Gender Dysphoria: Concepts, Diagnosis and Clinical Management

Authors

  • Carolina Alves Rodrigues Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa.
  • Miriam Marguilho Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa.
  • Bárbara Ferreira Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa.
  • Sandra Nascimento Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa.
  • Miguel Nascimento Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa.
  • Sónia Cardoso Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa.
  • Mariana Silva Serviço de Psiquiatria de Ligação. Hospital São José. Unidade Local de Saúde São José. Lisboa.
  • Ana Cristina Pablo Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa.
  • Catarina Soares Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa.
  • Carlos Fernandes Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa.
  • Marco Gonçalves Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa.

DOI:

https://doi.org/10.20344/amp.21057

Keywords:

Gender Dysphoria/diagnosis, Gender Dysphoria/therapy

Abstract

Gender dysphoria is defined as a condition characterized by mental suffering associated with the incongruence between one’s experienced gender and their birth-assigned sex. Gender as a construct and gender dysphoria as a condition in need of multidisciplinary intervention have developed as swiftly as their visibility in society, making it mandatory to promote the literacy and education of all healthcare professionals in this area. This article aims to review information based on scientific evidence on people with gender dysphoria and its clinical approach, while contributing to a safe, inclusive, and non-discriminatory practice of healthcare.

Downloads

Download data is not yet available.

References

Appendix I: Indo-European roots. The American Heritage Dictionary of the English Language. 4th ed. Boston: Houghton Mifflin Company; 2000.

Crocq MA. How gender dysphoria and incongruence became medical diagnoses – a historical review. Dialogues Clin Neurosci. 2021;1:44-51. DOI: https://doi.org/10.1080/19585969.2022.2042166

Beek TF, Cohen-Kettenis PT, Kreukels BP. Gender incongruence/gender dysphoria and its classification history. Int Rev Psychiatry. 2015;1369-627.

Money J. Hermaphroditism, gender and precocity in hyperadrenocorticism: psychologic findings. Bull John Hopkins Hosp. 1955;96:253-64.

Drescher J. Gender dysphoria and disorders of sex development. Progress in care and knowledge. Chapter 7. Gender identity diagnoses: history and controversies. New York: Springer Science; 2013. DOI: https://doi.org/10.1007/978-1-4614-7441-8_7

World Health Organization. International statistical classification of diseases and related health problems. 9th ed. Genebra: WHO; 1977.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington: APA; 1980.

American Psychiatric Association. Diagnostic and statistical classification of diseases and related health problems. 4th ed. Washington: APA; 1994.

American Psychiatric Association. Diagnostic and statistical classification of diseases and related health problems. 5th ed. Washington: APA; 2013.

Schaefer LC, Wheeler CW. Harry Benjamin’s first ten cases (1938-1953): a clinical historical note. Arch Sex Behav. 1995;24:73-93. DOI: https://doi.org/10.1007/BF01541990

Cohen-Kettenis PT, Gooren LJ. Transsexualismo: a review of etiology, diagnosis and treatment. J Psychosom Res. 1999;46:315-33. DOI: https://doi.org/10.1016/S0022-3999(98)00085-3

Coleman E, Radix AE, Bouman WP, Brown GR, de Vries AL, Deutsch MB, et al. Standards of care for the health of transgender and gender diverse people, Version 8. Int. J Transgend Health. 2022;23:S1-259.

Drescher J. Controversies in gender diagnoses. LGBT Health. 2014;1:10-4. DOI: https://doi.org/10.1089/lgbt.2013.1500

Drescher J. Queer diagnoses: parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and statistical manual (DSM). Arch Sex Behav. 2010;39:427-60. DOI: https://doi.org/10.1007/s10508-009-9531-5

World Health Organization. International statistical classification of diseases and related health problems. 11th ed. Genebra: WHO; 2019.

Bem SL. Gender schema theory: a cognitive account of sex typing. Psychol Rev. 1981;88:354-64. DOI: https://doi.org/10.1037//0033-295X.88.4.354

Guss C, Shumer D, Katz-Wise SL. Transgender and gender nonconforming adolescent care: psychosocial and medical considerations. Curr Opin Pediatr. 2015;26:421-6. DOI: https://doi.org/10.1097/MOP.0000000000000240

Moretti P, Bachetti MC, Sciarma T, Tortorella A. Dysphoria as a psychiatric syndrome: a preliminary study for a new transnosographic dimensional approach. Psychiatr Danub. 2018;30:582-7.

Zucker KJ. Epidemiology of gender dysphoria and transgender identity. Sexual Health. 2017;14:404-11. DOI: https://doi.org/10.1071/SH17067

Cooper K, Russell A, Mandy W, Butler C. The phenomenology of gender dysphoria in adults: A systematic review and meta-synthesis. Clin Psychol Rev. 2020;80:101875. DOI: https://doi.org/10.1016/j.cpr.2020.101875

Goodrich KM. Lived experiences of college-age transsexual individuals. J Coll Couns. 2012;15:215-32. DOI: https://doi.org/10.1002/j.2161-1882.2012.00017.x

Mullen G, Moane G. A qualitative exploration of transgender identity affirmation at the personal, interpersonal, and sociocultural level. Int J Transgend. 2013;14:140-54. DOI: https://doi.org/10.1080/15532739.2013.824847

Giovanardi G, Morales P, Mirabella M, Fortunato A, Chianura L, Speranza AM, et al. Transition memories: experiences of trans adult women with hormone therapy and their beliefs on the usage of hormone blockers to suppress puberty. J Endocrinol Invest. 2019;1-10. DOI: https://doi.org/10.1007/s40618-019-01045-2

