Gender dysphoria

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Gender dysphoria /
Gender identity disorder
Classification and external resources
Specialty Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value).
ICD-10 F64.9, F64.8
ICD-9-CM 302.85
MedlinePlus 001527
Patient UK Gender dysphoria
MeSH D005783
[[[d:Lua error in Module:Wikidata at line 863: attempt to index field 'wikibase' (a nil value).|edit on Wikidata]]]

Gender dysphoria or gender identity disorder (GID) is the formal diagnosis used by psychologists and physicians to describe people who experience significant dysphoria (distress) with their biological sex. In most cases, this syndrome is a symptom of other anxieties and can be caused by obsession with very crude and rigid gender stereotypes e.g. "boys play sport, girls like pink".

Rapid Onset Gender Dysphoria is a term for the phenomenon seen in children or adolescents who have always accepted their biological sex but suddenly become obsessed with changing it. Research indicates that this is causes by exposure to transgender ideas in the peer-group or in the media, and it is related to stress factors.

The research of Professor Paul Hewson in the UK reveals that among young people who suddenly develop GID, 49% say they have been sexually abused. [1]

Myths and Fallacies

There is a myth spread by the transgender lobby that people are born with an "innate gender identity". There is no scientific basis for this and the people who assert it are neither scientists nor researchers.

There is another myth that surgery can cure the condition by changing your sex, but this is as much a delusion as the belief that you are really a different sex from your body. Surgery can only make a healthy person into a eunuch. So-called sex-change or "gender-reassignment" treatment consists of taking sex hormones, removing breasts or male genitalia, and creating an artificial imitation of the organs of the opposite sex, but these are non-functional. The person who has undergone this surgery is sterile, cannot experience sexual function and is never a member of the opposite sex. Their original XX or XY chromosomes remain in every cell of their body.

Myth number three is that people suffering from GID must be allowed to "transition" or they will commit suicide. In fact long-term follow-up studies show that the danger of suicide becomes higher after sex-change treatment. [2]

Political Influence on Diagnosis

In 2018 the transgender lobby persuaded the WHO to de-classify GID as a mental illness, but this was plainly a political move, not based on medical research or objective evidence.

Theories

There is very little evidence to suggest that GID is attributable to biological causes e.g genetics, or prenatal exposure to hormones.[3]

Estimates of the prevalence of gender dysphoria or GID range from a lower bound of 1:2000 (or about 0.05%) in the Netherlands and Belgium[4] to 0.5% of Massachusetts adults[5] to 1.2% of New Zealand high-school students.[6] These numbers are based on those who identify as transgender. It is estimated that about 0.005% to 0.014% of males and 0.002% to 0.003% of females would be diagnosed with gender dysphoria, based on current diagnostic criteria.[7] Research indicates people who transition in adulthood are up to three times more likely to be male assigned at birth, but that among people transitioning in childhood the sex ratio is close to 1:1.[8]

GID is classified as a medical disorder by the ICD-10 CM[9] and DSM-5 (called gender dysphoria).[10] Many transgender people and researchers support declassification of GID because they say the diagnosis pathologizes gender variance, reinforces the binary model of gender,[11] and can result in stigmatization of transgender individuals.[10] The official classification of gender dysphoria as a disorder in the DSM-5 may help resolve some of these issues, because the term gender dysphoria applies only to the discontent experienced by some persons resulting from gender identity issues.[10]

The current main psychiatric approaches to treatment for persons diagnosed with GID are psychotherapy or to support the individual's preferred gender through hormone therapy, gender expression and role, or surgery.[12]

Signs and symptoms

Symptoms of GID in children include disgust at their own genitalia, social isolation from their peers, anxiety, loneliness and depression.[13] According to the American Psychological Association, transgender children are more likely to experience harassment and violence in school, foster care, residential treatment centers, homeless centers and juvenile justice programs than other children.[14]

Adults with GID are at increased risk for stress, isolation, anxiety, depression, poor self-esteem and suicide.[13] Studies indicate that transgender people have an extremely high rate of suicide attempts; one study of 6,450 transgender people in the United States found 41% had attempted suicide, compared to a national average of 1.6%. It also found that suicide attempts were less common among transgender people who said their family ties had remained strong after they came out, but even transgender people at comparatively low risk were still much more likely to have attempted suicide than the general population.[15][16] Transgender people are also at heightened risk for certain mental disorders[17] such as eating disorders.[18][19]

In 2014, a researcher found that the brains of adolescents with gender dysphoria react to the sex hormone androstadienone in a measurable way similar to the brains of people of the gender with which the person identifies.[20]

Causes

There is growing evidence that gender dysphoria is caused by exposure to the propaganda of the LGBT movement. Other factors can be parental influence, childhood trauma associated with sexual abuse or adolescent anxiety. Gender dysphoria is a contagious mental illness and may be transmitted by example and imitation. A high percentage of children diagnosed with "gender dysphoria" are later found to be autistic.

