Gender dysphoria - Wikipedia

Biological treatments Genderdysphoria FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Longtermmentaldistressduetoamismatchbetweengenderidentityandsexassignedatbirth MedicalconditionGenderdysphoriaOthernamesGenderidentitydisorderSpecialtyPsychiatry,psychology SymptomsDistressrelatedtoone'sassignedgenderorsex[1][2][3]ComplicationsEatingdisorders,suicide,depression,anxiety,socialisolation[4]DifferentialdiagnosisVarianceingenderidentityorexpressionthatisnotdistressing[1][3]TreatmentTransitioning,psychotherapy[2][3]MedicationHormones(e.g.,androgens,antiandrogens,estrogens) PartofaseriesonTransgendertopics      Genderidentities Androgyne Cisgender Genderbender Non-binary(orgenderqueer) Thirdgender Akava'ine Bakla Bissu Calabai Faʻafafine Fakaleitī Femminiello Hijra Kathoey Khanith Koekchuch Māhū Maknyah Mukhannathun Muxe Albanianswornvirgins Takatāpui Travesti Two-spirit Winkte Transman Transwoman Transsexual History Outline Timeline UnitedKingdom UnitedStates Compton'sCafeteriariot Stonewallriots Intersex Healthcareandmedicine Detransition Genderdysphoria Inchildren Healthcare Hormonetherapy Pregnancy Sexreassignment Surgery Therapy Tofemale Tomale Voicetherapy Rightsandlegalissues Discrimination Anti-gendermovement Inequality Non-binary Transmisandry Transmisogyny Transphobia Legalstatus Rightsmovement Non-binary,thirdgender Organizations Militaryservice Toilets Bathroombills Unisex Violence Transbashing Unlawfulkillings Transpanic YogyakartaPrinciples Societyandculture LGBT-relatedfilms Events AwarenessWeek DayofRemembrance DayofVisibility March LGBT Flags History Mediaportrayals Fictionalcharacters Film Television People Non-binary Publications Religion Sports Transitioning Youth more Theoryandconcepts Ambiphilia,androphilia,gynephilia Childhoodgendernonconformity Cisgender /cissexual Cross-dressing Genderbinary Genderexpression Genderidentity Gender-sexualityquestioning Gendervariance Postgenderism Transfeminism Transmedicalism Transmisogyny Bycountry Argentina Australia Rights ReKevin Brazil Canada BillC-16,2016 Rights China Germany India RightsofTransgenderPersonsBill,2014 TamilNadu Iran Ireland NewZealand Singapore SouthAfrica Turkey UnitedKingdom Rights GenderRecognitionAct2004 History UnitedStates Cafeteriariot Disenfranchisement History Legalhistory Rights TitleIX Seealso Gender Intersex Queerheterosexuality LGBT Sex sexassignment Sexandgenderdistinction Sexualorientation  LGBTportal Transgenderportalvte Genderdysphoria(GD)isthedistressapersonfeelsduetoamismatchbetweentheirgenderidentity—theirpersonalsenseoftheirowngender—andtheirsexassignedatbirth.[5][6]Thediagnosticlabelgenderidentitydisorder(GID)wasuseduntil2013withthereleaseoftheDSM-5.Theconditionwasrenamedtoremovethestigmaassociatedwiththetermdisorder.[7] Peoplewithgenderdysphoriacommonlyidentifyastransgender.[8]Gendernonconformityisnotthesamethingasgenderdysphoria[9]anddoesnotalwaysleadtodysphoriaordistress.[10]AccordingtotheAmericanPsychiatricAssociation,thecriticalelementofgenderdysphoriais"clinicallysignificantdistress".[1] Thecausesofgenderdysphoriaareunknownbutagenderidentitylikelyreflectsgeneticandbiological,environmental,andculturalfactors.[11][12][13]Treatmentforgenderdysphoriamayincludesupportingtheindividual'sgenderexpressionortheirdesireforhormonetherapyorsurgery.[2][3]Treatmentmayalsoincludecounselingorpsychotherapy.[3] Someresearchersandtransgenderpeoplesupportdeclassificationoftheconditionbecausetheysaythediagnosispathologizesgendervarianceandreinforcesthebinarymodelofgender.[14] Contents 1Signsandsymptoms 2Causes 3Diagnosis 4Treatment 4.1Children 4.2Psychologicaltreatments 4.3Biologicaltreatments 5Comorbidities 6Epidemiology 7History 8Societyandculture 8.1Classificationasadisorder 8.2Gendereuphoria 9Seealso 10References 11Furtherreading 12Externallinks Signsandsymptoms[edit] Distressarisingfromanincongruencebetweenaperson'sfeltgenderandassignedsex/gender(usuallyatbirth)isthecardinalsymptomofgenderdysphoria.[15][16] Genderdysphoriainthoseassignedmaleatbirthtendstofollowoneoftwobroadtrajectories:early-onsetorlate-onset.Early-onsetgenderdysphoriaisbehaviorallyvisibleinchildhood.Sometimesgenderdysphoriawillstopforawhileinthisgroupandtheywillidentifyasgayorhomosexualforaperiodoftime,followedbyrecurrenceofgenderdysphoria.Thisgroupisusuallysexuallyattractedtomembersoftheirnatalsexinadulthood.Late-onsetgenderdysphoriadoesnotincludevisiblesignsinearlychildhood,butsomereporthavinghadwishestobetheoppositesexinchildhoodthattheydidnotreporttoothers.Transwomenwhoexperiencelate-onsetgenderdysphoriawillusuallybesexuallyattractedtowomenandmayidentifyaslesbiansorbisexual.Itiscommonforpeopleassignedmaleatbirthwhohavelate-onsetgenderdysphoriatocross-dresswithsexualexcitement.Inthoseassignedfemaleatbirth,early-onsetgenderdysphoriaisthemostcommoncourse.Thisgroupisusuallysexuallyattractedtowomen.Transmenwhoexperiencelate-onsetgenderdysphoriawillusuallybesexuallyattractedtomenandmayidentifyasgay.[17][18] SymptomsofGDinchildrenincludepreferencesforoppositesex-typicaltoys,games,oractivities;greatdislikeoftheirowngenitalia;andastrongpreferenceforplaymatesoftheoppositesex.[19]Somechildrenmayalsoexperiencesocialisolationfromtheirpeers,anxiety,loneliness,anddepression.[4] Inadolescentsandadults,symptomsincludethedesiretobeandtobetreatedastheothersex.[19]AdultswithGDareatincreasedriskforstress,isolation,anxiety,depression,poorself-esteem,andsuicide.[4]Transgenderpeoplearealsoatheightenedriskforeatingdisorders[20]andsubstanceabuse.[21] Causes[edit] Mainarticle:Causesoftranssexuality Thespecificcausesofgenderdysphoriaremainunknown,andtreatmentstargetingtheetiologyorpathogenesisofgenderdysphoriadonotexist.[22]Evidencefromstudiesoftwinssuggeststhatgeneticfactorsplayaroleinthedevelopmentofgenderdysphoria[11][12]andgenderidentityisthoughttolikelyreflectacomplexinterplayofbiological,environmental,andculturalfactors.[13] Diagnosis[edit] TheAmericanPsychiatricAssociationpermitsadiagnosisofgenderdysphoriainadolescentsoradultsiftwoormoreofthefollowingcriteriaareexperiencedforatleastsixmonths'duration:[19] Astrongdesiretobeofagenderotherthanone'sassignedgender Astrongdesiretobetreatedasagenderotherthanone'sassignedgender Asignificantincongruencebetweenone'sexperiencedorexpressedgenderandone'ssexualcharacteristics Astrongdesireforthesexualcharacteristicsofagenderotherthanone'sassignedgender Astrongdesiretoberidofone'ssexualcharacteristicsduetoincongruencewithone'sexperiencedorexpressedgender Astrongconvictionthatonehasthetypicalreactionsandfeelingsofagenderotherthanone'sassignedgender Inaddition,theconditionmustbeassociatedwithclinicallysignificantdistressorimpairment.