Gender Dysphoria In Adults Research Articles

Gender dysphoria in adults

Gender dysphoria (GD) is a condition where one feels distressed about one's assigned gender at birth. The construct has undergone successive revisions in understanding and terminology in contemporary classificatory systems. Currently, the terms “GD” and “gender incongruence” are used in the Diagnostic and Statistical Manual of Mental Disorders-5 and International Classification of Diseases-11, respectively. However, there continues to be a lack of clarity on terminologies used in describing related concepts. Sex is an inflexible categorical concept, whereas gender is a social construct. It is vital to understand and distinguish between sexual orientation and gender identity. Clarity in understanding and usage of these and other related terms in the field is central to addressing the issue of stigma faced by the members of the lesbian, gay, bisexual, transgender, queer, intersex, asexual+ (LGBTQIA+) community, an umbrella term used to denote individuals with nonconformative gender identity and orientation. Several clinical and ethical issues exist with diagnosing and managing GD such as optimal treatment of minors, fertility after gender affirming treatments, and dissatisfaction following gender reassignment. To clarify these issues and facilitate access to care for LGBTQIA+ individuals, the GD category has been retained in the classificatory systems despite activists calling for dropping the term from diagnostic manuals to minimize associated stigma. Other controversies in the area include inclusion of childhood GD diagnosis on the grounds of uncertainty of longitudinal trajectory of the clinical phenomenon and use of nonevidence-based, potentially harmful, treatments such as “conversion therapies.” There is a need to sensitize clinicians about these issues and mainstream them in the assessment and management of GD. Such an approach would aid development of culturally sensitive and evidence-based treatments for gender variance.

Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists

(Copyright © William Byne et al. 2018; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.).

Assessment and Treatment of Gender Dysphoria and Gender Variant Patients: A Primer for Psychiatrists.

Assessment and Treatment of Gender Dysphoria and Gender Variant Patients: A Primer for Psychiatrists.

Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists.

Regardless of their area of specialization, adult psychiatrists are likely to encounter gender-variant patients; however, medical school curricula and psychiatric residency training programs devote little attention to their care. This article aims to assist adult psychiatrists who are not gender specialists in the delivery of respectful, clinically competent, and culturally attuned care to gender-variant patients, including those who identify as transgender or transsexual or meet criteria for the diagnosis of Gender Dysphoria (GD) as defined by The Diagnostic and Statistical Manual of Mental Disorders (5th edition). The article will also be helpful for other mental health professionals. The following areas are addressed: evolution of diagnostic nosology, epidemiology, gender development, and mental health assessment, differential diagnosis, treatment, and referral for gender-affirming somatic treatments of adults with GD.

Genotypes and Haplotypes of the Estrogen Receptor α Gene (ESR1) Are Associated With Female-to-Male Gender Dysphoria

