Gender Identity Disorder: Diagnosis and Treatment

There are many well-known phrases that make bigger implications than we realise – such as boys will be boys – but what happens when boys want to be girls, or vice versa? Gender Identity Disorder (GID) can play a huge role in an individual’s sexual health, and overall wellbeing, with people feeling that their body does not match who they are on the inside. Also known as gender identity confusion, gender dysphoria, transgenderism and transsexualism, the condition can cause some people to use clothing and cosmetics to explore this identity, while others may choose to change their appearance with hormones or even surgery.

 

According to noted wellness writer Maria Trimarchi, ‘Mental health professionals believe there are three components that make up our gender identity: our sexual orientation, behaviour and mannerism preferences, and core gender identity (that gut feeling we have about the gender we identify with). In most of us, these three components and our anatomy align as male or female. For some, however, these components don’t all match up. The cause of gender identity disorder is still being debated. Theories suggest it is caused by genetic abnormalities, endocrine problems like a testosterone or oestrogen imbalance in the womb, social factors like parenting or some combination of issues.’ But at what age do parents begin to see symptoms of GID in children?

 

There are five steps to diagnosing GID: diagnostic assessment, psychotherapy, real-life experience, hormone therapy and surgery. Trimarchi explains, ‘The process begins when a person consults a mental health professional, who performs sessions of psychotherapy and formulates a diagnosis. To become a candidate for gender reassignment surgery, a person must first be diagnosed with Gender Identity Disorder (GID) or gender dysphoria. The International Classification of Diseases-10 (ICD-10) lists gender identity disorder as a disorder and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) lists gender dysphoria.’

 

The reason why diagnosis is important is because there is a wide range of variables that fall under the GID umbrella, and prospective candidates for gender reassignment surgery must work with a mental health professional for the right diagnosis. Once the diagnosis is complete, there are three phases left for patients who wish to undergo surgery:

 

1. Hormone therapy

 

2. Real-Life Experience, or the Real-Life Test

 

3. Surgery to change genitalia and other sex characteristics

 

Trimarchi notes, ‘Not all transgender people need all three phases of therapy; each path to gender reassignment is tailored to the person…Before a patient can begin hormone therapy or breast surgery, a mental health professional must write a letter of recommendation to the physician providing medical treatment. In addition to the letter, the World Professional Association for Transgender Health’s Standards of Care require several eligibility and readiness criteria for hormone therapy.’ To undergo hormone therapy, you must:

 

• Be 18 years of age


• Understand what the medical ability of hormones, as well as their social benefits and risks


• Have either a minimum of three months of psychotherapy or a documented three month real-life experience


• Show stable or improved mental health


• Demonstrate ability to take hormones in a responsible manner

 

Trimarchi details, ‘The Real-Life Experience immerses the individual into life as his or her preferred gender. The candidate is required to maintain full or part-time employment (or attend school full or part-time), legally change his or her first name to one that is gender appropriate and prove that people other than the therapist and doctor know his or her desired gender. After 12 months of continuous and successful hormone therapy and Real-Life Experience, the individual is eligible for genital surgery. Two letters of recommendation, usually one from the mental health professional and one from the hormone-prescribing physician, are required for surgery.’

Categories: diagnosis, gender dysphoria, gender identity, gender reassignment, health professional, Hormone Therapy, identity disorder, life experience, Mental Health, Real Life, treatment

Jargon Busters: Understanding Gender Identity Disorder

How do you know that you’re a woman or a man? Does it just come down to the genitals you have, or did you work out your gender identity on more factors? Gender is not a cut-and-dry sexual health issue; it’s not just a case of penises for boys and vaginas for girls. Rather, there is a number of people for whom the body doesn’t match up with what’s going on in the mind, which is commonly known as gender identity disorder. Usually, struggles with gender identity begin in early childhood, but it can happen at any age. Gender identity disorder can be confusing, both for those whose wellbeing is affected by it, and their friends and family. So, let’s clear up the jargon.

 

1. Transexual: The community of people with gender identity disorder is commonly described as “transsexuals” by medical professionals. This term was coined Dr. Harry Benjamin, one of the pioneering doctors to research and work with gender identity disorders, using the research of Magnus Hirschfeld, of the Institute for Sexual Science, and Alfred Kinsey, of the Kinsey Institute, as his springboard.