Parental Preference

Parental preference and prejudice is a leading cause of gender dysphoria. Children sense even from babyhood that a parent preferred a child of the other sex, and suffer misery, then try to change themselves to please the parent.

Nancy Verhelst, a Belgian woman who died in 2013 at the age of 44, was a classic example of a person whose gender dysphoria was caused by parental preference. "I was the girl that nobody wanted," Verhelst told Het Laatste Nieuws newspaper in the hours before her death. "While my brothers were celebrated, I got a storage room above the garage as a bedroom. 'If only you had been a boy', my mother complained. I was tolerated, nothing more." Suffering such cruelty and rejection, no wonder Nancy wanted to be a man. She changed her name to Nathan at the age of 42. Verhelst started using male hormones in 2009, followed by a mastectomy and surgery to construct a penis in 2012. But "none of these operations worked as desired". The surgery was reported as "botched" but in fact phalloplasty and sex re-assignment are never simple or straightforward and often require a series of up to 30 operations. Her disappointment was inevitable as phalloplasty is a crude and unconvincing adaptation of the female body to impersonate the male. The resulting "penis" is neither realistic nor functional.

"I was ready to celebrate my new birth," Verhelst told the newspaper. "But when I looked in the mirror, I was disgusted with myself. My new breasts did not match my expectations and my new penis had symptoms of rejection. I do not want to be... a monster." In fact any new appendage on the body will always have "symptoms of rejection" caused by the body's own healthy immune system fighting back. Suppressant drugs often have to be used for a long time, and this risks health damage in many other respects. Moreover, the ability for sexual arousal and pleasure is permanently destroyed. See Trans man.[21]

Verhelt was so depressed after the surgery that she persuaded a doctor to end her life by euthanasia. When her mother was told about this, she responded callously, saying the death did not bother her. ""When I saw 'Nancy' for the first time, my dream was shattered. She was so ugly. I had a phantom birth. Her death does not bother me," she told Het Laatste Nieuws newspaper. "For me, this chapter is closed. Her death does not bother me. I feel no sorrow, no doubt or remorse. We never had a bond." [22]

Biological Causes

There are no biological causes for gender dysphoria. One study that claimed there were was based on a laughably tiny sample of only six people and their ability to smell one substance.[23] [3] Zhou et al. (1995), in a study of six individuals, found that in one area of the brain, transsexual people who were assigned male at birth have a typically female structure, and transsexual people who were assigned female at birth have a typically male structure.[24] [25]

Diagnosis

The American Psychiatric Association permits a diagnosis of gender dysphoria if the criteria in the Diagnostic and Statistical Manual of Mental Disorders (5th Edition), or DSM-5, are met. The DSM-5 moved this diagnosis out of the sexual disorders category and into a category of its own, under pressure from LGBT activists and lobby groups. The change was not a scientific decision.[26] The DSM-5 states that at least two of the criteria for gender dysphoria must be experienced for at least six months' duration in adolescents or adults for diagnosis.[27] The diagnosis was renamed from "Gender Identity Disorder" to "Gender Dysphoria", after criticisms that the former term was stigmatizing.[28] Subtyping by sexual orientation was deleted. The diagnosis for children was separated from that for adults. The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing, or ability to express it in the event that they have insight.[29]

The International Classification of Diseases (ICD-10) list three diagnostic criteria for "transsexualism" (F64.0):[12] Uncertainty about gender identity which causes anxiety or stress is diagnosed as sexual maturation disorder, according to the ICD-10.[30]

Management

Treatment for a person diagnosed with GID may include psychotherapy or to support the individual's preferred gender through hormone therapy, gender expression and role, or surgery. This may include psychological counseling, resulting in lifestyle changes, or physical changes, resulting from medical interventions such as hormonal treatment, genital surgery, electrolysis or laser hair removal, chest/breast surgery, or other reconstructive surgeries. The goal of treatment may simply be to reduce problems resulting from the person's transgender status, for example, counseling the patient in order to reduce guilt associated with cross-dressing, or counseling a spouse to help them adjust to the patient's situation.[31]