[19] TheDSM-5movedthisdiagnosisoutofthesexualdisorderscategoryandintoacategoryofitsown.[19]Thediagnosiswasrenamedfromgenderidentitydisordertogenderdysphoria,aftercriticismsthattheformertermwasstigmatizing.[23]Subtypingbysexualorientationwasdeleted.Thediagnosisforchildrenwasseparatedfromthatforadults,as"genderdysphoriainchildren".Thecreationofaspecificdiagnosisforchildrenreflectsthelesserabilityofchildrentohaveinsightintowhattheyareexperiencing,orabilitytoexpressitiftheyhaveinsight.[24]Otherspecifiedgenderdysphoriaorunspecifiedgenderdysphoriacanbediagnosedifapersondoesnotmeetthecriteriaforgenderdysphoriabutstillhasclinicallysignificantdistressorimpairment.[19]IntersexpeoplearenowincludedinthediagnosisofGD.[25] TheInternationalClassificationofDiseases(ICD-10)listsseveraldisordersrelatedtogenderidentity:[26][27] Transsexualism(F64.0):Desiretoliveandbeacceptedasamemberoftheoppositesex,usuallyaccompaniedbyadesireforsurgeryandhormonaltreatment Genderidentitydisorderofchildhood(F64.2):Persistentandintensedistressaboutone'sassignedgender,manifestedpriortopuberty Othergenderidentitydisorders(F64.8) Genderidentitydisorder,unspecified(F64.9) Sexualmaturationdisorder(F66.0):Uncertaintyaboutone'sgenderidentityorsexualorientation,causinganxietyordistress TheICD-11,whichwillcomeintoeffecton1January2022,significantlyrevisesclassificationofgenderidentity-relatedconditions.[28]Under"conditionsrelatedtosexualhealth",theICD-11lists"genderincongruence",whichiscodedintothreeconditions:[29] Genderincongruenceofadolescenceoradulthood(HA60):replacesF64.0 Genderincongruenceofchildhood(HA61):replacesF64.2 Genderincongruence,unspecified(HA6Z):replacesF64.9 Inaddition,sexualmaturationdisorderhasbeenremoved,alongwithdual-roletransvestism.[30]ICD-11definesgenderincongruenceas"amarkedandpersistentincongruencebetweenanindividual’sexperiencedgenderandtheassignedsex",withnorequirementforsignificantdistressorimpairment. Treatment[edit] TreatmentforapersondiagnosedwithGDmayincludepsychologicalcounseling,supportingtheindividual'sgenderexpression,orhormonetherapyorsurgery.Thismayinvolvephysicaltransitionresultingfrommedicalinterventionssuchashormonaltreatment,genitalsurgery,electrolysisorlaserhairremoval,chest/breastsurgery,orotherreconstructivesurgeries.[31]Thegoaloftreatmentmaysimplybetoreduceproblemsresultingfromtheperson'stransgenderstatus,forexample,counselingthepatientinordertoreduceguiltassociatedwithcross-dressing.[32] Guidelineshavebeenestablishedtoaidclinicians.TheWorldProfessionalAssociationforTransgenderHealth(WPATH)StandardsofCareareusedbysomecliniciansastreatmentguidelines.OthersuseguidelinesoutlinedinGiannaIsraelandDonaldTarver'sTransgenderCare.[33]Guidelinesfortreatmentgenerallyfollowa"harmreduction"model.[34][35][36] Children[edit] Mainarticle:Genderdysphoriainchildren Thequestionofwhethertocounselyoungchildrentobehappywiththeirassignedsex,ortoallowthemtocontinuetoexhibitbehaviorsthatdonotmatchtheirassignedsex—ortoexploreagendertransition—iscontroversial.Follow-upstudiesofchildrenwithgenderdysphoriauntil2013consistentlyshowthatthemajorityofthemwillnotremaingenderdysphoricafterpubertyandwillinsteadidentifyasgayorlesbian.[37][38][39][needsupdate]Peoplearemorelikelytokeephavinggenderdysphoriathemoreintensetheirgenderdysphoria,cross-genderedbehavior,andverbalidentificationwiththedesired/experiencedgenderare(i.e.statingthattheyareadifferentgenderratherthanwishtobeadifferentgender).[40] Professionalswhotreatgenderdysphoriainchildrensometimesprescribepubertyblockerstodelaytheonsetofpubertyuntilachildisbelievedtobeoldenoughtomakeaninformeddecisiononwhetherhormonalorsurgicalgenderreassignmentisintheirbestinterest.[41][42]TheAmericanAcademyofPediatricsstatethat"pubertalsuppressioninchildrenwhoidentifyasTGD[transgenderandgenderdiverse]generallyleadstoimprovedpsychologicalfunctioninginadolescenceandyoungadulthood."[43] AreviewcommissionedbytheUKDepartmentofHealthfoundthattherewasverylowcertaintyofqualityofevidenceaboutpubertyblockeroutcomesintermsofmentalhealth,qualityoflifeandimpactongenderdysphoria.[44]TheFinnishgovernmentcommissionedareviewoftheresearchevidencefortreatmentofminorsandtheFinnishMinistryofHealthconcludedthattherearenoresearch-basedhealthcaremethodsforminorswithgenderdysphoria.[45]Nevertheless,theyrecommendtheuseofpubertyblockersforminorsonacase-by-casebasis.IntheUnitedStates,severalstateshaveintroducedorareconsideringlegislationthatwouldprohibittheuseofpubertyblockersinthetreatmentoftransgenderchildren.[46]TheAmericanMedicalAssociation,theEndocrineSociety,theAmericanPsychologicalAssociation,theAmericanAcademyofChildandAdolescentPsychiatryandtheAmericanAcademyofPediatricsopposebansonpubertyblockersfortransgenderchildren.[47][48][49][50][51]IntheUK,inthecaseofBellvTavistock,anappealcourtruledthatchildrenunder16couldgiveconsenttoreceivingpubertyblockers.[52] Psychologicaltreatments[edit] Mainarticle:Psychotherapy Untilthe1970s,psychotherapywastheprimarytreatmentforgenderdysphoriaandgenerallywasdirectedtohelpingthepersonadjusttotheirassignedsex.Psychotherapyisanytherapeuticinteractionthataimstotreatapsychologicalproblem.Psychotherapymaybeusedinadditiontobiologicalinterventions,althoughsomecliniciansuseonlypsychotherapytotreatgenderdysphoria.[22]PsychotherapeutictreatmentofGDinvolveshelpingthepatienttoadapttotheirgenderincongruenceortoexplorativeinvestigationofconfoundingco-occurring[53][54][55][56]mentalhealthissues.AttemptstoalleviateGDbychangingthepatient'sgenderidentitytoreflectassignedsexhavebeenineffective.[57]: 1741  Biologicaltreatments[edit] Mainarticle:Sexreassignmenttherapy Biologicaltreatmentsphysicallyalterprimaryandsecondarysexcharacteristicstoreducethediscrepancybetweenanindividual'sphysicalbodyandgenderidentity.[58]BiologicaltreatmentsforGDaretypicallyundertakeninconjunctionwithpsychotherapy;however,theWPATHStandardsofCarestatethatpsychotherapyshouldnotbeanabsoluterequirementforbiologicaltreatments.[59]Itisknownthatsomementaldisordersareimportanttoevaluateandtreatbeforeproceedingwithhormonesorsurgery,astreatmentofthesementaldisorderscansometimesmakethewishforalteringone'sbodydisappearorsignificantlylessen.