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Wikipedia

Gender dysphoria

December 23, 2023

Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth.[5][6] The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder.[7]

Gender dysphoria
Other namesGender identity disorder
SpecialtyPsychiatry, psychology 
SymptomsDistress related to one's assigned gender, sex, and/or sex characteristics[1][2][3]
ComplicationsEating disorders, suicide, depression, anxiety, social isolation[4]
Differential diagnosisVariance in gender identity or expression that is not distressing[1][3]
TreatmentTransitioning, psychotherapy[2][3]
MedicationHormones (e.g., androgens, antiandrogens, estrogens)

People with gender dysphoria commonly identify as transgender.[8] Gender nonconformity is not the same thing as gender dysphoria[9] and does not always lead to dysphoria or distress.[10]

The causes of gender incongruence are unknown but a gender identity likely reflects genetic, biological, environmental, and cultural factors.[11][12][13] Diagnosis can be given at any age, although gender dysphoria in children and adolescents may manifest differently than in adults.[14] Complications may include anxiety, depression, and eating disorders.[8] Treatment for gender dysphoria includes social transitioning and often includes hormone replacement therapy (HRT) and/or gender-affirming surgeries, and psychotherapy.[2][3]

Some researchers and transgender people argue for the declassification of the condition because they say the diagnosis pathologizes gender variance and reinforces the binary model of gender.[15] However, this declassification could carry implications for healthcare accessibility, as HRT and gender-affirming surgery could be deemed cosmetic by insurance providers, as opposed to medically necessary treatment, thereby affecting coverage.[16]

Signs and symptoms

Distress arising from an incongruence between a person's felt gender and assigned sex/gender (usually at birth) is the cardinal symptom of gender dysphoria.[17][18]

No particular sexual orientation indicates gender dysphoria.[19][20] A 2021 review in Dialogues in Clinical Neuroscience found no relation to sexual orientation, but acknowledged that historically the two were often erroneously conflated.[21] The British National Health Service also stated "gender dysphoria is not related to sexual orientation".[22]

Gender dysphoria in those assigned male at birth (AMAB) tends to follow one of two broad trajectories: early-onset or late-onset. Early-onset gender dysphoria is behaviorally visible in childhood but may temporarily subside, leading the person to identify as gay or homosexual for a period of time, followed by recurrence of gender dysphoria. A 2016 review in the Archives of Sexual Behavior states this group is usually sexually attracted to members of their natal sex in adulthood, commonly identifying as heterosexual. Late-onset gender dysphoria does not include visible signs in early childhood, but some report having had wishes to be the opposite sex in childhood that they did not report to others.[23] Likewise, according to the review, transgender people assigned male at birth who experience late-onset gender dysphoria will usually be attracted to women and may identify as lesbians or bisexual, while those with early-onset will usually be attracted to men.[23] The review states a similar pattern occurs in those assigned female at birth (AFAB), with those experiencing early-onset GD being most likely to be attracted to women and those with late-onset being most likely to be attracted to men and identify as gay.[23][24]

Symptoms of GD in children include preferences for opposite sex-typical toys, games, activities, or playmates as well as a great dislike of their own genitalia.[25] Some children may also experience social isolation from their peers, anxiety, loneliness, and depression.[4] In adolescents and adults, symptoms include the desire to be and to be treated as a different gender.[25] Adults with GD are at increased risk for stress, isolation, anxiety, depression, poor self-esteem, and suicide.[4] Transgender people are also at heightened risk for eating disorders[26] and substance abuse.[27] According to the American Psychiatric Association,[28] those who experience gender dysphoria later in life "often report having secretly hidden their gender dysphoric feelings from others when they were younger".[29]

Causes

See also: Causes of gender incongruence

The specific causes of gender dysphoria remain unknown, and treatments targeting the etiology or pathogenesis of gender dysphoria do not exist.[30] Evidence from studies of twins suggests that genetic factors play a role in the development of gender dysphoria.[11][12] Gender identity is thought to likely reflect a complex interplay of biological, environmental, and cultural factors.[13]

Diagnosis

The American Psychiatric Association permits a diagnosis of gender dysphoria in adolescents or adults if two or more of the following criteria are experienced for at least six months' duration:[25]

  • A strong desire to be of a gender other than one's assigned gender
  • A strong desire to be treated as a gender other than one's assigned gender
  • A significant incongruence between one's experienced or expressed gender and one's sexual characteristics
  • A strong desire for the sexual characteristics of a gender other than one's assigned gender
  • A strong desire to be rid of one's sexual characteristics due to incongruence with one's experienced or expressed gender
  • A strong conviction that one has the typical reactions and feelings of a gender other than one's assigned gender

In addition, the condition must be associated with clinically significant distress or impairment.[25]

The DSM-5 moved this diagnosis out of the sexual disorders category and into a category of its own.[25] The diagnosis was renamed from gender identity disorder to gender dysphoria, after criticisms that the former term was stigmatizing.[31] Subtyping by sexual orientation was deleted. The diagnosis for children was separated from that for adults, as "gender dysphoria in children". The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing, or ability to express it if they have insight.[32] Other specified gender dysphoria or unspecified gender dysphoria can be diagnosed if a person does not meet the criteria for gender dysphoria but still has clinically significant distress or impairment.[25] Intersex people are no longer excluded from the diagnosis of GD.[33]

