Gender Dysphoria

By Eva R. Montoya, MA-Psy, ASN. EMT-B

What is gender dysphoria?

Gender dysphonia, described by DSM-5, is a mental distress, not a mental disorder. Gender dysphoria or Gender Identity Disorder (GID) is when an individual is born one gender (male or female), though has the mind of the opposite gender. For example, a male is born, but the brain of the individual develops as female. It is unknown whether the brain develops as the opposite gender during gestation or during puberty. Some psychologists and medical specialists suggest that the right caudate nucleus and hypothalamus in the brain starts to develop as the opposite gender somewhere between childhood (birth to puberty) and adolescence (puberty to early adulthood).

What is the difference between gender dysphoria and GID?

There is little difference between gender dysphoria and GID, but every individual diagnosed with gender dysphoria (DSM-5) is also diagnosed with gender identity disorder. Here is the difference: Gender identity disorder is the main diagnosis of a transgender person; being born in the wrong body. Dysphoria, coming from the Greek term dysphoros, meaning unhappy, the sense of unhappiness or poor well beings gives the term gender dysphoria as a person diagnosed with gender identity disorder with great distress over the situation. They feel anxiety and strong desires to be the opposite sex and rid themselves of their natural gender characteristics. They also feel strong convictions of their feelings as being the gender they identify with.

What are the signs and symptoms of gender dysphoria and GID?
The signs that children can display that may lead to a diagnosis of gender identity disorder are acquiring strong characteristics of the opposite sex. Although, this brings forth a question psychologists have pondered on for century- is it nature or nurture? A person that displays characteristics of the opposite gender and is diagnosed with gender identity disorder is nature. Depending on the role models, environment, and influence on an individual during childhood can nurture them to display characteristics of the opposite gender but does not mean that the child has gender identity disorder.

How is gender identity disorder diagnosed?

Legally, a medical doctor, psychiatrist, therapist, or psychologist practicing therapeutic services must make the initial diagnosis of gender identity disorder according the guidelines set from the American Psychiatric Associations (APA) DSM-5. The DSM-5 is a book of guidelines set by the APA to correctly diagnose mental, dissociative, and certain medical disorders. The guidelines for diagnosing GID are: (source; DSM-5 2013)

For a person to be diagnosed with gender dysphoria, there must be a marked difference between the individuals expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months. In children, the desire to be of the other gender must be present and verbalized. This condition causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Gender dysphoria is manifested in a variety of ways, including strong desires to be treated as the other gender or to be rid of ones sex characteristics, or a strong conviction that one has feelings and reactions typical of the other gender. The DSM-5 diagnosis adds a post-transition specifier for people who are living fulltime as the desired gender (with or without legal sanction of the gender change). This ensures treatment access for individuals who continue to undergo hormone therapy, related surgery, or psychotherapy or counseling to support their gender transition.

What treatments are available for gender dysphoria?

Treatments available for gender dysphoria are psychotherapeutic counseling. Once there is no longer dysphoria present, the treatments for gender identity disorder can begin. The ultimate treatment for GID is fully transitioning into the desired gender and gender roll. Anti-testosterone/estrogen blockers are used to block out the affects of the bodys natural chemistries (set from puberty), hormone replacement therapy (testosterone or estrogen) is given to the individual in pill or injection form, resulting in the body to go through puberty again- but this time with the desired gender form. The transgender individual must go through two years of psychotherapeutic counseling and live life as the desired gender two years before a transgender issues specialist (a plastic surgeon with experience in the recreation of genitalia).

What is sexual reassignment surgery; a treatment for GID?

Sexual reassignment surgery (SRS) is the recreation of ones genitalia to match the desired gender. Female to male sexual reassignment consists of hormone replacement therapy. The individual is given estrogen blockers to block the ovaries duty to feminize the body, and testosterone injections are given to form the female body characteristics into more masculine characteristics. During hormone replacement, the individual will start to grow facial and body hair, and the muscles will start to become more noticeable as a male. The clitoris will also grow up to 3 inches, ultimately forming a penis like structure. During SRS, a urologist will reroute the urethra into the thickened clitoris, and skin is taken from fatty areas and used to create a longer penis. Three chambers are placed inside the penis for erection. The scrotum is created again out of fatty tissue used from the thighs, buttocks, or back and a pump is placed inside the scrotum (made to look and feel like testicles) but used to pump the internal penile pump to achieve erection and have intercourse.

Male to female SRS is very different. After hormone replacement, the penis is reconstructed into a vagina. A part of the glans (tip of the penis) is constructed into a clitoris, the shaft is inverted and made into the vaginal walls (fatty tissue is also abstracted and used), and the other part of the glans are used inside the vaginal walls for sexual stimulation and a g-spot. The labia minora, labia majora, and hymen are constructed by fine fatty tissue, usually from the back of the thighs. The urethra is then rerouted under the newly designed clitoris and the construction of the vagina (vaginoplasty) is now complete. When reconstructed by a well experienced L.A.C.S. Plastic Surgeon with a significant amount of training in sexual reassignment surgery, it is said that without an extensive vaginal exam, there is no way to tell that the now female patient was born male. The healing time for both male and female post-operative patients very depending on clotting abilities, bruising, and dissolvable staples.