[58] Psychotherapy,hormonetherapy,andsexreassignmentsurgerycanbeeffectiveattreatingGDwhentheWPATHStandardsofCare6arefollowed.[57]: 1570 Hormonaltreatmentshavebeenshowntoreduceanumberofsymptomsofpsychiatricdistressassociatedwithgenderdysphoria.[60]AWPATHcommissionedsystematicreviewoftheoutcomesofhormonetherapy"foundevidencethatgender-affirminghormonetherapymaybeassociatedwithimprovementsin[qualityoflife]scoresanddecreasesindepressionandanxietysymptomsamongtransgenderpeople."Thestrengthoftheevidencewaslowduetomethodologicallimitationsofthestudiesundertaken.[61]Thosewhochoosetoundergosexreassignmentsurgeryreporthighsatisfactionrateswiththeoutcome,thoughthesestudieshavelimitationsincludingriskofbias(lackofrandomization,lackofcontrolledstudies,self-reportedoutcomes)andhighlosstofollowup.[62][63][64] Foradolescents,muchisunknown,includingpersistence.Disagreementamongpractitionersregardingtreatmentofadolescentsisinpartduetothelackoflong-termdata.[53]YoungpeoplequalifyingforbiomedicaltreatmentaccordingtotheDutchmodel[65][66](includinghavingGDfromearlychildhoodonwhichintensifiesatpubertyandabsenceofpsychiatriccomorbiditiesthatcouldchallengediagnosisortreatment)foundreductioningenderdysphoria,althoughlimitationstotheseoutcomestudieshavebeennoted,suchaslackofcontrolsorconsideringalternativeslikepsychotherapy.[67] Morerigorousstudiesareneededtoassesstheeffectiveness,safety,andlong-termbenefitsandrisksofhormonalandsurgicaltreatments.[62]Forinstance,a2020Cochranereviewfoundinsufficientevidence[68]todeterminewhetherfeminizinghormonesweresafeoreffective.Severalstudieshavefoundsignificantlong-termpsychologicalandpsychiatricpathologyaftersurgicaltreatments.[62]TheSwedishWestRegioncommissionedHealthTechnologyAssessmentfoundin2018thatthecertaintyoftheevidenceforsustainedsatisfactionwithsurgerywasverylow.[69] Comorbidities[edit] Amongyouth,around20%to30%ofindividualsheadingtogenderclinicsmeettheDSMcriteriaforaanxietydisorder.[70] Areviewin2014statedthatgenderdysphoriasymptomsinpeoplewithschizophreniamayariseduetodelusionallychangedgenderidentityorappearregardlessofpsychoticprocess.[71] Awidelyheldviewamongcliniciansisthatthereisanover-representationofneurodevelopmentalconditionsamongstindividualswithGD,althoughthisviewhasbeenquestioned.[72]Studiesonchildrenandadolescentswithgenderdysphoriahavefoundahighprevalenceofautismspectrumdisorder(ASD)traitsoraconfirmeddiagnosisofASD.AdultswithgenderdysphoriaattendingspecialistgenderclinicshavealsobeenshowntohavehighratesofASDtraitsoranautismdiagnosisaswell.[73]IthasbeenestimatedthatchildrenwithASDwereoverfourtimesaslikelytobediagnosedwithGD,[72]withASDbeingreportedfrom6%toover20%ofteensreferringtogenderidentityservices.[74] Epidemiology[edit] Seealso:Transgender§ Populationfigures,andTranssexual§ Prevalence TheDSM-5estimatesthatabout0.005%to0.014%ofpeopleassignedmaleatbirthand0.002%to0.003%ofpeopleassignedfemaleatbirtharediagnosablewithgenderdysphoria.[75] AccordingtoBlack'sMedicalDictionary,genderdysphoria“occursinonein30,000malebirthsandonein100,000femalebirths.”[76]StudiesinEuropeancountriesintheearly2000sfoundthatabout1in12,000natalmaleadultsand1in30,000natalfemaleadultsseekoutsexreassignmentsurgery.[77]Studiesofhormonaltreatmentorlegalnamechangefindhigherprevalencethansexreassignment,with,forexamplea2010Swedishstudyfindingthat1in7,750adultnatalmalesand1in13,120adultnatalfemalesrequestedalegalnamechangetoanameoftheoppositegender.[77] Studiesthatmeasuretransgenderstatusbyself-identificationfindevenhigherratesofgenderidentitydifferentfromsexassignedatbirth(althoughsomeofthosewhoidentifyastransgenderorgendernonconformingmaynotexperienceclinicallysignificantdistressandsodonothavegenderdysphoria).AstudyinNewZealandfoundthat1in3,630natalmalesand1in22,714natalfemaleshavechangedtheirlegalgendermarkers.[77]AsurveyofMassachusettsadultsfoundthat0.5%identifyastransgender.[77][78]AnationalsurveyinNewZealandof8,500randomlyselectedsecondaryschoolstudentsfrom91randomlyselectedhighschoolsfound1.2%ofstudentsresponded"yes"tothequestion"Doyouthinkyouaretransgender?".[79]Outsideofaclinicalsetting,thestabilityoftransgenderornon-binaryidentitiesisunknown.[77] Researchindicatespeoplewhotransitioninadulthoodareuptothreetimesmorelikelytobemaleassignedatbirth,butthatamongpeopletransitioninginchildhoodthesexratioiscloseto1:1.[80]Theprevalenceofgenderdysphoriainchildrenisunknownduetotheabsenceofformalprevalencestudies.[40] History[edit] NeithertheDSM-I(1952)northeDSM-II(1968)containedadiagnosisanalogoustogenderdysphoria.GenderidentitydisorderfirstappearedasadiagnosisintheDSM-III(1980),whereitappearedunder"psychosexualdisorders"butwasusedonlyforthechildhooddiagnosis.Adolescentsandadultsreceivedadiagnosisoftranssexualism(homosexual,heterosexual,orasexualtype).TheDSM-III-R(1987)added"GenderIdentityDisorderofAdolescenceandAdulthood,Non-TranssexualType"(GIDAANT).[81][82][83] Societyandculture[edit] Asignatatransrightsrally:"Genderislikethatoldjumperfrommycousin:Itwasgiventomeanditdoesn'tfit." ResearchersdisagreeaboutthenatureofdistressandimpairmentinpeoplewithGD.SomeauthorshavesuggestedthatpeoplewithGDsufferbecausetheyarestigmatizedandvictimized;[14][84]andthat,ifsocietyhadlessstrictgenderdivisions,transgenderpeoplewouldsufferless.[85] SomecontroversysurroundsthecreationoftheGDdiagnosis,withDavyetal.statingthatalthoughthecreatorsofthediagnosisstatethatithasrigorousscientificsupport,"itisimpossibletoscrutinizesuchclaims,sincethediscussions,methodologicalprocesses,andpromisedfieldtrialsofthediagnosishavenotbeenpublished."[25] Somecultureshavethreedefinedgenders:man,woman,andeffeminateman.Forexample,inSamoa,thefa'afafine,agroupoffemininemales,areentirelysociallyaccepted.Thefa'afafinedonothaveanyofthestigmaordistresstypicallyassociatedinmostcultureswithdeviatingfromamale/femalegenderrole.ThissuggeststhedistresssofrequentlyassociatedwithGDinaWesterncontextisnotcausedbythedisorderitself,butbydifficultiesencounteredfromsocialdisapprovalbyone'sculture.[86]However,researchhasfoundthattheanxietyassociatedwithgenderdysphoriapersistsincultures,Easternorotherwise,whicharemoreacceptingofgendernonconformity.[87] InAustralia,a2014HighCourtofAustraliajudgmentunanimouslyruledinfavorofaplaintiffnamedNorrie,whoaskedtobeclassifiedbyathirdgendercategory,'non-specific',afteralongcourtbattlewiththeNSWRegistrarofBirths,DeathsandMarriages.