The International Classification of Diseases (ICD-11) lists 3 conditions related to gender identity:[34]

  • Gender incongruence of adolescence or adulthood (HA60)
  • Gender incongruence of childhood (HA61)
  • Gender incongruence, unspecified (HA6Z)

ICD-11 defines gender incongruence as "a marked and persistent incongruence between an individual's experienced gender and the assigned sex", with no requirement for significant distress or impairment.[34]

Treatment

Treatment for a person diagnosed with GD may include psychological counseling, supporting the individual's gender expression, or hormone therapy or surgery. This may involve physical transition resulting from medical interventions such as hormonal treatment, genital surgery, electrolysis or laser hair removal, chest/breast surgery, or other reconstructive surgeries.[35] The goal of treatment may simply be to reduce problems resulting from the person's transgender status, for example, counseling the patient in order to reduce guilt associated with cross-dressing.[36]

Guidelines have been established to aid clinicians. The World Professional Association for Transgender Health (WPATH) Standards of Care are used by some clinicians as treatment guidelines. Others use guidelines outlined in Gianna Israel and Donald Tarver's Transgender Care.[37] Guidelines for treatment generally follow a "harm reduction" model.[38][39][40]

Children

Main article: Gender dysphoria in children

Medical, scientific, and governmental organizations have opposed conversion therapy, defined as treatment viewing gender nonconformity as pathological and something to be changed, instead supporting approaches that affirm children's diverse gender identities.[41][42][43] People are more likely to keep having gender dysphoria the more intense their gender dysphoria, cross-gendered behavior, and verbal identification with the desired/experienced gender are (i.e. stating that they are a different gender rather than wish to be a different gender).[44]

Professionals who treat gender dysphoria in children sometimes prescribe puberty blockers to delay the onset of puberty until a child is believed to be old enough to make an informed decision on whether hormonal or surgical gender reassignment is in their best interest.[45][46] Short-term side effects of puberty blockers include headaches, fatigue, insomnia, muscle aches and changes in breast tissue, mood, and weight.[47] Research on the long-term effects on brain development, cognitive function, fertility, and sexual function is limited.[48][49][50]

A review published in Child and Adolescent Mental Health found that puberty blockers are reversible, and that they are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.[51]

According to the American Psychiatric Association, "Due to the dynamic nature of puberty development, lack of gender-affirming interventions (i.e. social, psychological, and medical) is not a neutral decision; youth often experience worsening dysphoria and negative impact on mental health as the incongruent and unwanted puberty progresses. Trans-affirming treatment, such as the use of puberty suppression, is associated with the relief of emotional distress, and notable gains in psychosocial and emotional development, in trans and gender diverse youth".[14]

In its position statement published December 2020, the Endocrine Society stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care. They noted a decrease in suicidal ideation among youth who have access to gender-affirming care and comparable levels of depression to cisgender peers among socially transitioned pre-pubertal youth.[52] In its 2017 guideline on treating those with gender dysphoria, it recommends puberty blockers be started when the child has started puberty (Tanner Stage 2 for breast or genital development) and cross-sex hormones be started at 16, though they note "there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD/gender incongruence". They recommend a multidisciplinary team of medical and mental health professionals manage the treatment for those under 18 and recommend "monitoring clinical pubertal development every 3 to 6 months and laboratory parameters every 6 to 12 months during sex hormone treatment".[53]

The World Professional Association for Transgender Health's Standards of Care 8, published in 2022, declare puberty blocking medication as "medically necessary", and recommends them for usage in transgender adolescents once the patient has reached Tanner stage 2 of development, and state that longitudinal data shows improved outcomes for transgender patients who receive them.[54] Some medical professionals disagree that adolescents are cognitively mature enough to make a decision with regard to hormone therapy or surgery, and advise that irreversible genital procedures should not be performed on individuals under the age of legal consent in their respective country.[55]

A review commissioned by the UK Department of Health found that there was very low certainty of quality of evidence about puberty blocker outcomes in terms of mental health, quality of life and impact on gender dysphoria.[56] The Finnish government commissioned a review of the research evidence for treatment of minors and the Finnish Ministry of Health concluded that there are no research-based health care methods for minors with gender dysphoria.[57] Nevertheless, they recommend the use of puberty blockers for minors on a case-by-case basis, and the American Academy of Pediatrics state that "pubertal suppression in children who identify as TGD [transgender and gender diverse] generally leads to improved psychological functioning in adolescence and young adulthood.".[58]

In the United States, several states have introduced or are considering legislation that would prohibit the use of puberty blockers in the treatment of transgender children.[59] The American Medical Association,[60] the Endocrine Society,[61] the American Psychological Association,[62] the American Academy of Child and Adolescent Psychiatry[63] and the American Academy of Pediatrics[64] oppose bans on puberty blockers for transgender children. In the UK, in the case of Bell v Tavistock, an appeal court, overturning the original decision, ruled that children under 16 could give consent to receiving puberty blockers.[65] In 2022, the National Board of Health and Welfare in Sweden issued new guidelines recommending that puberty blockers only be given in "exceptional cases" and said that their use was grounded in "uncertain science." Instead, they recommended child psychiatric treatment, psychosocial interventions, and suicide prevention measures to be offered by clinicians.[66][67]

