GENDER

DYSPHORIA
Raynand Sorita De Rosas
GENDER DYSPHORIA
  In DSM- V Gender Dysphoria has replaced Gender
Identity Disorder.
 The current term is more descriptive than the previous
DSM-IV term gender identity disorder and focuses on
dysphoria as the clinical problem, not identity per se
 Gender Dysphoria can be diagnosed at two different life
stages, either during Childhood and adolescence or
adulthood
GENDER DYSPHORIA
Definition
 Gender dysphoria refers to the distress that may
accompany the incongruence between one's experienced
or expressed gender and one's assigned gender. Although
not all individuals will experience distress as a result of
such incongruence, many are distressed if the desired
physical interventions by means of hormones and/or
surgery are not available.
 Gender dysphoria is discomfort with ones sex-relevant
physical characteristics or with one’s assigned gender
 Duration of at least 6 months
 GENDER DYSPHORIA IN CHILDREN
Girls with gender dysphoria :
 May express the wish to be a boy, assert they are a boy,
or assert they will grow up to be a man.
 Prefer boys' clothing and hairstyles, are often perceived
by strangers as boys, and may ask to be called by a boy's
name.
 Display intense negative reactions to parental attempts to
have them wear dresses or other feminine attire.
 Some may refuse to attend school or social events where
such clothes are required.
 These girls may demonstrate marked cross-gender
identification in role-playing, dreams, and fantasies.
 Contact sports, rough-and-tumble play, traditional
boyhood games, and boys as playmates are most often
preferred.
 They show little interest in stereotypically feminine toys
(e.g., dolls) or activities (e.g., feminine dress-up or role-
play)
BOYS WITH GENDER DYSPHORIA
  The wish to be a girl or assert they are a girl or that they
will grow up to be a woman.
 They have a preference for dressing in girls' or women's
clothes or may improvise clothing from available
materials
 e.g., using towels, aprons, and scarves for long hair or
skirts).
 These children may role play female figures (e.g.,
playing "mother") and often are intensely interested in
female fantasy figures.
 Traditional feminine activities, stereotypical games, and
pastimes (e.g., "playing house"; drawing feminine
pictures; watching television or videos of favorite female
characters) are most often preferred.
 Stereotypical female-type dolls (e.g.. Barbie) are often
favorite toys, and girls are their preferred playmates.
They avoid rough-and- tumble play and competitive
sports and have little interest in stereotypically
masculine toys (e.g., cars, trucks).
GENDER DYSPHORIA IN ADOLESCENTS
AND ADULTS
Young adolescents with gender dysphoria:
 Clinical features may resemble those of children or
adults with the condition, depending on developmental
level.
 As secondary sex characteristics of young adolescents
are not yet fully developed, these individuals may not
state dislike of them, but they are concerned about
imminent physical changes.
 ADULTS WITH GENDER DYSPHORIA
  The discrepancy between experienced gender and
physical sex characteristics is often, but not always,
accompanied by a desire to be rid of primary and/or
secondary sex characteristics and/or a strong desire to
acquire some primary / secondary sex characteristics of
the other gender.
 They may adopt the behavior, clothing, and mannerisms
of the experienced gender.
 They feel uncomfortable being regarded by others, or
functioning in society, as members of their assigned
gender.
CONTINUE……….
 Some adults may have a strong desire to be of a different
gender and treated as such, and they may have an inner
certainty to feel and respond as the experienced gender
without seeking medical treatment to alter body
characteristics.
 They may find other ways to resolve the incongruence
between experienced/ expressed and assigned gender by
partially living in the desired role or by adopting a
gender role neither conventionally male nor
conventionally female.
PSYCHIATRIC AND BIOLOGICAL
CAUSES
 It was traditionally thought to be a psychiatric condition
meaning a mental ailment. Now there is evidence that
the disease may not have origins in the brain alone.
 Studies suggest that gender dysphoria may have
biological causes associated with the development of
gender identity before birth.
 More research is needed before the causes of gender
dysphoria can be fully understood.
GENETIC CAUSES OF BIOLOGICAL SEX 
Hormonal causes :
 Hormones that trigger the development of sex and
gender in the womb may not function adequately.
 For example, anatomical sex from the genitals may be
male, while the gender identity that comes from the brain
could be female.
 This may result from the excess female hormones from
the mother’s system or by the fetus's insensitivity to the
hormones.
ANDROGEN RECEPTOR
 The research suggests reduced androgen and androgen
signaling contributes to the female gender identity of
male-to-female transsexuals.
 The authors say that a decrease in testosterone levels in
the brain during development might prevent complete
masculinization of the brain in male-to-female
transsexuals and thereby cause a more feminized brain
and a female gender identity
Other causes of gender dysphoria
 The loss of a female-specific CYP17 allele distribution
pattern is associated with FtM transsexuality.
 There may be chromosomal abnormalities that may lead
to gender dysphoria.
 Sometimes defects in normal human bonding and child
rearing may be contributing factor to gender identity
disorders.
LEARNING THEORY
 Learning theory and concepts derived from it tend to favor a
causative model in which the primary attachment figure(s) is
(are) postulated to exert an exogenous-reinforcing, active-
manipulative effect on the development of features typifying
the opposite sex.
 This explanatory approach ascribes primary importance to a
desire on the parent’s part for the child to be of the opposite
sex. A high rate of psychological abnormalities in the parents
of children with GD has been reported in more than one
study . It is essential, therefore, to explore thoroughly the
psychopathology of the child’s attachment figures and their
"sexual world view," including any sexually traumatizing
experiences they may have undergone, in order to discover
any potential "transsexual genic influences."
  TREATMENTS
PSYCHOTHERAPY
 Individuals can be taught about self awareness and
confidence needed to handle any issues arising in their
daily lives.
 The support of family members can be engaged through
the use of group, marital, and family therapy, which can
help in creating an accommodating and encouraging
environment
 Through the use of speech therapy, male-to- female
individuals with gender dysphoria can learn how to
engage their voice and sound a lot female while talking.
PHARMACOLOGIC THERAPY
 Many individuals, especially those desiring a complete
transformation will need hormonal therapy to enable that
process.
 For females seeking a male transformation, the hormone
testosterone will be helpful in promoting body hair.
 Some individuals may also have comorbid psychiatric
diagnoses, such as depression, anxiety, or psychosis.
These are best treated with medications like
antidepressants, anxiolytics, and antipsychotics.
SEXUAL REASSIGNMENT SURGERY
 SRS among teenagers remains a controversial topic, and
much debate continues on this issue. In many countries,
SRS is not available to teenagers, on the other hand,
having this treatment done in the early stages when
secondary sex characteristics are not fully formed, may
be helpful.
 In adults, there is a reported satisfactory result in 87
percent of male-to-female and 97 percent of female-to-
male SRS patients
 Opposite sex genitals reassignment.
HORMONE THERAPY
 If child has gender dysphoria and they've reached
puberty, they could be treated with gonadotropin-
releasing hormone (GnRH) analogues. These are
synthetic (man-made) hormones that suppress the
hormones naturally produced by the body.
 GnRH analogues suppress the hormones produced by
child’s body which in turn suppress puberty.
 The effects of treatment with GnRH analogues are
considered to be fully reversible, so treatment can
usually be stopped at any time after a discussion between
parent, effected child and doctor.