[88]However,theCourtdidnotacceptthatgenderwasasocialconstruction:itfoundthatsexreassignment"surgerydidnotresolvehersexualambiguity".[88]: para11  Classificationasadisorder[edit] Thepsychiatricdiagnosisofgenderidentitydisorder(nowgenderdysphoria)wasintroducedinDSM-IIIin1980.ArleneIstarLevandDeborahRudacillehavecharacterizedtheadditionasapoliticalmaneuvertore-stigmatizehomosexuality.[89][90](HomosexualitywasremovedfromDSM-IIin1974.)Bycontrast,KennethZuckerandRobertSpitzerarguethatgenderidentitydisorderwasincludedinDSM-IIIbecauseit"metthegenerallyacceptedcriteriausedbytheframersofDSM-IIIforinclusion."[91]Someresearchers,includingSpitzerandPaulJ.Fink,contendthatthebehaviorsandexperiencesseenintranssexualismareabnormalandconstituteadysfunction.[92]TheAmericanPsychiatricAssociationstatedthatgendernonconformityisnotthesamethingasgenderdysphoria,[9]andthat"gendernonconformityisnotinitselfamentaldisorder.Thecriticalelementofgenderdysphoriaisthepresenceofclinicallysignificantdistressassociatedwiththecondition."[1] Individualswithgenderdysphoriamayormaynotregardtheirowncross-genderfeelingsandbehaviorsasadisorder.Advantagesanddisadvantagesexisttoclassifyinggenderdysphoriaasadisorder.[3]Becausegenderdysphoriahadbeenclassifiedasadisorderinmedicaltexts(suchasthepreviousDSMmanual,theDSM-IV-TR,underthename"genderidentitydisorder"),manyinsurancecompaniesarewillingtocoversomeoftheexpensesofsexreassignmenttherapy.Withouttheclassificationofgenderdysphoriaasamedicaldisorder,sexreassignmenttherapymaybeviewedasacosmetictreatment,ratherthanmedicallynecessarytreatment,andmaynotbecovered.[93]IntheUnitedStates,transgenderpeoplearelesslikelythanotherstohavehealthinsurance,andoftenfacehostilityandinsensitivityfromhealthcareproviders.[94] TheDSM-IV-TRdiagnosticcomponentofdistressisnotinherentinthecross-genderidentity;rather,itisrelatedtosocialrejectionanddiscriminationsufferedbytheindividual.[86]PsychologyprofessorDarrylHillinsiststhatgenderdysphoriaisnotamentaldisorder,butratherthatthediagnosticcriteriareflectpsychologicaldistressinchildrenthatoccurswhenparentsandothershavetroublerelatingtotheirchild'sgendervariance.[92]Transgenderpeoplehaveoftenbeenharassed,sociallyexcluded,andsubjectedtodiscrimination,abuseandviolence,includingmurder.[4][85] InDecember2002,theBritishLordChancellor'sofficepublishedaGovernmentPolicyConcerningTranssexualPeopledocumentthatcategoricallystates,"Whattranssexualismisnot...Itisnotamentalillness."[95]InMay2009,thegovernmentofFrancedeclaredthatatranssexualgenderidentitywillnolongerbeclassifiedasapsychiatriccondition,[96]butaccordingtoFrenchtransrightsorganizations,beyondtheimpactoftheannouncementitself,nothingchanged.[97]Denmarkmadeasimilarstatementin2016.[98] IntheICD-11,GIDisreclassifiedas"genderincongruence",aconditionrelatedtosexualhealth.[29]TheworkinggroupresponsibleforthisrecategorizationrecommendedkeepingsuchadiagnosisinICD-11topreserveaccesstohealthservices.[30] Gendereuphoria[edit] Gendereuphoria(GE)isaproposedtermforthesatisfactionorenjoymentfeltbyapersonduetoconsistencybetweentheirgenderidentityandgenderedfeaturesassociatedwithagenderdifferenttothesextheywereassignedatbirth.Itismeanttobethepositivecounterpartofgenderdysphoria.[77][99] Seealso[edit] Listoftransgender-relatedtopics Transmedicalism ICD-11§ Genderincongruence References[edit] ^abcd"GenderDysphoria"(PDF).AmericanPsychiatricPublishing.RetrievedDecember24,2016. ^abcMadduxJE,WinsteadBA(2015).Psychopathology:FoundationsforaContemporaryUnderstanding.Routledge.pp. 464–465.ISBN 978-1317697992. ^abcdefColemanE(2011)."StandardsofCarefortheHealthofTranssexual,Transgender,andGender-NonconformingPeople,Version7"(PDF).InternationalJournalofTransgenderism.RoutledgeTaylor&FrancisGroup.13(4):165–232.doi:10.1080/15532739.2011.700873.S2CID 39664779.Archivedfromtheoriginal(PDF)onAugust2,2014.RetrievedAugust30,2014. ^abcdDavidson,MichelleR.(2012).ANurse'sGuidetoWomen'sMentalHealth.SpringerPublishingCompany.p. 114.ISBN 978-0-8261-7113-9. ^Campaign,HumanRights."SexualOrientationandGenderIdentityDefinitions". ^SexualOrientationandGenderExpressioninSocialWorkPractice,editedbyDeanaF.MorrowandLoriMessinger(2006,ISBN 0231501862),p.8:"Genderidentityreferstoanindividual'spersonalsenseofidentityasmasculineorfeminine,orsomecombinationthereof." ^AmericanPsychiatricAssociation,DSM-5FactSheets,UpdatedDisorders:GenderDysphoria(Washington,D.C.:AmericanPsychiatricAssociation,2013):2("DSM-5aimstoavoidstigmaandensureclinicalcareforindividualswhoseeandfeelthemselvestobeadifferentgenderthantheirassignedgender.Itreplacesthediagnosticname'genderidentitydisorder'with'genderdysphoria',aswellasmakesotherimportantclarificationsinthecriteria."). ^RussoJ,CokerJK,KingJH(2017).DSM-5®andFamilySystems.SpringerPublishingCompany.p. 352.ISBN 978-0826183996.PeoplemeetingcriteriaforGenderDysphoriamostoftenidentifythemselvesastransortransgender.Transortransgendercanbeusedasumbrellatermstoincludethebroadspectrumofpersonswhosegenderidentitydiffersfromtheassignedgender(APA,2013). ^abRannaParekh."WhatIsGenderDysphoria?".AmericanPsychiatricPublishing.RetrievedNovember20,2018. ^WorldProfessionalAssociationforTransgenderHealth(WPATH),StandardsofCarefortheHealthofTranssexual,Transgender,andGenderNonconformingPeople,ver.7(2011),5("onlysomegendernonconformingpeopleexperiencegenderdysphoriaatsomepointintheirlives.") ^abHeylensG,DeCuypereG,ZuckerKJ,SchelfautC,ElautE,VandenBosscheH,DeBaereE,T'SjoenG(March2012)."Genderidentitydisorderintwins:areviewofthecasereportliterature".TheJournalofSexualMedicine.9(3):751–7.doi:10.1111/j.1743-6109.2011.02567.x.PMID 22146048.Of23monozygoticfemaleandmaletwins,nine(39.1%)wereconcordantforGID;incontrast,noneofthe21same‐sexdizygoticfemaleandmaletwinswereconcordantforGID,astatisticallysignificantdifference(P = 0.005)...ThesefindingssuggestaroleforgeneticfactorsinthedevelopmentofGID. ^abDiamond,Milton(2013)."TranssexualityAmongTwins:IdentityConcordance,Transition,Rearing,andOrientation".InternationalJournalofTransgenderism.14(1):24–38.doi:10.1080/15532739.2013.750222.S2CID 144330783.Combiningdatafromthepresentsurveywiththosefrompast-publishedreports,20%ofallmaleandfemalemonozygotictwinpairswerefoundconcordantfortranssexualidentity...Theresponsesofourtwinsrelativetotheirrearing,alongwithourfindingsregardingsomeoftheirexperiencesduringchildhoodandadolescenceshowtheiridentitywasmuchmoreinfluencedbytheirgeneticsthantheirrearing. ^abRosenthal,StephenM.