Psychological treatments

Main article: Psychotherapy

Until the 1970s, psychotherapy was the primary treatment for gender dysphoria and generally was directed to helping the person adjust to their assigned sex. Psychotherapy is any therapeutic interaction that aims to treat a psychological problem. Psychotherapy may be used in addition to biological interventions, although some clinicians use only psychotherapy to treat gender dysphoria.[30] Psychotherapeutic treatment of GD involves helping the patient to adapt to their gender incongruence or to explorative investigation of confounding co-occurring[68][69][70][71] mental health issues. Attempts to alleviate GD by changing the patient's gender identity to reflect assigned sex have been ineffective and are regarded as conversion therapy by most health organizations.[41][72]: 1741 

Biological treatments

Main article: Sex reassignment therapy

Biological treatments physically alter primary and secondary sex characteristics to reduce the discrepancy between an individual's physical body and gender identity.[73] Biological treatments for GD are typically undertaken in conjunction with psychotherapy; however, the WPATH Standards of Care state that psychotherapy should not be an absolute requirement for biological treatments.[74]

Hormonal treatments have been shown to reduce a number of symptoms of psychiatric distress associated with gender dysphoria.[75] A WPATH commissioned systematic review of the outcomes of hormone therapy "found evidence that gender-affirming hormone therapy may be associated with improvements in [quality of life] scores and decreases in depression and anxiety symptoms among transgender people." The strength of the evidence was low due to methodological limitations of the studies undertaken.[76] Some literature suggests that gender-affirming surgery is associated with improvements in quality of life and decreased incidence of depression.[77] Those who choose to undergo sex reassignment surgery report high satisfaction rates with the outcome, though these studies have limitations including risk of bias (lack of randomization, lack of controlled studies, self-reported outcomes) and high loss to follow up.[78][79][80]

For adolescents, much is unknown, including persistence. Disagreement among practitioners regarding treatment of adolescents is in part due to the lack of long-term data.[20] Young people qualifying for biomedical treatment according to the Dutch model[81][82] (including having GD from early childhood on which intensifies at puberty and absence of psychiatric comorbidities that could challenge diagnosis or treatment) found reduction in gender dysphoria, although limitations to these outcome studies have been noted, such as lack of controls or considering alternatives like psychotherapy.[83]

In its position statement published December 2020, the Endocrine Society stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care. They noted a decrease in suicidal ideation among youth who have access to gender-affirming care and comparable levels of depression to cisgender peers among socially transitioned pre-pubertal youth.[52] In its 2017 guideline on treating those with gender dysphoria, it recommends puberty blockers be started when the child has started puberty (Tanner Stage 2 for breast or genital development) and cross-sex hormones be started at 16, though they note "there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD/gender incongruence". They recommend a multidisciplinary team of medical and mental health professionals manage the treatment for those under 18. They also recommend "monitoring clinical pubertal development every 3 to 6 months and laboratory parameters every 6 to 12 months during sex hormone treatment".[53]

A review published in Child and Adolescent Mental Health found that puberty blockers are fully reversible, and that they are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.[51]

More rigorous studies are needed to assess the effectiveness, safety, and long-term benefits and risks of hormonal and surgical treatments.[78] For instance, a 2020 Cochrane review found insufficient evidence to determine whether feminizing hormones were safe or effective, due to the lack of "completed studies that met [their] inclusion criteria."[84] Several studies have found significant long-term psychological and psychiatric pathology after surgical treatments.[78]

In 2021, a review published in Plastic and Reconstructive Surgery found that less than 1% of people who undergo gender-affirming surgery regret the decision. It concluded that "There is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population."[85]

Comorbidities

Among youth, around 20% to 30% of individuals attending gender clinics meet the DSM criteria for an anxiety disorder.[86] Gender dysphoria is also associated with an increased risk of eating disorders in transgender youth.[87]

A widely held view among clinicians is that there is an over-representation of neurodevelopmental conditions amongst individuals with GD, although this view has been questioned due to the low quality of evidence.[88] Studies on children and adolescents with gender dysphoria have found a high prevalence of autism spectrum disorder (ASD) traits or a confirmed diagnosis of ASD. Adults with gender dysphoria attending specialist gender clinics have also been shown to have high rates of ASD traits or an autism diagnosis as well.[89] It has been estimated that children with ASD were over four times as likely to be diagnosed with GD,[88] with ASD being reported from 6% to over 20% of teens referring to gender identity services.[20]

Epidemiology

See also: Transgender § Population figures and prevalence, and Transsexual § Prevalence

Different studies have arrived at different conclusions about the prevalence of gender dysphoria. The DSM-5 estimates that about 0.005% to 0.014% of people assigned male at birth (5-14 per 100k) and 0.002% to 0.003% of people assigned female at birth (2-3 per 100k) are diagnosable with gender dysphoria.[90]

According to Black's Medical Dictionary, gender dysphoria "occurs in one in 30,000 male births and one in 100,000 female births."[91] Studies in European countries in the early 2000s found that about 1 in 12,000 natal male adults (8 per 100k) and 1 in 30,000 (3 per 100k) natal female adults seek out sex reassignment surgery.[92] Studies of hormonal treatment or legal name change find higher prevalence than sex reassignment, with, for example a 2010 Swedish study finding that 1 in 7,750 (13 per 100k) adult natal males and 1 in 13,120 (8 per 100k) adult natal females requested a legal name change to a name of the opposite gender.[92]

