Gender dysphoria was formerly called gender identity disorder (GID). Gender dysphoria is the medical diagnosis for someone who feels a strong sense of discontent with the biological (physical) gender that he or she has been assigned. These individuals often feel a strong desire or need to belong to the sex opposite their own and will dress and behave in ways traditionally ascribed to the opposite gender. People with this condition are generally referred to as transgender.
Gender dysphoria is a complex condition in which individuals strongly identify with the gender opposite their own and feel trapped or stuck in the wrong body. To better understand this condition, a few terms must be defined:
Many people identify with, or conform to, traditional roles and expectations that the culture assigns to males and females. Sometimes, individuals may enjoy activities that are most often associated with the opposite sex. For example, someone who is biologically female may like to play football, and someone who is biologically male may like to do embroidery. Generally, this does not interfere with a person's sense that that she or he is female or male, and it does not mean that she or he has gender dysphoria. Gender dysphoria should not be confused with nonconformity to traditional or typical gender roles. People who do not conform with all aspects of traditional gender roles seldom have any desire to be the opposite sex.
Gender dysphoria goes beyond a failure or reluctance to identify with traditional roles or expectations about being female or male. There is nothing unusual about girls who prefer football to piano or boys who prefer needlepoint to tools. A person with gender dysphoria who is biologically female has a strong sense that she is a male. Likewise, a person with gender dysphoria who is biologically male has a strong belief that he is a female. Cross-gender identification often causes an incredible amount of distress and can impair a person's ability to function. When that occurs, a person is said to have gender dysphoria.
Gender nonconforming (GNC) is another, broader term that can include people with gender dysphoria, but it also includes people who identify with both genders or with neither gender.
Gender dysphoria is not the same as intersexuality, or intersex conditions. Intersex conditions may be marked, for example, by genitals * that are not completely male or female. The person with this condition may be genetically * male but physically female (or the opposite). For example, a male with an intersex condition would have the XY sex chromosomes of males, but his genitals might appear female. Although there are many variations and degrees of intersexuality, about 1 in 1,500 to 1 in 2,000 children are born with noticeably atypical genitalia.
There also is a difference between gender dysphoria and transvestitism. A cross-dresser or a transvestite becomes sexually excited by dressing in the clothes of the opposite sex. Often, the term transvestite is applied to gay or bisexual * men who dress in women's clothing, and the term cross-dresser is applied to heterosexual * men who dress in women's clothing. Transvestites and cross-dressers should not be confused with transgender persons (people with gender dysphoria) who cross-dress to gain a sense of physical and emotional completeness rather than sexual excitement.
The causes of gender dysphoria are uncertain. Some researchers think that biological factors play a role, and others think that environmental factors, such as the lack of a bond with a parent or caregiver during childhood, are involved. The more important question may be how to resolve the problems that gender dysphoria may create.
The emotional strain gender dysphoria causes is real, and for some adults, the only effective relief for this distress is a gender reassignment procedure, which usually involves sex-change surgical operations that remove and create physical genitalia. Because of the irreversible nature of these procedures, candidates must undergo extensive psychological screening and physical preparation that can take several years to complete.
Gender reassignment procedures begin with lengthy and detailed screenings, as well as psychological evaluations. These interviews determine the existence and severity of gender dysphoria. The person then is instructed about adopting a lifestyle that agrees with his or her gender identity, which is called real life experience (RLE). If people successfully adjust to this lifestyle change over a period of several months to a year, they often then begin hormone * Surgery
After patients successfully complete screening, psychological evaluation, RLE, and hormone therapy, they may undergo gender reassignment surgery. For males wishing to become females, hormone treatments may produce satisfactory breast development, although some people choose later to have breast enlargement surgery. Many people also elect to have a bilateral orchiectomy, or removal of the testicles, rendering the person infertile and without testosterone. In male to female reassignment, a tracheal shave may be performed in which the Adam's apple is made to appear smaller by removing part of the trachea * . Body and facial hair growth is reduced by the hormone treatments, and hair may also be removed by electrolysis * . Males who have gender reassignment surgery to become females undergo vaginoplasty, or the construction of a vagina from the penis, and are able to have sexual intercourse.
Females wishing to become males usually elect to have surgery to remove the breasts (bilateral mastectomy), the uterus * , and the ovaries * and to seal off the vagina * . The operation to construct a penis is extremely complicated, and the resulting penis is not capable of a natural erection. There are, however, artificial devices, such as erectile implants, which can be used to help the person achieve erection and successfully engage in sexual intercourse.
There have been several worldwide studies conducted to assess the outcomes of sex-change surgery. These studies have shown that 9 in 10 transsexuals who undergo hormonal and surgical sex-reassignment procedures experience a satisfactory result. One of the studies found that 94 percent of the people who underwent the surgery and answered questionnaires stated that if they had it to do over again, they would make the same choice.
See also Body Image • Lesbian, Gay, Bisexual, and Transgender (LGBT) Issues
Dreger, Alice. “Why Gender Dysphoria Should No Longer Be Considered a Medical Disorder.” Pacific and Standard, October 18, 2013. http://www.psmag.com/health-and-behavior/take-gender-identitydisorder-dsm-68308 (accessed October 21, 2015).
Sherer, Ilana, Joel Baum, Diane Ehrensaft, and Stephen M. Rosenthal. “Affirming Gender: Caring for Gender-Atypical Children and Adolescents.” Contemporary Pediatrics, January 1, 2015. http://contemporarypediatrics.modernmedicine.com/contemporarypediatrics/news/affirming-gender-caring-gender-atypical-childrenand-adolescents?page=full (accessed October 21, 2015).
Health Resources and Services Administration. “LGTB Health.” U.S. Department of Health and Human Services. http://www.hrsa.gov/lgbt (accessed October 21, 2015)
National LGBT Health Education Center. 1340 Boylston St., Ansin Building, 8th Floor, Boston, MA 02215. Telephone: 617-927-6354. Website: http://www.lgbthealtheducation.org (accessed October 21, 2015).
* chromosomes (KRO-mo-somz) are threadlike chemical structures inside cells on which the genes are located. There are 46 (23 pairs) chromosomes in normal human cells. Genes on the X and Y chromosomes (known as the sex chromosomes) help determine whether a person is male or female. Females have two X chromosomes; males have one X and one Y chromosome.
* vulva (VUL-vuh) refers to the organs of the female genitals that are located on the outside of the body.
* genitals (JEH-nih-tuls) are the external sexual organs.
* genetically (je-NE-ti-klee) means due to heredity and stemming from genes. Genes are located on the chromosomes in cells of the human body that helps determine physical and mental characteristics, such as hair and eye color. The X and Y chromosomes contain genetic information that determines sex.
* bisexual (bi-SEK-shoo-al) means being sexually attracted to both sexes.
* heterosexual (he-te-ro-SEKshoo-al) refers to a tendency to be sexually attracted to the opposite sex.
* hormone is a chemical substance that is produced by a gland and sent into the bloodstream carrying messages that have certain effects on other parts of the body.
* trachea (TRAY-kee-uh) is the windpipe—the firm, tubular structure that carries air from the throat to the lungs.
* electrolysis (ee-lek-TRAW-li-sis) is a method of destroying hair roots by passing an electric current through them.
* uterus (YOO-teh-rus) is the muscular, pear-shaped internal organ in a woman where a baby develops until birth.
* ovaries (O-vuh-reez) are the sexual glands from which ova, or eggs, are released in women.
* vagina (vah-JY-nah) is the canal, or passageway, in a woman that leads from the uterus to the outside of the body.