(2014-12-01)."ApproachtothePatient:TransgenderYouth:EndocrineConsiderations".TheJournalofClinicalEndocrinology&Metabolism.99(12):4379–4389.doi:10.1210/jc.2014-1919.ISSN 0021-972X.PMID 25140398. ^abBryant,Karl(2018)."GenderDysphoria".EncyclopædiaBritannicaOnline.RetrievedAugust16,2018. ^Zucker,KennethJ.;Lawrence,AnneA.;Kreukels,BaudewijntjeP.C.(2016)."GenderDysphoriainAdults".AnnualReviewofClinicalPsychology.12:217–247.doi:10.1146/annurev-clinpsy-021815-093034.PMID 26788901.[ForDSM-5]areconceptualizationwasarticulatedinwhich'identity'persewasnotconsideredasignofamentaldisorder.Rather,itwastheincongruencebetweenone’sfeltgenderandassignedsex/gender(usuallyatbirth)leadingtodistressand/orimpairmentthatwasthecorefeatureofthediagnosis. ^Lev,ArleneIstar(2013)."GenderDysphoria:TwoStepsForward,OneStepBack".ClinicalSocialWorkJournal.41(3):288–296.doi:10.1007/s10615-013-0447-0.S2CID 144556484.[Despitesomemisgivings],IthinkthatthechangeinnomenclaturefromtheDSM-IVtotheDSM-5isastepforward,thatis,removingtheconceptofgenderasthesiteofthedisorderandplacingthefocusonissuesofdistressanddysphoria. ^DiagnosticandStatisticalManualofMentalDisorders(Fifth ed.).Arlington,VA:AmericanPsychiatricPublishing.2013.pp. 451–460.ISBN 978-0-89042-554-1. ^GuillamonA,JunqueC,Gómez-GilE(October2016)."AReviewoftheStatusofBrainStructureResearchinTranssexualism".ArchivesofSexualBehavior.45(7):1615–48.doi:10.1007/s10508-016-0768-5.PMC 4987404.PMID 27255307. ^abcdefAmericanPsychiatryAssociation(2013).DiagnosticandStatisticalManualofMentalDisorders(DSM-5)(5th ed.).Washington,DCandLondon:AmericanPsychiatricPublishing.pp. 451–460.ISBN 978-0-89042-555-8. ^DiemerEW,GrantJD,Munn-ChernoffMA,PattersonDA,DuncanAE(August2015)."GenderIdentity,SexualOrientation,andEating-RelatedPathologyinaNationalSampleofCollegeStudents".TheJournalofAdolescentHealth.57(2):144–9.doi:10.1016/j.jadohealth.2015.03.003.PMC 4545276.PMID 25937471. ^Harmon,A.,&Oberleitner,M.G.(2016).Genderdysphoria.InGale(Ed.),Galeencyclopediaofchildren'shealth:Infancythroughadolescence(3rded.).Farmington,MI:Gale. ^abGijs,L;Brawaeys,A(2007)."SurgicalTreatmentofGenderDysphoriainAdultsandAdolescents:RecentDevelopments,Effectiveness,andChallenges".AnnualReviewofSexResearch.18(178–224). ^"GenderDysphoriainChildren".AmericanPsychiatricAssociation.May4,2011.RetrievedJuly3,2011. ^"P00GenderDysphoriainChildren".AmericanPsychiatricAssociation.RetrievedApril2,2012. ^abDavy,Zowie;Toze,Michael(2018)."WhatIsGenderDysphoria?ACriticalSystematicNarrativeReview".TransgenderHealth.MaryAnnLiebert,Inc.Publishers.3(1):159–169.doi:10.1089/trgh.2018.0014.PMC 6225591.PMID 30426079. ^"InternationalClassificationofDiseases(ICD)F64Genderidentitydisorders".WorldHealthOrganization.RetrievedAugust9,2018. ^Potts,S;Bhugra,D(1995)."Classificationofsexualdisorders".InternationalReviewofPsychiatry.7(2):167–174.doi:10.3109/09540269509028323. ^"InternationalClassificationofDiseases".WorldHealthOrganization.RetrievedAugust11,2018. ^ab"Genderincongruence(ICD-11)".icd.who.int.WHO.RetrievedAugust28,2018. ^abReedGM,DrescherJ,KruegerRB,AtallaE,CochranSD,FirstMB,Cohen-KettenisPT,Arango-deMontisI,ParishSJ,CottlerS,BrikenP,SaxenaS(October2016)."DisordersrelatedtosexualityandgenderidentityintheICD-11:revisingtheICD-10classificationbasedoncurrentscientificevidence,bestclinicalpractices,andhumanrightsconsiderations".WorldPsychiatry.15(3):205–221.doi:10.1002/wps.20354.PMC 5032510.PMID 27717275. ^"NHS-Treatment-Genderdysphoria".NHS.2016.RetrievedJanuary10,2019. ^Leiblum,Sandra(2006).PrinciplesandPracticeofSexTherapy,FourthEdition.TheGuilfordPress.pp. 488–9.ISBN 978-1-59385-349-5. ^Heyes,C.J.,&Latham,J.R.(2018).Transsurgeriesandcosmeticsurgeries:Thepoliticsofanalogy.TransgenderStudiesQuarterly,5(2),174-189. ^CommitteeOnAdolescence(July2013)."Office-basedcareforlesbian,gay,bisexual,transgender,andquestioningyouth".Pediatrics.132(1):198–203.doi:10.1542/peds.2013-1282.PMID 23796746.However,adolescentswithmultipleoranonymouspartners,havingunprotectedintercourse,orhavingsubstanceabuseissuesshouldbetestedatshorterintervals. ^"www.glma.orgCompendiumofHealthProfessionAssociationLGBTPolicy&PositionStatements"(PDF).GLMA.2013.RetrievedAugust27,2013. ^"APAPolicyStatementsonLesbian,Gay,Bisexual,&TransgenderConcerns"(PDF).AmericanPsychologicalAssociation.2011.RetrievedAugust27,2013.BEITFURTHERRESOLVEDthatAPArecognizestheefficacy,benefit,andnecessityofgendertransitiontreatmentsforappropriatelyevaluatedindividualsandcallsuponpublicandprivateinsurerstocoverthesemedicallynecessarytreatments; ^Wallien,M.S.C.,&Cohen-Kettenis,P.T.(2008).Psychosexualoutcomeofgender-dysphoricchildren.JournaloftheAmericanAcademyofChildandAdolescentPsychiatry,47,1413–1423. ^Drummond,K.D.,Bradley,S.J.,Badali-Peterson,M.,&Zucker,K.J.(2008).Afollow-upstudyofgirlswithgenderidentitydisorder.DevelopmentalPsychology,44,34–45. ^Steensma,T.D.,McGuire,J.K.,Kreukels,B.P.C.,Beekman,A.J.,&Cohen-Kettenis,P.T.(2013).Factorsassociatedwithdesistenceandpersistenceofchildhoodgenderdysphoria:Aquantitativefollow-upstudy.JournaloftheAmericanAcademyofChildandAdolescentPsychiatry,52,582–590. ^abRistori,Jiska;Steensma,ThomasD.(2January2016)."Genderdysphoriainchildhood".InternationalReviewofPsychiatry.28(1):13–20.doi:10.3109/09540261.2015.1115754.PMID 26754056.S2CID 5461482. ^TheTransgenderedChild:AHandbookforFamiliesandProfessionals(BrillandPepper,2008)[fullcitationneeded][page needed] ^Alleyne,Richard(15April2011)."Pubertyblockerforchildrenconsideringsexchange".TheTelegraph.Retrieved1December2020. ^Rafferty,Jason;Health,CommitteeonPsychosocialAspectsofChildandFamily;Adolescence,CommitteeOn;SectiononLesbian,Gay(2018-10-01)."EnsuringComprehensiveCareandSupportforTransgenderandGender-DiverseChildrenandAdolescents".Pediatrics.142(4):e20182162.doi:10.1542/peds.2018-2162.ISSN 0031-4005.PMID 30224363. ^"Evidencereview:Gonadotrophinreleasinghormoneanaloguesforchildrenandadolescentswithgenderdysphoria".Retrieved2April2021.Thecriticaloutcomesfordecisionmakingaretheimpactongenderdysphoria,mentalhealthandqualityoflife.ThequalityofevidencefortheseoutcomeswasassessedasverylowcertaintyusingmodifiedGRADE. ^"Finnishguidelinesfortreatmentofchildandadolescentgenderdysphoria(publishedmarch2021)"(PDF).CouncilforChoicesinHealthCare(COHERE).Retrieved22April2021.p.6:”Terveydenhuoltolainmukaan(8§)terveydenhuollontoiminnanonperustuttavanäyttöönjahyviinhoito-jatoimintakäytäntöihin.Alaikäistenosaltatutkimusnäyttöönperustuviaterveydenhuollonmenetelmiäeiole.”