Gender Dysphoria (GD): what role for the psychiatrist?

Abstract

The psychiatrist has two objectives: • Avoid unsatisfactory results (10% of patients): in subjects whose psychological and social conditions has worsened after the operation. Transitory and definitive definitive regrets are expressed in respectively 10 and 2% of patients. Sex reassignment surgery improves psychological conditions for most of patients, but the rates of severe depression and suicide are significantly higher than in general population • Optimize a successful transformation in terms of patient's global satisfaction and psycho-social adaptation to the new gender. • The psychiatrist's role: • Confirm GD diagnostic, • Establish the differential diagnosis of GD related to or associated with a psychiatric pathology, • Detect and inform the patient about negative predictive factors that concern him/her and that should be used to discuss the benefits of a surgical conversion, • Detect unrealistic expectations to prevent undue frustrations and disappointments that will impact the surgical team, • Make sure that the patient fully understands the limitations and consequences of SRS, • Propose him personalized care, • Prepare him to the transformation during the real life experience, • Help him to confront difficulties implied by the transformation. The objective of psychiatric assessment is not to restrict access to SRS but to identify vulnerable patients. The psychic predictive factors of a pre-operative evolution of post-sex change disorders must be discussed within the team. Even if these vulnerability factors are not contra-indications to sex change, they should lead to caution in order for the surgeon to be able to assess the impact of the surgical act.