Studies that measure transgender status by self-identification find even greater prevalence of gender identity different from sex assigned at birth (although some of those who identify as transgender or gender nonconforming may not experience clinically significant distress and so do not have gender dysphoria). A study in New Zealand found that 1 in 3,630 natal males (13 per 100k) and 1 in 22,714 (4 per 100k) natal females have changed their legal gender markers.[92] A survey of Massachusetts adults found that 0.5% (500 per 100k) identify as transgender.[92][93] A national survey in New Zealand of 8,500 randomly selected secondary school students from 91 randomly selected high schools found 1.2% (1,200 per 100k) of students responded "yes" to the question "Do you think you are transgender?".[94] Outside of a clinical setting, the stability of transgender or non-binary identities is unknown.[92]

Research indicates that among people who transition in adulthood, individuals are up to three times more likely to be male assigned at birth. However, among people transitioning in childhood, the sex ratio is closer to 1:1.[95] The prevalence of gender dysphoria in children remains uncertain due to the lack of formal prevalence studies.[44] A 2022 literature review reported that approximately 36% of adolescents assessed in specialized gender clinics were natal males, and 63% were natal females. One study highlighted in the review found no significant change in these proportions from 2014-2016.[96] However, when comparing more recent data with earlier studies, there has been a shift favoring natal females (ratio of 1:3) as opposed to nearly equal proportions in earlier studies (ratios of 0.8–0.9:1).[97]

History

Neither the DSM-I (1952) nor the DSM-II (1968) contained a diagnosis analogous to gender dysphoria. Gender identity disorder first appeared as a diagnosis in the DSM-III (1980), where it appeared under "psychosexual disorders" but was used only for the childhood diagnosis. Adolescents and adults received a diagnosis of transsexualism (homosexual, heterosexual, or asexual type). The DSM-III-R (1987) added "Gender Identity Disorder of Adolescence and Adulthood, Non-Transsexual Type" (GIDAANT).[98][99][100] DSM-V (2013) replaced gender identity disorder (GID) with gender dysphoria (GD) to avoid the stigma of the term disorder.[1]

Society and culture

 
A sign at a trans rights rally: "Gender is like that old jumper from my cousin: It was given to me and it doesn't fit."

Researchers disagree about the nature of distress and impairment in people with GD. Some authors have suggested that people with GD suffer because they are stigmatized and victimized;[15][101] and that, if society had less strict gender divisions, transgender people would suffer less.[102]

Some controversy surrounds the creation of the GD diagnosis, with Davy et al. stating that although the creators of the diagnosis state that it has rigorous scientific support, "it is impossible to scrutinize such claims, since the discussions, methodological processes, and promised field trials of the diagnosis have not been published."[33]

Some cultures have three or more defined genders. The existence of accepted social categories other than man or woman may alleviate the distress associated with cross-gender identity. For example, in Samoa, the fa'afafine, a group of feminine males, are mostly socially accepted. The fa'afafine appear similar to transgender women in terms of their lifelong identities and gendered behavior, but experience far less distress than do transgender women in Western cultures. This suggests that the distress of gender dysphoria is mostly not caused by the cross-gender identity itself, but by difficulties encountered from social disapproval by one's culture.[103] Overall, it is unclear whether or not gender dysphoria persists in cultures with third gender categories.[104]

Classification as a disorder

The psychiatric diagnosis of gender identity disorder (now gender dysphoria) was introduced in DSM-III in 1980. Arlene Istar Lev and Deborah Rudacille have characterized the addition as a political maneuver to re-stigmatize homosexuality.[105][106] (Homosexuality was declassified as a mental disorder in the DSM-II in 1974.) By contrast, Kenneth Zucker and Robert Spitzer argue that gender identity disorder was included in DSM-III because it "met the generally accepted criteria used by the framers of DSM-III for inclusion."[107] Some researchers, including Spitzer and Paul J. Fink, contend that the behaviors and experiences seen in transsexualism are abnormal and constitute a dysfunction.[108] The American Psychiatric Association stated that gender nonconformity is not the same thing as gender dysphoria,[9] and that "gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition."[1]

Individuals with gender dysphoria may or may not regard their own cross-gender feelings and behaviors as a disorder. Advantages and disadvantages exist to classifying gender dysphoria as a disorder.[3] Because gender dysphoria had been classified as a disorder in medical texts (such as the previous DSM manual, the DSM-IV-TR, under the name "gender identity disorder"), many insurance companies are willing to cover some of the expenses of sex reassignment therapy. Without the classification of gender dysphoria as a medical disorder, sex reassignment therapy may be viewed as a cosmetic treatment, rather than medically necessary treatment, and may not be covered.[16] In the United States, transgender people are less likely than others to have health insurance, and often face hostility and insensitivity from healthcare providers.[109] Gender dysphoria being a disorder also means it is covered by the Americans with Disabilities Act, which may aid transgender people in accessing legal protections they otherwise may be unable to.[110] Some researchers and transgender people support declassification of the condition because they say the diagnosis pathologizes gender variance and reinforces the binary model of gender.[15]

