Transgender and Gender Dysphoria: Viewpoints on Clinical Care and Psychological Stress

Abstract

Gender identity is a topic of growing interest in mental health research. People with non-conforming gender identity are prone to suffer from stigmatization and bullying, and often present with psychiatric issues. Transgender denotes the broad spectrum of individuals who identify differently from their assigned gender. Some transgender people meet the requirements of the "gender dysphoria" (GD) diagnosis in the DSM-5-TR (diagnostic and statistical manual of mental disorders, fifth edition, text revision). When these individuals seek or undergo a social transition from male to female or female to male, which in many, but not all, cases also involves a somatic transition by cross-sex hormone treatment and genital (gender affirming) surgery, they are categorized as "transsexual". There are two requirements for transgender identity recognition in Taiwan: two psychiatrists' certificates of GD and the surgical removal of external and internal genitalia. In the DSM-5-TR, GD, as a general descriptive term, refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. GD manifests itself differently in different age groups. Several developmental-stage-dependent hormonal treatment options are available for GD. Puberty may exacerbate dysphoria due to the development of unwanted secondary sexual characteristics, which may be suppressed using a gonadotropin-releasing hormone agonist. On the other hand, gender-affirming hormones (aka cross-sex hormonal therapy) allow individuals to actively masculinize or feminize their physical appearance to become more consistent with their gender identity. In addition to biological treatment, psychosocial intervention is another key point for transgender people. These individuals experience higher risks of violence victimization, suicide, and sexual violence than their cisgender peers. Several studies have also indicated the presence of an association between autism spectrum disorder and GD. Mental health professionals should address these issues in practice and seek further understanding from transgender people.