---(Googletranslate:)“AccordingtotheHealthCareAct(Section8),healthcareactivitiesmustbebasedonevidenceandgoodcareandoperatingpractices.Therearenoresearch-basedhealthcaremethodsforminors.” ^Safer,JoshuaD.(17February2020)."Controversialpubertalblockerlegislationmaybringunintendedconsequencesforchildren".Healio.Retrieved15December2020. ^"EndocrineSocietyurgespolicymakerstofollowscienceontransgenderhealth". ^"AMAfightstoprotecthealthcarefortransgenderpatients". ^"CriminalizingGenderAffirmativeCarewithMinors". ^"AACAPStatementRespondingtoEffortstobanEvidence-BasedCareforTransgenderandGenderDiverseYouth". ^Schmidt,Samantha."FAQ:Whatyouneedtoknowabouttransgenderchildren".TheWashingtonPost. ^Siddique,Haroon(17September2021)."AppealcourtoverturnsUKpubertyblockersrulingforunder-16s17September2021".Guardian.Guardian.Retrieved17September2021. ^abKaltiala-Heino,Riittakerttu;Sumia,Maria;Työläjärvi,Marja;Lindberg,Nina(2015)."Twoyearsofgenderidentityserviceforminors:overrepresentationofnatalgirlswithsevereproblemsinadolescentdevelopment".ChildandAdolescentPsychiatryandMentalHealth.9:9.doi:10.1186/s13034-015-0042-y.ISSN 1753-2000.PMC 4396787.PMID 25873995."forthemajorityofadolescent-onsetcases,GDpresentedinthecontextofseverementaldisordersandgeneralidentityconfusion.Insuchsituations,appropriatetreatmentforpsychiatriccomorbiditiesmaybewarrantedbeforeconclusionsregardinggenderidentitycanbedrawn.","Thereisstillnoclearconsensusregardinghormonaltreatmentforadolescentsbecauselong-termdataareunavailable;","Inanationwidelong-termfollow-upstudyofadultcases,psychiatricmorbidity,suicideattemptsandsuicidemortalitypersistedaselevatedafterjuridicalandmedicalSR. ^SwedishNationalBoardofHealthandWelfare(Feb2020)."Developmentofthediagnosisgenderdysphoria(Swedish)"(PDF).socialstyrelsen.se.Retrieved13March2021. ^Kozlowska,Kasia;Chudleigh,Catherine;McClure,Georgia;Maguire,AnnM.;Ambler,GeoffreyR.(2021-01-12)."AttachmentPatternsinChildrenandAdolescentsWithGenderDysphoria".FrontiersinPsychology.11:582688.doi:10.3389/fpsyg.2020.582688.ISSN 1664-1078.PMC 7835132.PMID 33510668. ^D’Angelo,Roberto;Syrulnik,Ema;Ayad,Sasha;Marchiano,Lisa;Kenny,DiannaTheadora;Clarke,Patrick(2021-01-01)."OneSizeDoesNotFitAll:InSupportofPsychotherapyforGenderDysphoria".ArchivesofSexualBehavior.50(1):7–16.doi:10.1007/s10508-020-01844-2.ISSN 1573-2800.PMC 7878242.PMID 33089441. ^abGeorgeR.Brown,MD(July20,2011)."Chapter165SexualityandSexualDisorders".InRobertS.Porter,MD;et al.(eds.).TheMerckManualofDiagnosisandTherapy(19th ed.).WhitehouseStation,NJ,USA:Merck&Co.,Inc.pp. 1740–1747.ISBN 978-0-911910-19-3. ^abBockting,W;Knudson,G;Goldberg,J(January2006)."CounsellingandMentalHealthCareofTransgenderAdultsandLovedOnes".InternationalJournalofTransgenderism.9(3–4):35–82.doi:10.1300/J485v09n03_03.S2CID 71503744."AsperFigure1,delusionsaboutsexorgender,dissociativedisorders,thoughtdisorders,orobsessiveorcompulsivefeaturesshouldbeevaluatedandtreatedpriortoproceedingwithhormonetherapyorsurgery.Thoughtdisorders,dissociativedisorders,andobsessive-compulsivedisorderscan,rarely,causeatransientwishforsexreassignmentwhichdisappearsorsignificantlylessenswhentheunderlyingmentalhealthconditionistreated.Itisimportanttotreatthesedisordersbeforeproceedingwithhormonesorsurgerytoensurethatthedesireforalterationofprimaryorsecondarysexcharacteristicsisnotatemporarydesire."SeealsoWPATHStandardsofCare,version7,page23:“Theroleofmentalhealthprofessionalsincludesmakingreasonablysurethatthegenderdysphoriaisnotsecondarytoorbetteraccountedforbyotherdiagnoses.”AndtheparadigmaticDutchmodelforconsiderationofcomorbidconditionsbeforeproceedingwithtreatmentforchildhoodonset. ^"StandardsofCarefortheHealthofTranssexual,Transgender,andGenderNonconformingPeople"(PDF).WorldProfessionalAssociationforTransgenderHealth.pp. 28–29.Retrieved15March2021. ^Altinay,Murat;Anand,Amit(2020)."Neuroimaginggenderdysphoria:anovelpsychobiologicalmodel".BrainImagingandBehavior.14(4):1281–1297.doi:10.1007/s11682-019-00121-8.PMID 31134582.S2CID 167207854.Retrieved2021-10-16.Arecentlypublishedstudy(Colizzietal.2014),where118patientswerefollowedbeforeand12monthsafterHRTrevealedthat14%ofthepatientshadcomorbidAxis-Ipsychiatricdiagnosis.PsychiatricdistressandimpairmentwerefoundtobehigherinthebeginningphaseofthestudybutafterHRT,therewasasignificantimprovementinmajordepressivedisorder,anxietyandfunctionalimpairment.Similarly,Fisherandcolleagues’(Fisheretal.2013)2013papersuggeststhatthedysfunctionandimpairmentinthetransgenderpopulationishighlyassociatedwithlackofHRT,whichmaysuggestthatatleastafractionoftheimpairmentthatwasdocumentedascomorbidAxis-IpsychiatricdisorderscouldinfactbeimpairmentfromGD.Finally,ametanalysisdonebyDhejneandcolleagues(Dhejneetal.2016)reviewed38longitudinalstudiesthatinvestigatedpsychiatriccomorbiditiespreandpostgenderaffirmationtreatmentsintransgenderpeoplewithGD.TheresultsofthisanalysisindicatethatdepressionandGADdohavehigherprevalenceintransgenderpopulationbutthisfindingwasisolatedtobaseline(pre-genderaffirmationtreatments)whereaftergenderaffirmationtherapies,rateofpsychiatriccomorbiditiesdecreasedtocisgenderpopulationlevels ^Baker,KellanE.;Wilson,LisaM.;Sharma,Ritu;Dukhanin,Vadim;McArthur,Kristen;Robinson,KarenA.(2021)."HormoneTherapy,MentalHealth,andQualityofLifeAmongTransgenderPeople:ASystematicReview".JournaloftheEndocrineSociety.5(4):bvab011.doi:10.1210/jendso/bvab011.PMC 7894249.PMID 33644622.Thissystematicreviewof20studiesfoundevidencethatgender-affirminghormonetherapymaybeassociatedwithimprovementsinQOLscoresanddecreasesindepressionandanxietysymptomsamongtransgenderpeople.Associationsweresimilaracrossgenderidentityandage.Thestrengthofevidencefortheseconclusionsislowduetomethodologicallimitations. ^abcHembree,WylieC;Cohen-Kettenis,PeggyT;Gooren,Louis;Hannema,SabineE;Meyer,WalterJ;Murad,MHassan;Rosenthal,StephenM;Safer,JoshuaD;Tangpricha,Vin;T’Sjoen,GuyG(2017-11-01)."EndocrineTreatmentofGender-Dysphoric/Gender-IncongruentPersons:AnEndocrineSocietyClinicalPracticeGuideline".TheJournalofClinicalEndocrinology&Metabolism.102(11):3869–3903.doi:10.1210/jc.2017-01658.ISSN 0021-972X.PMID 28945902."Inthefuture,weneedmorerigorousevaluationsoftheeffectivenessandsafetyofendocrineandsurgicalprotocols.Specifically,endocrinetreatmentprotocolsforGD/genderincongruenceshouldincludethecarefulassessmentofthefollowing:(1)theeffectsofprolongeddelayofpubertyinadolescentsonbonehealth,gonadalfunction,andthebrain(includingeffectsoncognitive,emotional,social,andsexualdevelopment);[...]and(4)therisksandbenefitsofgender-affirminghormonetreatmentinoldertransgenderpeople.”