 

2. Transgender: “Transgender” is used as a general, non-medical term to describe anyone whose gender identity is different from their physical sex at birth. If you’re transgender, you may wish to live as a different gender than the one you were born with, and may put your physical wellbeing at risk to do so. You may undergo gender reassignment surgery – or a sex change – to transform your body to reflect who you are underneath. However, you might not think your gender wellness merits these types of surgeries, and that’s OK too.

 

3. Transman or Transwoman: If you were born as a biological man but you identify as a woman, you are known as a transwoman, or transgender woman. A biologically born woman who identifies as a man is known as transman, or transgender man.

 

4. Third Gender: You might not want to refer to yourself as male or female, but rather find that your identity lies somewhere along a spectrum. This is sometimes referred to as “third gender”, but some people prefer no label at all.

 

5. Transvestite: You may have head someone who dresses in clothing more typically worn by the opposite sex labelled as a “cross-dresser,” “transvestite,” “drag queen” or “drag king”. However, the important distinction to make here is that these words don’t describe a person’s gender.

 

6. Transition: Instead of sticking to the sex you were assigned with at birth, you may decide to move towards the gender you perceive yourself to be. This shift is described as “transition”. Sex reassignment surgery may be part of your transition, but this isn’t always the case.

 

So how do you know if you have gender identity disorder? Diagnosis involves a consultation with a mental health professional, who performs sessions of psychotherapy and formulates a diagnosis. The DSM-IV breaks gender identity disorders into several types: Gender Identity Disorder of Childhood, Gender Identity Disorder of Adolescence or Adulthood and Gender Identity Disorder Not Otherwise Specified. Additionally, the ICD-10 provides five diagnosis types for GIDs: Transsexualism, Dual-role Transvestism, Gender Identity Disorder of Childhood, Other Gender Identity Disorders and Unspecified Gender Identity Disorder. The ICD-10 states that you are diagnosed as transsexual when you have a desire to live as and be accepted as a member of the opposite sex, along with the desire to transform your body with gender reassignment surgery or hormone therapy. Your gender identity needs to be present for at least two years, and the desire for gender change cannot be a symptom of another disorder or a chromosomal abnormality.

Categories: Disorder, Gender, gender identity, gender reassignment, identity, identity disorder, identity disorders, nbsp, reassignment surgery, transgender, transsexual

Your Sexual Health Questions, Answered: What is Transgender?

For most guys and girls, gender isn’t something that really gets questioned. Most guys feel perfectly normal being male, and most girls feel very natural being female. However, this isn’t true for everyone. Some people who are born male feel as though they should have been born female, and vice versa. These people are known as being “transgender” and it’s a serious wellness issue. Feeling like you’re living in the wrong body isn’t just a matter of sexual health, but really your mental and emotional wellbeing, as well as your relationships.

 

What society thinks of as being intrinsically male or female will play a role in how you feel about yourself. These expectations can include things like hairstyles, clothing, and jobs — and how people should act or behave. These aren’t often spoken rules but rather cultural norms which cause you to grow up believing men should act a certain way and women should act a certain way, and you don’t really give this much thought. These assumptions, however, don’t fit with your gender identity if you’re transgendered. Somehow, you know you feel “different” from the time you’re young, from puberty or even later in life. This mismatch may make you feel confused and emotionally conflicted.

 

As a result of this conflict, you may decide to physically change your body to match your gender identity. This can be done through surgery or taking hormones, but either route you take can be a long, complicated, and expensive process. For this reason, and others, some transgender people decide to keep things as they are, but dress as the opposite gender instead. Then there are those who decide to use a different name and pronouns that go with that name. If your birth name is Anthony, for example, you might ask people to call you Amanda and refer to you as a “she”. You might find you aren’t completely sure what you want to do yet. If you do decide to start living like someone of the opposite gender, it’s likely for certain issues to arise. Filling out forms that ask for your gender and choosing which public toilets to use can suddenly become very complicated decisions to make.