Applegarth G, Nuttal J. The lived experience of transgender people of talking therapies. Int J Transgend. 2016;17:66-72. DOI: https://doi.org/10.1080/15532739.2016.1149540

Baams L, Beek T, Hille H, Zevenbergen FC, Bos HM. Gender nonconformity, perceived stigmatization, and psychological well-being in Dutch sexual minority youth and young adults. A mediation analysis. Arch Sex Behav. 2013;42:765-73. DOI: https://doi.org/10.1007/s10508-012-0055-z

Bockting W, Miner MH, Romine R, Hamilton A, Coleman E. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health. 2013;103:943-51. DOI: https://doi.org/10.2105/AJPH.2013.301241

Connolly MD, Zervos MJ, Barone CJ, Johnson CC, Joseph CL. The mental health of transgender youth: advances in understanding. J Adolesc Health. 2016;59:489-95. DOI: https://doi.org/10.1016/j.jadohealth.2016.06.012

Puckett JA, Maroney MR, Wadsworth LP, Mustanki B, Newcomb ME. Coping and discrimination: The insidious effects of gender minority stigma on depression and anxiety in transgender individuals. J Clin Psychol. 2019;76:176-94. DOI: https://doi.org/10.1002/jclp.22865

Rood BA, Maroney MR, Puckett JA, Berman AK, Reisner SL, Pantalone DW. Identity concealment in transgender adults: a qualitative assessment of minority stress and gender affirmation. Am J Orthopsychiat. 2017;18:704-13. DOI: https://doi.org/10.1037/ort0000303

Smith AJ, Hallum-Montes R, Nevin K, Zenker R, Sutherland B, Reagor S, et al. Determinants of transgender individuals’ well-being, mental health and suicidality in a rural state. Rural Ment Health. 2018;42:116-32. DOI: https://doi.org/10.1037/rmh0000089

Rood BA, Reisner SL, Surace FI, Puckett JA, Maroney MR, Pantalone DW. Expecting rejection: understanding the minority stress experiences of transgender and gender-nonconforming individuals. Transgend Health. 2016;1:151-64. DOI: https://doi.org/10.1089/trgh.2016.0012

Scandurra C, Vitelli R, Maldonato NM, Valerio P, Bochicchio V. A qualitative study on minority stress subjectively experienced by transgender and gender nonconforming people in Italy. Sexologies. 2019;28:61-71. DOI: https://doi.org/10.1016/j.sexol.2019.05.002

Byne W, Karasic DH, Coleman E, Eyler AE, Kidd JD, Meyer-Bahlburg HF, et al. Gender dysphoria in adults: an overview and primer for psychiatrists. Transgend Health. 2018;3:57-A3. DOI: https://doi.org/10.1089/trgh.2017.0053

Walter PB, Amets SS, Joz M, Adam S, Joshua DS, Madeline BD, et al. Language and trans health. Int J Transgend. 2017;18:1-6. DOI: https://doi.org/10.1080/15532739.2016.1262127

Rodrigues J, Lemos C, Figueiredo Z. Discriminação e barreiras ao acesso ao serviço nacional de saúde percecionados por pessoas trans. Rev Port Psiquiatria Saúde Mental. 2020;6:98-108. DOI: https://doi.org/10.51338/rppsm.2020.v6.i3.152

Rothblum ED. The Oxford handbook of sexual and gender minority mental health. Oxford: Oxford University Press; 2020. DOI: https://doi.org/10.1093/oxfordhb/9780190067991.001.0001

Portugal. Decreto-Lei n.º38/2018. Diário da República, I Série, n.º 151 (2018/08/07). p.3922-4.

Lew-Starowicz, M, Giraldi A, Krüger TH. Psychiatry and sexual medicine: a comprehensive guide for clinical practitioners. Hannover: Springer International Publishing; 2021. DOI: https://doi.org/10.1007/978-3-030-52298-8

Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, Erwin PJ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol. 2010;72:214-31. DOI: https://doi.org/10.1111/j.1365-2265.2009.03625.x

Dhejne C, Van VR, Heylens G, Arcelus J. Mental health and gender dysphoria: a review of the literature. Int Rev Psychiatry. 2016;28:44-57. DOI: https://doi.org/10.3109/09540261.2015.1115753

Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender- dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017;102:3869-903. DOI: https://doi.org/10.1210/jc.2017-01658

Heylens G, Verroken C, De Cock S, T’Sjoen G, Cuypere G. Effects of different steps in gender reassignment therapy on psychopathology: a prospective study of persons with agender identity disorder. J Sex Med. 2014;11:19-26. DOI: https://doi.org/10.1111/jsm.12363

Direção-Geral da Saúde, Administração Central do Sistema de Saúde. Circular Normativa Conjunta. URGUS – Unidade do SNS para o acompanhamento de utentes no processo de reatribuição sexual. Lisboa: DGS; 2017.

Published

2024-04-03

How to Cite

1.
Alves Rodrigues C, Marguilho M, Ferreira B, Nascimento S, Nascimento M, Cardoso S, Silva M, Pablo AC, Soares C, Fernandes C, Gonçalves M. Gender Dysphoria: Concepts, Diagnosis and Clinical Management. Acta Med Port [Internet]. 2024 Apr. 3 [cited 2024 Jul. 25];37(5):379-85. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/21057

Issue

Section

Review Articles