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 nonconformity is when a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular gender.
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.
Only some gender nonconforming people experience gender dysphoria at some point in their lives.
The term "gender identity disorder" has been replaced by "gender dysphoria" in the latest "Diagnostic and statistical manual of mental disorders, 5th edition" (DSM-5) after consideration by the American Psychiatric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.
History and exam
Key diagnostic factors
- gender dysphoria
- altered appearance or affect
Other diagnostic factors
- diminished sexual function or homosexuality
- atypical speech and vocal quality
- congenital adrenal hyperplasia
- partial androgen insensitivity syndromes
- Klinefelter syndrome
1st investigations to order
- serum testosterone
- serum dihydrotestosterone
- serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
- serum prolactin
- serum liver function tests
- serum lipid screen
James Barrett, FRCPsych, BSc, MSc
Consultant Psychiatrist and Lead Clinician
Charing Cross Gender Identity Clinic
JB has produced educational material for the Royal College of Physicians Gender Healthcare course and is a tutor on the course. He has occasionally received payment for speaking engagements on the subject and usually gets expenses. JB is an author of a number of references cited in this topic.
Roy Goldberg, MD
Kings Harbor Multicare Center
RG declares that he has no competing interests.
Craig N. Sawchuk, PhD
Affiliate Assistant Professor
Department of Psychiatry and Behavioral Sciences
University of Washington Medical Center
CNS declares that he has no competing interests.
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- Ego-dystonic sexual orientation
- Endocrine treatment of gender-dysphoric/gender-incongruent persons
- Guidelines for psychological practice with transgender and gender nonconforming people
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Gender dysphoria in adults: hormone treatmentMore Patient leaflets
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