An analysis of the Samoan third gender fa'afafine suggests that the DSM-IV-TR diagnostic component of distress is not inherent in the cross-gender identity; rather, it is related to social rejection and discrimination suffered by the individual.[103] Psychology professor Darryl Hill insists that gender dysphoria is not a mental disorder, but rather that the diagnostic criteria reflect psychological distress in children that occurs when parents and others have trouble relating to their child's gender variance.[108] Transgender people have often been harassed, socially excluded, and subjected to discrimination, abuse and violence, including murder.[4][102]

In December 2002, the British Lord Chancellor's office published a Government Policy Concerning Transsexual People document that categorically states, "What transsexualism is not ... It is not a mental illness."[111] In May 2009, the government of France declared that a transsexual gender identity will no longer be classified as a psychiatric condition,[112] but according to French trans rights organizations, beyond the impact of the announcement itself, nothing changed.[113] Denmark made a similar statement in 2016.[114]

In the ICD-11, GID is reclassified as "gender incongruence", a condition related to sexual health.[34] The working group responsible for this recategorization recommended keeping such a diagnosis in ICD-11 to preserve access to health services.[115]

Gender euphoria

 
In 1990, Virginia Prince ended an article wishing her readers "gender euphoria."

Gender euphoria (GE) is a term for the satisfaction, enjoyment, or relief felt by trans and non-binary people when they feel their gender expression matches their personal gender identity.[92][116][117] Psych Central's definition is "deep joy when your internal gender identity matches your gender expression."[118] It is proposed that feelings of gender euphoria require societal acceptance of gender expression.[116] In academics and the medical field, a consensus has not yet been reached on a precise definition of the term, as it has been mainly used within a social context.[119][120] The first attempt to rigorously define gender euphoria through an online survey took place in 2021, conducted by Will Beischel, Stéphanie Gauvin, and Sari van Anders.[120][121] Transgender congruence is also used to ascribe transgender individuals feeling genuine, authentic, and comfortable with their gender identity and external appearance.[122][123]

The term gender euphoria has been used by the transgender community since at least the mid-1970s.[121] Originally, it referred to the feeling of joy arising from fulfilling a mix of gender roles, which was different from the concept of gender dysphoria, which is used to describe individuals who wished to medically transition to a different sex.[121] In the 1980s, the term was published in trans contexts, coming up in interviews with trans people.[124][125][126] For example, in a 1988 interview with a trans man, the subject states, "I think that day [Dr. Charles Ilhenfeld] administered my first shot of the 'wonder-drug' must have been one of the 'peak-experiences' of my life -- talk about 'gender euphoria'!"[127] The interview indicates he is referring to testosterone.[127]

Other figures, including Mariette Pathy Allen and Virginia Prince, have used the term in their work. In 1990, Virginia Prince used the phrase in the trans magazine Femme Mirror, ending an article with, "...from here on you can enjoy GENDER EUPHORIA - HAVE A GOOD LIFE!"[128] Starting in 1991, a monthly newsletter named Gender Euphoria was released,[129] featuring articles about transgender topics; Leslie Feinberg read the newsletter to better understand the transgender community.[130] However, there are instances in which gender euphoria has been used with a different meaning, such as in 1979, when the Black feminist Michele Wallace used it to describe the male privilege present in Black men.[131][132]

The term has been embraced as part of a movement to stop pathologizing being transgender.[133] In 1989, Mariette Pathy Allen published an unnamed transgender person's quote in her photography book Transformations: "The shrinks may call it 'gender dysphoria,' but for some of us, it's gender 'euphoria,' and we're not going to apologize anymore!"[134] The movement to focus on the positive side of gender expression was also advocated for in 1994, when the Scottish "TV/TS" periodical The Tartan Skirt wrote, "Let's accentuate the positive, discard the negative, and promote the new condition of 'Gender Euphoria.'"[135] In 1997, Patrick Califia described transgender activists picketing using signs that read "Gender Euphoria NOT Gender Dysphoria" and handing out "thousands of leaflets" at protests.[133] The following year, in 1998, Second Skins: The Body Narratives of Transsexuality reported:

The transactivist group Transexual Menace is campaigning to have the diagnosis "Gender Identity Disorder" removed entirely from the Diagnostic and Statistical Manual of Mental Disorders. "Gender Euphoria NOT Gender Dysphoria"; its slogans invert the pathologizing of transgender, offering pride in queer difference as an alternative to the psychiatric story.[136]

Similarly, Florence Ashley has advocated for the medical field to focus on helping patients achieve gender euphoria instead of treating patients on the basis of gender dysphoria.[137][138] They argue that currently, in order for individuals to receive gender-affirming care, they must be diagnosed with gender dysphoria, which is not always accessible and entails people must be experiencing significant distress before they can fully express their own gender identity.[139] Ashley's stance that gender euphoria does not need to be preceded by a clinical diagnosis of gender dysphoria, and that gender euphoria is complex, is echoed by Elliot Tebbe and Stephanie Budge in their 2022 Nature Reviews Psychology[140] article, in which they write, "Gender euphoria is not merely the absence of gender dysphoria, but rather a conglomeration of positive emotions and subjective well-being in response to being affirmed in one’s gender."[141]