 

One thing to bear in mind is that being transgender is not the same thing as being gay. Rather, being transgender is about your gender identity, or the way you see yourself and the gender you most closely identify with. Being gay or lesbian, on the other hand, is about your sexual orientation, or the gender you are attracted to. Many gay and lesbian people are completely comfortable with their gender; they are simply a man who is attracted to other men, or a woman who is attracted to other women. However, because sexual orientation is a different thing from gender identity, a transgender person can be straight, gay, or bisexual — just like other people can.

 

Another important distinction to make is that dressing in clothes typically worn by the opposite sex does not automatically mean you are a transgender person. People who dress in clothes that are usually associated with a different gender are sometimes called cross-dressers or transvestites, and these people can make these clothing choices for a variety of reasons. Yes, this may be because of their gender identity, but people who dress as the opposite sex can also be making a clothing choice for fun, comfort, or as a way to express their personal style — not because they see themselves as the other gender. To find out more, look online for more information, as well as support groups for people going through the same things you are.

Categories: feel, Gender, gender identity, identity, orientation, people, sexual health, sexual orientation, transgender, transgender person

Why Do Transgender People Face Higher Mental Health Risks?

It’s not hard to see how being transgender can affect your mental wellbeing; not only do you have to come to terms with your gender identity, but you also face more mental distress as a result of the social disapproval and discrimination you encounter. Research shows that, as a transgender person, you come across harassment, discrimination and even violence in all areas of life, including health provision, corporate wellness, social exclusion and hate crime. This makes you a high risk for depression, self-harm and suicide.

 

In 2007, a survey of 872 trans people showed that a third (34%) of respondents had considered suicide, which is considerably higher than the general population. This is because transgender people come up against a whole host of difficulties, including:

 

1. Lack of understanding from your loved ones, employer, medical professionals and others.

2. Trouble finding work or keeping your job once your background becomes known to others.

3. Rejection by your family and friends.

4. Negative or hurtful comments from transphobic people.

5. Intimidation and violence on the streets and outside your home.

6. Being stared at and laughed at when you’re out running errands.

7. Bullying and name-calling

 

According to Ady Davis, a psychosexual therapist with the North-East Gender Dysphoria Service, ‘The main issues that affect the mental wellbeing of trans people are related to discrimination.’ This discrimination may cause you to feel conflict within yourself, as you may, for example, have certain religious beliefs that discriminate against your trans status. You may also experience conflict in your relationships, be it with your parents, school or workplace. There’s also wider discrimination from society.

 

‘Some trans people can’t do everyday activities such as going shopping without getting stared at, attracting comments, having their self-esteem knocked or experiencing violence on occasion,’ Davis explains. ‘When you put them together, all these difficulties can have a massive impact on mental health. Trans people may isolate themselves, and they may experience feelings of depression, suicide or self-harm. For example, they may mutilate their bodies by trying to remove the parts they’re not happy with, such as their breasts or penis. They may also start using alcohol or drugs as a way to escape.’

 

If you are questioning your gender, feeling you should be the opposite gender or feeling that you have no gender at all, there is help available to ensure you don’t fall prey to these mental health problems. Davis notes, ‘If this is a temporary doubt that lasts no more than a few months, it may be something you resolve yourself, but if your feelings of gender discomfort are consistent, you can get support that can help you feel more comfortable with your gender identity.’ Areas of support include:

 

Your GP: This is the first port of call when you’re questioning your gender, as your doctor can directly refer you to the appropriate service.

 

Community Support Groups: Look on charity websites such as The Gender Trust, Mermaids and The Beaumont Society to find groups in your area for trans people and their families. Local lesbian, gay and bisexual groups also have information about support for trans people.

 

Helplines: NHS Direct 111 and the Samaritans (08457 90 90 90), as well as your GP, can give you confidential, non-judgemental emotional support if you are having depressed, self harm or suicidal thoughts.

 

Psychological therapy: Davis notes, ‘All types of treatment generally aim to get someone to a point where they feel more content in their gender…For example, someone may want to express a female side but fear of telling a partner is preventing them. In this case, a therapist would help the trans person to express those feelings, and to work out how they would be accepted in the relationship. The therapist may talk to the partner as well. If they accept it, that may be enough.’

Categories: davis notes, Discrimination, Gender, gender identity, Mental Health, mental wellbeing, nbsp, people, suicide, trans people, Transgender People

Halt "don"t ask, don"t tell" in doc"s office

By Katie Kerwin McCrimmon

An informal “don’t ask don’t tell” policy in doctors’ offices is preventing lesbian, gay, bisexual and transgender patients from getting optimal health care, according to a report released today called “Becoming Visible.”