IntroductionGender dysphoria, a marked incongruence between one's experienced gender and biological sex, is commonly believed to arise from discrepant cerebral and genital sexual differentiation. With the discovery that estrogen receptor β is associated with female-to-male (FtM) but not with male-to-female (MtF) gender dysphoria, and given estrogen receptor α involvement in central nervous system masculinization, it was hypothesized that estrogen receptor α, encoded by the ESR1 gene, also might be implicated. AimTo investigate whether ESR1 polymorphisms (TA)n-rs3138774, PvuII-rs2234693, and XbaI-rs9340799 and their haplotypes are associated with gender dysphoria in adults. MethodsMolecular analysis was performed in peripheral blood samples from 183 FtM subjects, 184 MtF subjects, and 394 sex- and ethnically-matched controls. Main Outcome MeasuresGenotype and haplotype analyses of the (TA)n-rs3138774, PvuII-rs2234693, and XbaI-rs9340799 polymorphisms. ResultsAllele and genotype frequencies for the polymorphism XbaI were statistically significant only in FtM vs control XX subjects (P = .021 and P = .020). In XX individuals, the A/G genotype was associated with a low risk of gender dysphoria (odds ratio [OR] = 0.34; 95% CI = 0.16–0.74; P = .011); in XY individuals, the A/A genotype implied a low risk of gender dysphoria (OR = 0.39; 95% CI = 0.17–0.89; P = .008). Binary logistic regression showed partial effects for all three polymorphisms in FtM but not in MtF subjects. The three polymorphisms were in linkage disequilibrium: a small number of TA repeats was linked to the presence of PvuII and XbaI restriction sites (haplotype S-T-A), and a large number of TA repeats was linked to the absence of these restriction sites (haplotype L-C-G). In XX individuals, the presence of haplotype L-C-G carried a low risk of gender dysphoria (OR = 0.66; 95% CI = 0.44–0.99; P = .046), whereas the presence of haplotype L-C-A carried a high susceptibility to gender dysphoria (OR = 3.96; 95% CI = 1.04–15.02; P = .044). Global haplotype was associated with FtM gender dysphoria (P = .017) but not with MtF gender dysphoria. ConclusionsXbaI-rs9340799 is involved in FtM gender dysphoria in adults. Our findings suggest different genetic programs for gender dysphoria in men and women.Cortés-Cortés J, Fernández R, Teijeiro N, et al. Genotypes and Haplotypes of the Estrogen Receptor α Gene (ESR1) Are Associated With Female-to-Male Gender Dysphoria. J Sex Med 2017;14:464–472.

Development and validation of a measure for assessing gender dysphoria in adults: The Gender Preoccupation and Stability Questionnaire

ABSTRACTAvailable clinically useful questionnaires for people with gender dysphoria incorporate outdated binary male/female gender stereotypes. Moreover, no tools assess for gender dysphoria, a construct applicable to a gender-diverse population. This study's purpose was to develop and validate an instrument that overcame these shortcomings: the Gender Preoccupation and Stability Questionnaire (GPSQ). Method: The 14-item GPSQ was developed through consultation with patients with gender dysphoria and experts in the field. The scale was administered to three groups of participants: those seeking treatment for gender dysphoria and Control Groups 1 and 2 with no gender dysphoria.Participants were also administered the Gender Dysphoria questionnaire (a 27-item scale wherein gender dysphoria was based on a bipolar dichotomous identity, which is at one pole male and at the other pole female, with varying degrees of gender dysphoria existing between them). Results: The GPSQ showed acceptable internal consistency (α = .90), known groups, and convergent validity. The scale's sensitivity and positive predictive power were 88% and 91%, respectively. Conclusion: The GPSQ was shown to be an effective, valid, reliable outcome tool to measure gender dysphoria. The tool is likely suitable to measure the effectiveness of a number of clinical interventions within this population.

Surgical Treatment of Gender Dysphoria in Adults and Adolescents: Recent Developments, Effectiveness, and Challenges

In 1990 Green and Fleming concluded that sex reassignment surgery (SRS) is an effective treatment for transsexuality because it reduced gender dysphoria drastically. Since 1990, many new outcome st...

Recommendations for Revision of the DSM Diagnosis of Gender Identity Disorder in Adults

The World Professional Association for Transgender Health (WPATH) conducted a consensus process in order to make recommendations for revision of the DSM diagnoses of Gender Identity Disorders. This is a report from the work group proposing new diagnostic criteria for Gender Identity Disorders for adults if the diagnosis were to be retained in the next revision of the DSM. The group recommended changing the diagnosis to one based on distress rather than on identity, on which the current diagnosis is based. Hence, they proposed changing the name of the diagnosis from Gender Identity Disorder to the more accurate and less pathologizing Gender Dysphoria, a name familiar to the field, used before, and describing the condition of distress. They proposed the following criteria for a diagnosis of Gender Dysphoria in Adults: (a) strong and persistent distress with physical sex characteristics or ascribed social gender role that is incongruent with persistent gender identity, and (b) the distress is clinically significant or causes impairment in social, occupational, or other important areas of functioning and this distress or impairment is not solely due to external prejudice or discrimination. There was consensus that a transgender identity is not pathology. Gender variant individuals are not inherently disordered; rather, the distress of gender dysphoria is the psychological problem.