Gender euphoria has also been expressed through art. In 2019, the Midsumma festival in Australia hosted "Gender Euphoria," a cabaret focusing on "bliss" in transgender experiences, including musical, ballet, and burlesque performances.[142][143][144][145] A reviewer described it as "triumphant – honest, unpretentious, touching, and a vital celebration."[143] Moreover, photography in the East Village in Manhattan has served as means to express gender euphoria, contrasting fashion photography, which is said to reinforce the gender binary.[146]

See also

References

  1. ^ a b c d "Gender Dysphoria" (PDF). American Psychiatric Publishing. (PDF) from the original on December 29, 2016. Retrieved December 24, 2016.
  2. ^ a b c Maddux JE, Winstead BA (2015). Psychopathology: Foundations for a Contemporary Understanding. Routledge. pp. 464–465. ISBN 978-1317697992. from the original on 2020-06-05. Retrieved 2019-12-26.
  3. ^ a b c d e Coleman E (2011). (PDF). International Journal of Transgenderism. Routledge Taylor & Francis Group. 13 (4): 165–232. doi:10.1080/15532739.2011.700873. S2CID 39664779. Archived from the original (PDF) on August 2, 2014. Retrieved August 30, 2014.
  4. ^ a b c d Davidson MR (2012). A Nurse's Guide to Women's Mental Health. Springer Publishing Company. p. 114. ISBN 978-0-8261-7113-9.
  5. ^ Human Rights Campaign. "Sexual Orientation and Gender Identity Definitions". from the original on 2015-11-25. Retrieved 2021-06-13.
  6. ^ Morrow DF, Messinger L, eds. (2006). Sexual Orientation and Gender Expression in Social Work Practice: working with gay, lesbian, bisexual, and transgender people. New York: Columbia University Press. p. 8. ISBN 978-0-231-50186-6. Gender identity refers to an individual's personal sense of identity as masculine or feminine, or some combination thereof.
  7. ^ American Psychiatric Association, DSM-5 Fact Sheets, Updated Disorders: Gender Dysphoria 2016-12-29 at the Wayback Machine (Washington, D.C.: American Psychiatric Association, 2013): 2 ("DSM-5 aims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than their assigned gender. It replaces the diagnostic name 'gender identity disorder' with 'gender dysphoria', as well as makes other important clarifications in the criteria.").
  8. ^ a b Russo J, Coker JK, King JH (2017). DSM-5® and Family Systems. Springer Publishing Company. p. 352. ISBN 978-0826183996. from the original on 2021-04-19. Retrieved 2020-12-03. People meeting criteria for Gender Dysphoria most often identify themselves as trans or transgender. Trans or transgender can be used as umbrella terms to include the broad spectrum of persons whose gender identity differs from the assigned gender (APA, 2013).
  9. ^ a b Ranna Parekh. "What Is Gender Dysphoria?". American Psychiatric Publishing. from the original on January 14, 2020. Retrieved November 20, 2018.
  10. ^ World Professional Association for Transgender Health (WPATH), Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People 2015-08-14 at the Wayback Machine, ver. 7 (2011), 5 ("only some gender nonconforming people experience gender dysphoria at some point in their lives.")
  11. ^ a b Heylens G, De Cuypere G, Zucker KJ, Schelfaut C, Elaut E, Vanden Bossche H, et al. (March 2012). "Gender identity disorder in twins: a review of the case report literature". The Journal of Sexual Medicine. 9 (3): 751–757. doi:10.1111/j.1743-6109.2011.02567.x. PMID 22146048. Of 23 monozygotic female and male twins, nine (39.1%) were concordant for GID; in contrast, none of the 21 same‐sex dizygotic female and male twins were concordant for GID, a statistically significant difference (P = 0.005)... These findings suggest a role for genetic factors in the development of GID.
  12. ^ a b Diamond, Milton (2013). "Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation". International Journal of Transgenderism. 14 (1): 24–38. doi:10.1080/15532739.2013.750222. S2CID 144330783. Combining data from the present survey with those from past-published reports, 20% of all male and female monozygotic twin pairs were found concordant for transsexual identity... The responses of our twins relative to their rearing, along with our findings regarding some of their experiences during childhood and adolescence show their identity was much more influenced by their genetics than their rearing.
  13. ^ a b Rosenthal SM (December 2014). "Approach to the patient: transgender youth: endocrine considerations". The Journal of Clinical Endocrinology and Metabolism. 99 (12): 4379–4389. doi:10.1210/jc.2014-1919. PMID 25140398.
  14. ^ a b "Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth" (PDF). (PDF) from the original on 2020-12-07.
  15. ^ a b c Bryant K (2018). "Gender Dysphoria". Encyclopædia Britannica Online. from the original on April 18, 2020. Retrieved August 16, 2018.
  16. ^ a b Ford Z. . ThinkProgress. Archived from the original on February 2, 2013. Retrieved April 7, 2013.
