Gender incongruity, or gender nonconformity, itself is not considered a disorder. However, when the perceived mismatch between birth sex and felt gender identity causes significant distress or disability, a diagnosis of gender dysphoria may be appropriate.
The distress is typically a combination of anxiety, depression, and irritability. Although precise figures are lacking, an estimated 0. Many more people would identify themselves as transgender people but do not meet criteria for gender dysphoria. Some scholars argue that the diagnosis of gender dysphoria is primarily a medical condition, akin to disorders of sex development, and not a mental disorder at all.
Conversely, some members of the transgender community consider even extreme forms of gender nonconformity to be simply a normal variant in human gender identity and expression. Some studies show a higher concordance rate for gender dysphoria in monozygotic twins than in dizygotic twins, suggesting that there is a heritable component to transgender identity.
Rarely, transsexualism is associated with genital ambiguity intersex conditions [disorders of sex development] or a genetic abnormality eg, Turner syndrome , Klinefelter syndrome. When sex labeling and rearing are confusing eg, in cases of ambiguous genitals or genetic syndromes altering genital appearance, such as androgen insensitivity syndromes , children may become uncertain about their gender identity or role, although the level of importance of environmental factors remains controversial.
Childhood gender dysphoria often manifests by age 2 to 3 years. Children commonly do the following:. For example, a young girl may insist she will grow a penis and become a boy; she may stand to urinate. A boy may fantasize about being female and avoid rough-and-tumble play and competitive games. He may sit to urinate and wish to be rid of his penis and testes. For boys, distress at the physical changes of puberty is often followed by a request during adolescence for feminizing somatic treatments.
Most children with gender dysphoria are not evaluated until they are age 6 to 9, at a point when gender dysphoria is already chronic. Only a minority of children diagnosed with gender dysphoria remain gender dysphoric as adults. Although most transsexuals have gender dysphoria symptoms or experience a sense of being different in early childhood, some do not present until adulthood.
Autogynephilia in women.
Male-to-female transsexuals transwomen may first be cross-dressers and only later in life come to accept their cross-gender identity. Marriage and military service are common among transsexuals who seek to run from their cross-gender transgender feelings. Once they accept their cross-gender feelings and publicly transition, many transwomen blend seamlessly into the fabric of society as women—with or without hormone therapy or sex reassignment surgery. Others experience problems, which may include anxiety, depression, and suicidal behavior.
These problems may be related to societal and family stressors associated with lack of acceptance of gender-nonconforming behaviors. Gender dysphoria is expressed differently in different age groups. But for diagnosis of gender dysphoria in all age groups, DSM-5 criteria require the presence of both of the following:. A strong preference for dressing in clothing typical of the opposite gender and, in girls, resistance to wearing typically feminine clothing. A strong rejection of toys, games, and activities typical of the gender that matches their birth sex. Cross-gender identification must not be merely a desire for perceived cultural advantages of being the other sex.
For example, a boy who says he wants to be a girl so that he will receive the same special treatment his younger sister receives is not likely to have gender dysphoria. Diagnosis of gender dysphoria in adults focuses on determining whether there is significant distress or obvious impairment in social, occupational, or other important areas of functioning.
Gender nonconformity alone is insufficient for diagnosis. For certain motivated patients above a certain age typically 16 years or older , cross-sex hormone therapy and sometimes sex reassignment surgery and other gender-affirming surgeries, with consent and assent as required. Gender-nonconforming behavior, such as cross-dressing, may not require treatment if it occurs without concurrent psychologic distress or functional impairment. Such behavior is not considered a disorder.
When treatment is required, it is aimed at helping patients adapt to rather than trying to dissuade them from their identity. Attempts at altering gender identity in adults have not proved effective and are now considered unethical. In most Western cultures, most transsexuals who request treatment are birth-sex males who claim a female gender identity and regard their genitals and masculine features with repugnance.
However, as treatments have improved, female-to-male transsexual people transmen are increasingly seen in medical and psychiatric practice, although the incidence in Western cultures is about one third of that for male-to-female transsexualism. The combination of psychotherapy, hormonal reassignment, living at least a year in the felt gender, and sex reassignment surgery may be curative when the disorder is appropriately diagnosed and clinicians follow the internationally accepted standards of care for the treatment of gender identity disorders, available from the World Professional Association for Transgender Health WPATH.
Although patients with gender dysphoria are no longer required to have psychotherapy before consideration for cross-sex hormonal and surgical procedures, mental health care practitioners can do the following to help patients make decisions:.
IJ TRANSGENDER - Transgender Identity Affirmation and Mental Health
Assess and treat comorbid disorders eg, depression , substance use disorders. Feminizing hormones in moderate doses eg, estradiol transdermal patches 0. Feminizing hormones have significant beneficial effects on the symptoms of gender dysphoria, often before there are any visible changes in secondary sexual characteristics eg, breast growth, decreased facial and body hair growth, redistribution of fat to the hips. Feminizing hormones, even without psychologic support or surgery, are all some patients need to make them feel sufficiently comfortable as a female.
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Sex reassignment surgery is requested by many male-to-female transsexuals. Surgery involves removal of the penis and testes and creation of an artificial vagina. A part of the glans penis is retained as a clitoris, which is usually sexually sensitive and retains the capacity for orgasm in most cases. The decision to pursue sex reassignment surgery often raises important social problems for patients.
Many of these patients are married and have children. A parent or spouse who changes sex and gender role will likely have substantial adjustment issues in intimate relationships and may lose loved ones in the process. In follow-up studies, genital surgery has helped some transsexuals live happier and more productive lives and so is justified in highly motivated, appropriately assessed and treated transsexuals who have completed at least 1 year of living full-time in the opposite gender role.
Some patients also pursue nongenital, gender-affirming surgical procedures such as breast augmentation, facial feminization surgeries eg, rhinoplasty, brow lift, hairline changes, jaw reconfiguration, tracheal cartilage shave [reduction of the laryngeal cartilage] , or vocal cord surgeries to change the quality of the voice.
Participation in gender support groups, available in most large cities or through the Internet, is usually helpful. Female-to-male patients often ask for mastectomy early because it is difficult to live in the male gender role with a large amount of breast tissue; breast binding often makes breathing difficult. Then, hysterectomy and oophorectomy may be done after a course of androgenic hormones eg, testosterone ester preparations to mg IM every 3 weeks or equivalent doses of androgen transdermal patches or gels.
Testosterone preparations permanently deepen the voice, induce a more masculine muscle and fat distribution, induce clitoromegaly, and promote growth of facial and body hair. Additional research is needed to further elucidate the social psychological processes involved in the association between identity affirmation and mental health among transgender persons.
Trans women do not regard the wearing of female attire as "cross dressing". Bentler, R. Journal of Clinical Psychology , — Blanchard, R. Archives of Sexual Behavior , — Blumenstein, R. Denny Ed. Bolin, A. South Hadley: Bergin and Garvey. Boswell, H. Boszormenyi-Nagy, I. Brown, G. Bullough, V. Journal of Sexual Research , — Burke, P. American Social Review , — Cast, A.
Social Psychology Quarterly , 68— Clements-Nolle, K. American Journal of Public Health , — Cole, C. Archives of Sexual Behavior , 13— Cole, S. Szuchman and F.
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http://derivid.route1.com/no-saba-que-te-amaba.php Journal of Psychology and Human Sexuality , 6: 49— Hartmann, U. Preliminary results of a prospective study. Accessed September 8th Herek, G. Journal of Interpersonal Violence , 5: 16— Higgins, E. Baumeiser Ed.
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