Summary
Definition
History and exam
Key diagnostic factors
- incongruence between birth-assigned gender and experienced gender
- altered appearance or affect
Risk factors
- congenital adrenal hyperplasia
- partial androgen insensitivity syndromes
- Klinefelter syndrome
Diagnostic investigations
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
- CBC
Treatment algorithm
born males
born females
Contributors
Authors
James Barrett, FRCPsych, BSc, MSc
Consultant Psychiatrist and Lead Clinician
Charing Cross Gender Identity Clinic
London
UK
Disclosures
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 paid expenses. JB is an author of a number of references cited in this topic.
Peer reviewers
Roy Goldberg, MD
Medical Director
Kings Harbor Multicare Center
Bronx
NY
Disclosures
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
Seattle
WA
Disclosures
CNS declares that he has no competing interests.
Differentials
- Autogynephilia
- Body dysmorphic disorder
- Ego-dystonic sexual orientation
More DifferentialsGuidelines
- Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR)
- International Classification of Diseases 11th revision (ICD-11)
More GuidelinesPatient leaflets
Gender dysphoria in adults: what is it?
Gender dysphoria in adults: hormone treatment
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