1]
Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, v7. Int J Transgend. 2012;13(4):165-232.
https://s3.amazonaws.com/amo_hub_content/Association140/files/Standards%20of%20Care%20V7%20-%202011%20WPATH%20(2)(1).pdf
Only some gender non-conforming people experience gender dysphoria at some point in their lives.
[1]
Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, v7. Int J Transgend. 2012;13(4):165-232.
https://s3.amazonaws.com/amo_hub_content/Association140/files/Standards%20of%20Care%20V7%20-%202011%20WPATH%20(2)(1).pdf
The term 'gender identity disorder' has been replaced by 'gender dysphoria' in the latest "Diagnostic and statistical manual of mental disorders, 5th edition" (DSM-5) after consideration by the American Psychiatric Association.
[2]
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.
[3]
Byne W, Bradley SJ, Coleman E, et al. Report of the American Psychiatric Association Task Force on treatment of gender identity disorder. Arch Sex Behav. 2012 Aug;41(4):759-96.
http://www.ncbi.nlm.nih.gov/pubmed/22736225?tool=bestpractice.com