Conducted by the LGBT advocacy group One Colorado in concert with the Colorado Medical Society and the Denver Medical Society, the report finds that most doctors are comfortable caring for LGBT patients.

Yet, most don’t ask about sexual orientation or gender identity. At the same time, many LGBT patients believe that medical providers may be biased against them and don’t speak up. The lack of frank discussions between providers and patients can undermine care.

Dr. Mark Thrun of Denver Health: ““We doctors are afraid to offend our patients. So nobody talks about sexual health.”

Experts say it’s up to doctors to break the silence.

“Providers need to recognize that they hold the power in these relationships. The onus is on the medical community,” said Dr. Mark Thrun, director of HIV and STD prevention and control at Denver Health and a board member for One Colorado. Thrun, who is gay, helped conduct the research for Becoming Visible, which included extensive surveys with about 400 doctors.

“We doctors are afraid to offend our patients,” Thrun said, “so nobody talks about sexual health.”

In the clinic where Thrun treats people for STDs, he said he asks all his  patients about their sexual orientation and gender identity, but that’s not standard among doctors, especially among older providers.

And Thrun said studies show doctors are the least comfortable among medical providers in talking about sexual health. Nurses, social workers and nurse practitioners seem to be more at ease asking relevant questions.

Ashley Wheeland, health policy director for One Colorado, said the report helps triangulate the gap between patient views and physician perspectives.

The new report “Becoming Visible” finds that doctors aren’t always comfortable asking patients about their sexual preference or gender identity. Without this information, doctors can’t give optimal care. (Photo by Mark Manger. Courtesy One Colorado.)

“There is a disconnect in how LGBT feel in our health system and how physicians feel they’re treating LGBT people,” Wheeland said.

Doctors now overwhelmingly recognize that sexual orientation and gender identity are vital to health and that’s a huge change from just 10 years ago, said Wheeland.

Better training for doctors and simple practices to make LGBT patients feel more comfortable can make a big difference in overall health, she said.

A previous One Colorado report called Invisible http://www.one-colorado.org/news/lgbt-health-report/ surveyed about 1,300 LGBT people in Colorado and found that patients are more likely to get an array of helpful preventive services from flu shots to dental care and annual checkups if they have a good trusting relationship with their providers and believe that they are receptive to working with LGBT patients.

LGBT patients are also at higher risk for some health problems including HIV, heart disease, breast cancer and depression, so knowing their sexual history is vital.

“If I don’t know that my patient is LGBT, I may not be asking the next questions that might drive screening tests or future referrals,” Thrun said.

“And as a doctor, I need to know who my patients are, who is going to twist their arm to get them to take their meds, who takes care of them at home, who helps them stay healthy. Whether straight or gay, I need to know who your support systems are,” he said.

The major findings and recommendations from the report include:

• Physicians report high levels of comfort in serving lesbian gay and bisexual patients. Fewer providers are comfortable serving transgender patients, who are the most stigmatized among LGBT patients.


• Physicians care about how they are serving the LGBT community and recognize that sexual orientation and gender identity are vital factors in overall health.


• Physicians and other providers should ask patients about sexual history and preferences.


• Subtle signs of support for LGBT people — like rainbow or equality symbols — can let patients know they are welcome. The survey results show few providers have policies in place to show that they are LGBT-friendly even though simple changes to forms or visual cues could go a long way in helping LGBT patients feel more at ease.


• Colorado physicians are more comfortable when patients disclose sexual orientation or gender identity and are less comfortable asking patients directly.


• Physicians generally believe they are already treating their LGBT patients equally, but not all LGBT patients are getting the care they need.


• Primary care physicians were more likely than specialists to acknowledge the role that sexual orientation and gender identity may play in overall health.


• Younger physicians and those in urban areas offer more LGBT-friendly policies than those in rural areas.

Along with the report, One Colorado and the report partners also created a continuing education program for physicians on how they can better care for LGBT patients. (Click here for more information.)

Categories: denver health, gender identity, lgbt friendly, lgbt patients, lgbt people, medical providers, sexual health, sexual history, sexual orientation