Differentials

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Male patient seeks hormone treatment and/or surgery to obtain female bodily characteristics (usually breasts) but either does not want to change social gender role or makes no more than token gestures in this regard.

Often a greater degree of earlier sexual activity than in transsexualism, and a sexualized element to the desire for female characteristics (which may not be admitted).

INVESTIGATIONS

No distinguishing tests: diagnosis is clinical.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Patient abhors and seeks the removal of either primary or secondary sexual characteristics but has no sense of wanting any other gender role or plan to change social gender role.

Aside from this preoccupation, function in birth gender role has often been quite good.

INVESTIGATIONS

No distinguishing tests: diagnosis is clinical.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Patient's main motivation is an intimate relationship with someone of the same birth sex.

Patient has very negative views about homosexuality and seeks medical explanation and legitimization of this desire.

INVESTIGATIONS

No distinguishing tests: diagnosis is clinical.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Patient's presentation has the psychological texture of a delusion. Patient is not very worried about how others perceive him/her as a member of the opposite sex.

Often a history of psychosis or delusions. Sometimes negative symptoms or affective symptoms present at the time of interview.

INVESTIGATIONS

No distinguishing tests: diagnosis is clinical.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Wearing of the clothes of the opposite sex is associated with sexual arousal. The clothes are often sexualized. The behavior may be accompanied by masturbation. After orgasm there is often a sense of shame and the rapid removal of the clothes, accompanied by a (transitory) resolution never to cross-dress again.

Found almost exclusively in males.

INVESTIGATIONS

No distinguishing tests: diagnosis is clinical.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Sense of identity is generally unclear, not isolated to gender identity. Beliefs about a variety of aspects of identity are intense but shallow and sometimes brief.

Other aspects of personal history are consistent with personality disorder, and this diagnosis may have already been made. Gender dysphoria is of recent onset but very intensely presented.

Borderline personality disorder should not preclude referral to a gender identity clinic but might make management more complicated.

INVESTIGATIONS

No distinguishing tests: diagnosis is clinical.

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