Hormone treatment or surgery for GID is somewhat controversial because of the irreversibility of physical changes. Guidelines have been established to aid clinicians. The World Professional Association for Transgender Health (WPATH) Standards of Care are used by some clinicians as treatment guidelines. Others use guidelines outlined in Gianna Israel and Donald Tarver's Transgender Care. Guidelines for treatment generally follow a "harm reduction" model.[32][33][34]

Prepubescent children

The question of whether to counsel young children to be happy with their assigned sex or to encourage them to continue to exhibit behaviors that do not match their assigned sex—or to explore a transsexual transition—is controversial. Some clinicians report that a significant proportion of young children diagnosed with gender identity disorder later do not exhibit the dysphoria.[35]

Professionals who treat gender identity disorder in children have begun to refer and prescribe hormones, known as a puberty blocker, to delay the onset of puberty until a child is believed to be old enough to make an informed decision on whether hormonal gender reassignment leading to surgical gender reassignment will be in that person's best interest.[36] The vast majority of children who are put on puberty blockers remain gender dysphoria. Of those whose puberty is allowed to continue, 85% recover.

Psychological treatments

Until the 1970s, psychotherapy was the primary treatment for GID, and generally was directed to helping the person adjust to the gender of the physical characteristics present at birth. Psychotherapy is any therapeutic interaction that aims to treat a psychological problem. Though some clinicians still use only psychotherapy to treat GID, it may now be used in addition to biological interventions as treatment for GID.[37] Psychotherapeutic treatment of GID involves helping the patient to adapt. Attempts to "cure" GID by changing the patient's gender identity to reflect birth characteristics have been ineffective.[38]:1568

Biological treatments

Biological treatments physically alter primary and secondary sex characteristics to reduce the discrepancy between an individual's physical body and gender identity.[39] Biological treatments for GID without any form of psychotherapy is quite uncommon. Researchers have found that if individuals bypass psychotherapy in their GID treatment, they often feel lost and confused when their biological treatments are complete.[40]

Psychotherapy, hormone replacement therapy, and sex reassignment surgery together can be effective treating GID when the WPATH standards of care are followed.[38]:1570 The overall level of patient satisfaction with both psychological and biological treatments is very high.[37]

History

The term gender identity disorder is an older term for the condition. Some groups, including the American Psychiatric Association (APA), use the term gender dysphoria.[41] The APA's Diagnostic and Statistical Manual first described the condition in the third publication ("DSM-III") in 1980.[42]

In April 2011, the UK National Research Ethics Service approved prescribing monthly injection of puberty-blocking drugs to youngsters from 12 years old, in order to enable them to get older before deciding on formal sex change. The Tavistock and Portman NHS Foundation Trust (T&P) in North London has treated such children. Clinic director Dr. Polly Carmichael said, "Certainly, of the children between 12 and 14, there's a number who are keen to take part. I know what's been very hard for their families is knowing that there's something available but it's not available here." The clinic received 127 GID referrals in 2010.[43]

The T&P completed a three-year trial to assess the psychological, social and physical benefits and risks involved for 12- to 14-year-old patients. The trial was deemed such a success that doctors have decided to make the drugs more widely available and to children as young as 9 years of age. As recently as 2009, national guidelines stated that treatment for GID should not start until puberty had finished. Ferring Pharmaceuticals manufactures the drug Triptorelin, marketed under the name Gonapeptyl, at £82 per monthly dose. The treatment is reversible, which means the body will resume its previous state upon discontinuation of drugs. MP (Member of Parliament) Andrew Percy said "I think many people will be horrified at the thought of a nine-year-old being provided with a drug that effectively stops them developing and maturing naturally."[44] MP (Member of Parliament) Mark Pritchard said, "With competing NHS resources, especially for life-saving cancer drugs, there needs to be an immediate investigation into why these drugs are being prescribed to those so young."[45]

In May 2014, Carmichael said,

Now we’ve done the study--and the results thus far have been positive--we’ve decided to continue with it. So we’ve decided to do “stage not age” (as the criterion) because it’s obviously fairer. Twelve is an arbitrary age. If they started puberty aged nine or ten instead of 12, as long as they’re monitored and the bone density doesn’t suffer, then it is right that the aim is to stop the development of secondary sex characteristics.[45]


Classification as a disorder

The psychiatric diagnoses of gender identity disorder (now gender dysphoria) was introduced in the DSM-III in 1980. Some sources have characterized the addition as a political maneuver to re-stigmatize homosexuality.[46][47] (Homosexuality was removed from the DSM-II in 1974.) By contrast, Kenneth Zucker and Robert Spitzer argue that gender identity disorder was included in the DSM-III because it "met the generally accepted criteria used by the framers of DSM-III for inclusion."[48] Some researchers, including Robert Spitzer and Paul J. Fink, contend that the behaviors and experiences seen in transsexualism are abnormal and constitute a dysfunction.[49]