“Futureresearchisneededtoascertainthepotentialharmofhormonaltherapies(176).”"Thesatisfactionratewithsurgicalreassignmentofsexisnowveryhigh(187).“Owingtothelackofcontrolledstudies,incompletefollow-up,andlackofvalidassessmentmeasures,evaluatingvarioussurgicalapproachesandtechniquesisdifficult.""Severalpostoperativestudiesreportsignificantlong-termpsychologicalandpsychiatricpathology(259–261).”"Weneedmorestudieswithappropriatecontrolsthatexaminelong-termqualityoflife,psychosocialoutcomes,andpsychiatricoutcomestodeterminethelong-termbenefitsofsurgicaltreatment.” ^Murad,MohammadHassan;Elamin,MohamedB.;Garcia,MagalyZumaeta;Mullan,RebeccaJ.;Murad,Ayman;Erwin,PatriciaJ.;Montori,VictorM.(February2010)."Hormonaltherapyandsexreassignment:asystematicreviewandmeta-analysisofqualityoflifeandpsychosocialoutcomes".ClinicalEndocrinology.72(2):214–231.doi:10.1111/j.1365-2265.2009.03625.x.ISSN 1365-2265.PMID 19473181.S2CID 19590739.Theevidenceinthisreviewisofverylowquality9,10duetotheseriousmethodologicallimitationsofincludedstudies.Studieslackedbiasprotectionmeasuressuchasrandomizationandcontrolgroups,andgenerallydependedonself-reporttoascertaintheexposure(i.e.hormonaltherapywasself-reportedasopposedtobeingextractedfrommedicalrecords).Ourrelianceonreportedoutcomemeasuresmayalsoindicateahigherriskofreportingbiaswithinthestudies.Statisticalheterogeneityoftheresultswasalsosignificant. ^Sutcliffe,P.A.;Dixon,S.;Akehurst,R.L.;Wilkinson,A.;Shippam,A.;White,S.;Richards,R.;Caddy,C.M.(March2009)."Evaluationofsurgicalproceduresforsexreassignment:asystematicreview".JournalofPlastic,Reconstructive&AestheticSurgery:JPRAS.62(3):294–306,discussion306–308.doi:10.1016/j.bjps.2007.12.009.ISSN 1878-0539.PMID 18222742.TheevidenceconcerninggenderreassignmentsurgeryinbothMTFandFTMtranssexismhasseverallimitationsintermsof:(a)lackofcontrolledstudies,(b)evidencehasnotcollecteddataprospectively,(c)highlosstofollowupand(d)lackofvalidatedassessmentmeasures.Somesatisfactoryoutcomeswerereported,butthemagnitudeofbenefitandharmforindividualsurgicalprocedurescannotbeestimatedaccuratelyusingthecurrentavailableevidence. ^Cohen-Kettenis,PeggyT.;Delemarre-vandeWaal,HenrietteA.;Gooren,LouisJ.G.(2008)."Thetreatmentofadolescenttranssexuals:changinginsights".TheJournalofSexualMedicine.5(8):1892–1897.doi:10.1111/j.1743-6109.2008.00870.x.ISSN 1743-6109.PMID 18564158. ^deVries,AnnelouL.C.;McGuire,JeniferK.;Steensma,ThomasD.;Wagenaar,EvaC.F.;Doreleijers,TheoA.H.;Cohen-Kettenis,PeggyT.(2014)."Youngadultpsychologicaloutcomeafterpubertysuppressionandgenderreassignment".Pediatrics.134(4):696–704.doi:10.1542/peds.2013-2958.ISSN 1098-4275.PMID 25201798.S2CID 18155489. ^Zucker,KennethJ.(2019-10-01)."AdolescentswithGenderDysphoria:ReflectionsonSomeContemporaryClinicalandResearchIssues".ArchivesofSexualBehavior.48(7):1983–1992.doi:10.1007/s10508-019-01518-8.ISSN 1573-2800.PMID 31321594.S2CID 197663705.IntheDutchmodel,severalfactorswereidentifiedindeemingadolescenteligibilityforearlybiomedicaltreatment.AccordingtoCohen-Kettenis,Delemarre-vandeWaal,andGooren(2008),theseincludedthefollowing:(1)thepresenceofgenderdysphoriafromearlychildhoodon;(2)anexacerbationofthegenderdysphoriaafterthefirstsignsofpuberty;(3)theabsenceofpsychiatriccomorbiditythatwouldinterferewithadiagnosticevaluationortreatment;(4)adequatepsychologicalandsocialsupportduringtreatment;and(5)ademonstrationofknowledgeofthesex/genderreassignmentprocess.Severalstudieshavereportedonthebenefitsofthistherapeuticprotocolinreducinggenderdysphoria(e.g.,deVriesetal.,2014,whichisthebeststudytodate).Ofcourse,oneshouldbearinmindsomeofthelimitationtotheseoutcomestudies,includingthefactthatnotallassessedadolescentsweredeemedeligibleforthetreatmentprotocol(andthusweknowrelativelylittleaboutthelonger-termoutcomesoftheseyouth)andthatstudydesignshavenotincludedalternativetreatmentoptions(suchaspsychosocialtherapy)orevenbeingassignedtoawait-listcontrolcondition; ^Haupt,Claudia;Henke,Miriam;Kutschmar,Alexia;Hauser,Birgit;Baldinger,Sandra;Saenz,SarahRafaela;Schreiber,Gerhard(2020-11-28)."Antiandrogenorestradioltreatmentorbothduringhormonetherapyintransitioningtransgenderwomen".CochraneDatabaseofSystematicReviews.11:CD013138.doi:10.1002/14651858.cd013138.pub2.ISSN 1465-1858.PMC 8078580.PMID 33251587.Wefoundinsufficientevidencetodeterminetheefficacyorsafetyofhormonaltreatmentapproachesfortransgenderwomenintransition. ^GeorgasK,BeckmanU,BrymanI,ElanderA,JivegårdL,MattelinE,etal.Genderaffirmationsurgeryforgenderdysphoria-effectsandrisks.[Könskonfirmerandekirurgividkönsdysfori-effekterochrisker].Göteborg:VästraGötalandsregionen,SahlgrenskaUniversityHospital,HTA-centrum:2018.RegionalactivitybasedHTA2018:102.https://alfresco-offentlig.vgregion.se/alfresco/service/vgr/storage/node/content/workspace/SpacesStore/441006af-62a7-4f19-be73-6d698bf635f5/2018_102%20Rapport%20K%c3%b6nsdysfori.pdf?a=false&guest=true ^Janssen,Aron;Leibowitz,Scott(2018-05-22).AffirmativeMentalHealthCareforTransgenderandGenderDiverseYouth:AClinicalGuide.Springer.p. 8.ISBN 978-3-319-78307-9. ^Stusiński,Jarosław;Lew-Starowicz,Michał(2018-12-29)."Genderdysphoriasymptomsinschizophrenia".PsychiatriaPolska.52(6):1053–1062.doi:10.12740/PP/80013.ISSN 2391-5854.PMID 30659566. ^abThrower,Emily;Bretherton,Ingrid;Pang,KenC.;Zajac,JeffreyD.;Cheung,AdaS.(2020-03-01)."PrevalenceofAutismSpectrumDisorderandAttention-DeficitHyperactivityDisorderAmongstIndividualswithGenderDysphoria:ASystematicReview".JournalofAutismandDevelopmentalDisorders.50(3):695–706.doi:10.1007/s10803-019-04298-1.ISSN 1573-3432.PMID 31732891.S2CID 208061795. ^Kyriakou,Andreas;Nicolaides,NicolasC.;Skordis,Nicos(2020)."Currentapproachtotheclinicalcareofadolescentswithgenderdysphoria".ActaBioMedica :AteneiParmensis.91(1):165–175.doi:10.23750/abm.v91i1.9244.ISSN 0392-4203.PMC 7569586.PMID 32191677. ^Kaltiala-Heino,Riittakerttu;Bergman,Hannah;Työläjärvi,Marja;Frisén,Louise(2018-03-02)."Genderdysphoriainadolescence:currentperspectives".AdolescentHealth,MedicineandTherapeutics.9:31–41.doi:10.2147/AHMT.S135432.ISSN 1179-318X.PMC 5841333.PMID 29535563. ^DiagnosticandStatisticalManualofMentalDisorders5.AmericanPsychiatricAssociation.2013.p. 454.ISBN 978-0-89042-555-8. ^GenderIdentityDisorders.inHarveyMarcovitch,ed.Black'sMedicalDictionary,43rdedition,NewYork:Bloomsbury,2018 ^abcdefZucker,KennethJ.