  17. ^ Zucker KJ, Lawrence AA, Kreukels BP (2016). "Gender Dysphoria in Adults". Annual Review of Clinical Psychology. 12: 217–247. doi:10.1146/annurev-clinpsy-021815-093034. PMID 26788901. [For DSM-5] a reconceptualization was articulated in which 'identity' per se was not considered a sign of a mental disorder. Rather, it was the incongruence between one's felt gender and assigned sex/gender (usually at birth) leading to distress and/or impairment that was the core feature of the diagnosis.
  18. ^ Lev, Arlene Istar (2013). "Gender Dysphoria: Two Steps Forward, One Step Back". Clinical Social Work Journal. 41 (3): 288–296. doi:10.1007/s10615-013-0447-0. S2CID 144556484. [Despite some misgivings], I think that the change in nomenclature from the DSM-IV to the DSM-5 is a step forward, that is, removing the concept of gender as the site of the disorder and placing the focus on issues of distress and dysphoria.
  19. ^ Thompson, Lucy; Sarovic, Darko (2022). "A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology". PLOS Global Public Health. 2 (3): e0000245. doi:10.1371/journal.pgph.0000245. PMC 10021877. PMID 36962334. S2CID 247379163.
  20. ^ a b c Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L (2018-03-02). "Gender dysphoria in adolescence: current perspectives". Adolescent Health, Medicine and Therapeutics. 9: 31–41. doi:10.2147/AHMT.S135432. PMC 5841333. PMID 29535563. for the majority of adolescent-onset cases, GD presented in the context of severe mental disorders and general identity confusion. In such situations, appropriate treatment for psychiatric comorbidities may be warranted before conclusions regarding gender identity can be drawn."; "There is still no clear consensus regarding hormonal treatment for adolescents because long-term data are unavailable"; "In a nationwide long-term follow-up study of adult cases, psychiatric morbidity, suicide attempts and suicide mortality persisted as elevated after juridical and medical SR.
  21. ^ Crocq MA (2021). "How gender dysphoria and incongruence became medical diagnoses - a historical review". Dialogues in Clinical Neuroscience. 23 (1): 44–51. doi:10.1080/19585969.2022.2042166. PMC 9286744. PMID 35860172.
  22. ^ . 23 October 2017. Archived from the original on October 22, 2022. Retrieved October 23, 2022.
  23. ^ a b c Guillamon A, Junque C, Gómez-Gil E (October 2016). "A Review of the Status of Brain Structure Research in Transsexualism". Archives of Sexual Behavior. 45 (7): 1615–1648. doi:10.1007/s10508-016-0768-5. PMC 4987404. PMID 27255307.
  24. ^ Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. 2013. pp. 451–460. ISBN 978-0-89042-554-1.
  25. ^ a b c d e f American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (5th ed.). Washington, DC and London: American Psychiatric Publishing. pp. 451–460. ISBN 978-0-89042-555-8.
  26. ^ Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE (August 2015). "Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students". The Journal of Adolescent Health. 57 (2): 144–149. doi:10.1016/j.jadohealth.2015.03.003. PMC 4545276. PMID 25937471.
  27. ^ Harmon, A., & Oberleitner, M. G. (2016). Gender dysphoria. In Gale (Ed.), Gale encyclopedia of children's health: Infancy through adolescence (3rd ed.). Farmington, MI: Gale.
  28. ^ Turban, Jack. "What is Gender Dysphoria?". American Psychiatric Association. Retrieved October 23, 2023.
  29. ^ "Expert Q&A: Gender Dysphoria".
  30. ^ a b Gijs L, Brawaeys A (2007). "Surgical Treatment of Gender Dysphoria in Adults and Adolescents: Recent Developments, Effectiveness, and Challenges". Annual Review of Sex Research. 18 (178–224).
  31. ^ "Gender Dysphoria in Children". American Psychiatric Association. May 4, 2011. from the original on March 14, 2012. Retrieved July 3, 2011.
  32. ^ "P 00 Gender Dysphoria in Children". American Psychiatric Association. from the original on March 14, 2012. Retrieved April 2, 2012.
  33. ^ a b Davy Z, Toze M (2018). "What Is Gender Dysphoria? A Critical Systematic Narrative Review". Transgender Health. Mary Ann Liebert, Inc. Publishers. 3 (1): 159–169. doi:10.1089/trgh.2018.0014. PMC 6225591. PMID 30426079.
  34. ^ a b c "Gender incongruence (ICD-11)". icd.who.int. WHO. Archived from the original on August 1, 2018. Retrieved August 28, 2018.
  35. ^ "NHS - Treatment - Gender dysphoria". NHS. 2016. from the original on November 2, 2013. Retrieved January 10, 2019.
  36. ^ Leiblum S (2006). Principles and Practice of Sex Therapy, Fourth Edition. The Guilford Press. pp. 488–9. ISBN 978-1-59385-349-5.
  37. ^ Heyes, C. J., & Latham, J. R. (2018). Trans surgeries and cosmetic surgeries: The politics of analogy. Transgender Studies Quarterly, 5(2), 174-189.
  38. ^ Committee On Adolescence (July 2013). "Office-based care for lesbian, gay, bisexual, transgender, and questioning youth". Pediatrics. 132 (1): 198–203. doi:10.1542/peds.2013-1282. PMID 23796746. However, adolescents with multiple or anonymous partners, having unprotected intercourse, or having substance abuse issues should be tested at shorter intervals.
  39. ^ "www.glma.org Compendium of Health Profession Association LGBT Policy & Position Statements" (PDF). GLMA. 2013. (PDF) from the original on November 9, 2020. Retrieved August 27, 2013.