Individuals with gender dysphoria may or may not regard their own cross-gender feelings and behaviors as a disorder. Advantages and disadvantages exist to classifying gender dysphoria as a disorder.[12] Because gender dysphoria is classified as a disorder in medical texts (such as the previous DSM manual, the DSM-IV-TR, under the name "gender identity disorder"), many insurance companies are willing to cover some of the expenses of sex reassignment therapy. Without the classification of gender dysphoria as a medical disorder, sex reassignment therapy may be viewed as cosmetic treatment, rather than medically necessary treatment, and may not be covered.[50] In the United States, transgender people are less likely than others to have health insurance, and often face hostility and insensitivity from healthcare providers.[51]

The DSM-IV-TR diagnostic component of distress is not inherent in the cross-gender identity; rather, it is related to social rejection and discrimination suffered by the individual.[52] Psychology professor Darryl Hill insists that gender dysphoria is not a mental disorder, but rather that the diagnostic criteria reflect psychological distress in children that occurs when parents and others have trouble relating to their child's gender variance.[49] Transgender people have often been harassed, socially excluded, and subjected to discrimination, abuse and violence, including murder.[13][53]

In December 2002, the British Lord Chancellor's office published a Government Policy Concerning Transsexual People document that categorically states, "What transsexualism is not ... It is not a mental illness."[54] In May 2009, the government of France declared that a transsexual gender identity will no longer be classified as a psychiatric condition.[55]

In August 31, 2010, Thomas Hammarberg, Commissioner for Human Rights within the Strasbourg-based Council of Europe, an independent institution, opposed the mental disorder classification and the sterilization of transgender persons as a requirement for legal sex change.[56] The Principle 3 of The Yogyakarta Principles on The Application of International Human Rights Law In Relation to Sexual Orientation and Gender Identity states, "Persons of diverse sexual orientation and gender identities shall enjoy legal capacity in all aspects of life. Each person's self-defined sexual orientation and gender identity is integral to their personality and is one of the most basic aspects of self-determination, dignity and freedom," and the Principle 18 states, "Notwithstanding any classifications to the contrary, a person's sexual orientation and gender identity are not, in and of themselves, medical condition and are not to be treated, cured or suppressed."[citation needed]

Intimate relationships

Intimate relationships between lesbians and female-to-male people with GID will sometimes endure throughout the transition process, or shift into becoming supportive friendships. Intimate relationships between heterosexual women and male-to-female people with GID often suffer once the GID is known or revealed. Researchers say the fate of the relationship seems to depend mainly on the woman's adaptability. Problems often arise, with the cisgender partner becoming increasingly angry or dissatisfied, if her partner's time spent in a female role grows, if her partner's libido decreases, or if her partner is angry and emotionally cut-off when in the male role. Cisgender women sometimes also worry about social stigma and may be uncomfortable with the bodily feminization of their partner as the partner moves through transition. The cisgender women who are likeliest to accept and accommodate their partner's transition, researchers say, are those with a low sex drive or those who are equally sexually attracted to men and women.[57]

Legislation

In California, Assembly Bill (AB) No. 1266, authored by Assemblyman Tom Ammiano (D-San Francisco), was passed in May 2013 by the State Assembly:

Existing law prohibits public schools from discriminating on the basis of specified characteristics, including gender, gender identity, and gender expression, and specifies various statements of legislative intent and the policies of the state in that regard. Existing law requires that participation in a particular physical education activity or sport, if required of pupils of one sex, be available to pupils of each sex. This bill would require that a pupil be permitted to participate in sex-segregated school programs, activities, including athletic teams and competitions, and use facilities consistent with his or her gender identity, irrespective of the gender listed on the pupil's records.[58]

The California Catholic Conference opposed the bill as unnecessary, as laws exist already to fight discrimination against transgender students. A spokeswoman for the conference said that the issue should be handled by school officials.[58]

Petitions were collected to require a referendum on the legislation in question, but the Secretary of State of California, Debra Bowen, issued a decision determining that, due to disqualified signatures, the threshold of votes had not been reached to force the referendum in question.[59] Pacific Justice and Capitol Resource institutes, representing opponents of AB 1266, dispute this, filing a lawsuit, opposed by the State of California, to have the disqualified signatures validated and petitioners' names made public, which the State argues are confidential. Pro-referendum forces claim votes were mishandled due to malfeasance and incompetence in Tulare and Mono counties, respectively.[59]

See also

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Further reading

External links