(2017)."Epidemiologyofgenderdysphoriaandtransgenderidentity".SexualHealth.14(5):404–411.doi:10.1071/SH17067.ISSN 1448-5028.PMID 28838353. ^Conron,KJ;Scott,G;Stowell,GS;Landers,S(January2012),"TransgenderHealthinMassachusetts:ResultsfromaHouseholdProbabilitySampleofAdults",AmericanJournalofPublicHealth,AmericanPublicHealthAssociation,102(1):118–222,doi:10.2105/AJPH.2011.300315,ISSN 1541-0048,OCLC 01642844,PMC 3490554,PMID 22095354,Between2007and2009,surveyparticipantsaged18to64yearsintheMassachusettsBehavioralRiskFactorSurveillanceSystem(MA-BRFSS;N=28662)wereasked:"Somepeopledescribethemselvesastransgenderwhentheyexperienceadifferentgenderidentityfromtheirsexatbirth.Forexample,apersonbornintoamalebody,butwhofeelsfemaleorlivesasawoman.Doyouconsideryourselftobetransgender?"[…]Werestrictedtheanalyticsampleto28176participantswhoansweredyesornotothetransgenderquestion(excludingn=364,1.0%weightedwhodeclinedtorespond.[…]Transgenderrespondents(n=131;0.5%;95%confidenceinterval[CI]=0.3%,0.6%)weresomewhatyoungerandmorelikelytobeHispanicthanwerenontransgenderrespondents. ^ClarkTC,LucassenMF,BullenP,DennySJ,FlemingTM,RobinsonEM,RossenFV(July2014)."Thehealthandwell-beingoftransgenderhighschoolstudents:resultsfromtheNewZealandadolescenthealthsurvey(Youth'12)".TheJournalofAdolescentHealth.55(1):93–9.doi:10.1016/j.jadohealth.2013.11.008.PMID 24438852.Whetherastudentwastransgenderwasmeasuredbythequestion,"Doyouthinkyouaretransgender?Thisisagirlwhofeelslikesheshouldhavebeenaboy,oraboywhofeelslikeheshouldhavebeenagirl(e.g.,Trans,Queen,Fa’faffine,Whakawahine,TangatairaTane,Genderqueer)?"[…]Over8,000students(n=8,166)answeredthequestionaboutwhethertheyweretransgender.Approximately95%ofstudentsdidnotreportbeingtransgender(n=7,731;94.7%),96studentsreportedbeingtransgender(1.2%),202reportednotbeingsure(2.5%),and137didnotunderstandthequestion(1.7%). ^LandénM,WålinderJ,LundströmB(April1996)."Prevalence,incidenceandsexratiooftranssexualism".ActaPsychiatricaScandinavica.93(4):221–3.doi:10.1111/j.1600-0447.1996.tb10638.x.PMID 8712018.S2CID 26661088.Onaverage,themale[tofemale]:female[tomale]ratioinprevalencestudiesisestimatedtobe3:1.However[…]theincidencestudieshaveshownaconsiderablylowermale[tofemale]predominance.InSwedenandEnglandandWales,asexratioof1:1hasbeenreported.InthemostrecentincidencedatafromSweden,thereisaslightmale[tofemale]predominanceamongthegroupconsistingofallapplicantsforsexreassignment,whileinthegroupofprimary[earlyonset]transsexualsthereisnodifferenceinincidencebetweenmenandwomen. ^KohJ(2012)."[Thehistoryoftheconceptofgenderidentitydisorder]".SeishinShinkeigakuZasshi=PsychiatriaetNeurologiaJaponica.114(6):673–80.PMID 22844818. ^Pauly,IraB.(1993)."TerminologyandClassificationofGenderIdentityDisorders".JournalofPsychology&HumanSexuality.5(4):1–14.doi:10.1300/J056v05n04_01. ^Drescher,Jack,Transsexualism,GenderIdentityDisorderandtheDSM,JournalofGay&LesbianMentalHealth14,no.2(2010):112. ^Bryant,KarlEdward(2007).ThePoliticsofPathologyandtheMakingofGenderIdentityDisorder.AnnArbor,Michigan.p. 222.ISBN 978-0-549-26816-1. ^abGiordano,Simona(2012).ChildrenwithGenderIdentityDisorder:AClinical,Ethical,andLegalAnalysis.NewJersey:Routledge.p. 147.ISBN 978-0-415-50271-9. ^abVaseyPL,BartlettNH(2007)."WhatcantheSamoan"Fa'afafine"teachusabouttheWesternconceptofgenderidentitydisorderinchildhood?".PerspectivesinBiologyandMedicine.50(4):481–90.doi:10.1353/pbm.2007.0056.PMID 17951883.S2CID 37437172. ^DiagnosticandStatisticalManualofMentalDisorders5.AmericanPsychiatricAssociation.2013.p. 459.ISBN 978-0-89042-555-8. ^abNSWRegistrarofBirths,DeathsandMarriagesvNorrie[2014]HCA11(2April2014),HighCourt(Australia). ^Lev,ArleneIstar(2004).TransgenderEmergence:TherapeuticGuidelinesforWorkingwithGender-VariantPeopleandTheirFamilies.HaworthPress.p. 172.ISBN 978-0-7890-2117-5. ^Rudacille,Deborah(February2005).TheRiddleofGender:Science,Activism,andTransgenderRights.Pantheon.ISBN 978-0-375-42162-4.[page needed] ^Zucker,KJ;Spitzer,RL(Jan–Feb2005),"WasthegenderidentitydisorderofchildhooddiagnosisintroducedintoDSM-IIIasabackdoormaneuvertoreplacehomosexuality?Ahistoricalnote.",JournalofSexandMaritalTherapy,31(1):31–42,doi:10.1080/00926230590475251,PMID 15841704,S2CID 22589255 ^ab"ControversyContinuestoGrowOverDSM'sGIDDiagnosis".PsychiatricNews. ^Ford,Zack."APARevisesManual:BeingTransgenderisNoLongeraMentalDisorder".ThinkProgress.ArchivedfromtheoriginalonFebruary2,2013.RetrievedApril7,2013. ^Mallon,GeraldP.(2009).SocialWorkPracticewithTransgenderandGenderVariantYouth.NewJersey:Routledge.ISBN 978-0-415-99482-8. ^"GovernmentPolicyconcerningTranssexualPeople".People'srights/Transsexualpeople.U.K.DepartmentforConstitutionalAffairs.2003.ArchivedfromtheoriginalonMay11,2008. ^"Latranssexualiténeseraplusclasséecommeaffectationpsychiatrique".LeMonde.May16,2009. ^"LaFranceesttrèsenretarddanslapriseenchargedestranssexuels".Libération(inFrench).May17,2011.Enréalité,cedécretn'aétériend'autrequ'uncoupmédiatique,untrèsbeleffetd'annonce.Surleterrain,rienn'achangé. ^"Denmarkwillbecomefirstcountrytonolongerdefinebeingtransgenderasamentalillness".TheIndependent.May14,2016. ^Benestad,E.E.P.(October2010)."Fromgenderdysphoriatogendereuphoria:Anassistedjourney".Sexologies.19(4):225–231.doi:10.1016/j.sexol.2010.09.003.ISSN 1158-1360. Furtherreading[edit] Conway,Lynn(June26,2014)."SuccessfulTransMen:LinksandPhotos".ai.eecs.umich.edu.RetrievedDecember2,2014. Conway,Lynn(February5,2011)."TranssexualWomen'sSuccesses:LinksandPhotos".ai.eecs.umich.edu.RetrievedDecember2,2014. Jacques,Juliet."ATransgenderJourney".TheGuardian.RetrievedDecember2,2014. Sharp,VictoriaMadeleine;Lewis,CliveBuckland;Lieven,NatalieMarieDaniella."BellvTavistock"(PDF).IntheHighCourtofJusticeAdministrativeCourtDivisionalCourt([2020]EWHC3274(Admin)):CO/60/2020. WorldProfessionalAssociationforTransgenderHealth(2012).StandardsofCareforGenderIdentityDisorders(PDF).HarryBenjaminInternationalGenderDysphoriaAssociation.Archivedfromtheoriginal(PDF)onSeptember24,2014.IncludesadescriptionofICD-10criteria. Externallinks[edit] ClassificationDICD-10:F64.9,F64.8ICD-9-CM:302.85MeSH:D000068116ExternalresourcesMedlinePlus:001527 HealthLawStandardsofCareforTranssexualism–AnalternativetotheBenjaminStandardsofCareproposedbytheInternationalConferenceonTransgenderLawandEmploymentPolicy. 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