  40. ^ "APA Policy Statements on Lesbian, Gay, Bisexual, & Transgender Concerns" (PDF). American Psychological Association. 2011. (PDF) from the original on January 21, 2022. Retrieved August 27, 2013. Be it further resolved that APA recognizes the efficacy, benefit, and necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments
  41. ^ a b "Health and Medical Organization Statements on Sexual Orientation, Gender Identity/Expression and 'Reparative Therapy'". lambdalegal.org. Lambda Legal. from the original on 2017-06-15. Retrieved 2022-01-14.
  42. ^ "Policy and Position Statements on Conversion Therapy". Human Rights Campaign. from the original on 27 April 2017. Retrieved 12 April 2017.
  43. ^ American Psychiatric Association (December 2018). (PDF). American Psychiatric Association. Archived from the original (PDF) on 10 December 2021. While many might identify as questioning, queer, or a variety of other identities, 'reparative' or conversion therapy is based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill and should change ... APA encourages legislation which would prohibit the practice of 'reparative' or conversion therapies that are based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill(references omitted)
  44. ^ a b Ristori J, Steensma TD (2 January 2016). "Gender dysphoria in childhood". International Review of Psychiatry. 28 (1): 13–20. doi:10.3109/09540261.2015.1115754. PMID 26754056. S2CID 5461482.
  45. ^ The Transgendered Child: A Handbook for Families and Professionals (Brill and Pepper, 2008)[full citation needed][page needed]
  46. ^ Alleyne R (15 April 2011). "Puberty blocker for children considering sex change". The Telegraph. Archived from the original on 2022-01-11. Retrieved 1 December 2020.
  47. ^ "Puberty Blockers". www.stlouischildrens.org. Retrieved 18 August 2022.
  48. ^ "As children line up at gender clinics, families confront many unknowns". Reuters. 6 October 2022. Retrieved 10 October 2022.
  49. ^ Rosenthal SM (December 2016). "Transgender youth: current concepts". Annals of Pediatric Endocrinology & Metabolism. 21 (4): 185–192. doi:10.6065/apem.2016.21.4.185. PMC 5290172. PMID 28164070. The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development.
  50. ^ de Vries AL, Cohen-Kettenis PT (2012). "Clinical management of gender dysphoria in children and adolescents: the Dutch approach". Journal of Homosexuality. 59 (3): 301–320. doi:10.1080/00918369.2012.653300. PMID 22455322. S2CID 11731779.
  51. ^ a b Rew L, Young CC, Monge M, Bogucka R (February 2021). "Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature". Child and Adolescent Mental Health. 26 (1): 3–14. doi:10.1111/camh.12437. PMID 33320999. S2CID 229282305. from the original on 2022-05-20. Retrieved 2022-06-05. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.
  52. ^ a b "Transgender Health: An Endocrine Society Position Statement". www.endocrine.org. The Endocrine Society. 15 December 2020. Retrieved 15 June 2022.
  53. ^ a b Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. (November 2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology and Metabolism. 102 (11): 3869–3903. doi:10.1210/jc.2017-01658. PMID 28945902.
  54. ^ Coleman E, Radix AE, Bouman WP, Brown GR, de Vries AL, Deutsch MB, et al. (2022). "Standards of Care for the Health of Transgender and Gender Diverse People, Version 8". International Journal of Transgender Health. 23 (Suppl 1): S1–S259. doi:10.1080/26895269.2022.2100644. PMC 9553112. PMID 36238954.
  55. ^ Maddux JE, Winstead BA (2015). Psychopathology: Foundations for a Contemporary Understanding. Routledge. pp. 464–465. ISBN 978-1317697992.
  56. ^ "Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria". from the original on 2 April 2021. Retrieved 2 April 2021. The critical outcomes for decision making are the impact on gender dysphoria, mental health and quality of life. The quality of evidence for these outcomes was assessed as very low certainty using modified GRADE.
  57. ^ "Finnish guidelines for treatment of child and adolescent gender dysphoria" (PDF). Council for Choices in Health Care (COHERE). March 2021. (PDF) from the original on 3 December 2020. Retrieved 22 April 2021. p. 6: Terveydenhuoltolain mukaan (8§) terveydenhuollon toiminnan on perustuttava näyttöön ja hyviin hoito- ja toimintakäytäntöihin. Alaikäisten osalta tutkimusnäyttöön perustuvia terveydenhuollon menetelmiä ei ole. [According to the Health Care Act (Section 8), health care activities must be based on evidence and good care and operating practices. There are no research-based health care methods for minors. [translation provided by Wikipedia]]
  58. ^ Rafferty J (October 2018). "Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents". Pediatrics. 142 (4): e20182162. doi:10.1542/peds.2018-2162. PMID 30224363. from the original on 2019-07-19. Retrieved 2021-06-11.
  59. ^ Safer JD (17 February 2020). "Controversial pubertal blocker legislation may bring unintended consequences for children". Healio. from the original on 30 December 2020. Retrieved 15 December 2020.
  60. ^ "AMA fights to protect health care for transgender patients". State Advocacy Update. American Medical Association. March 26, 2021. from the original on June 29, 2021. Retrieved June 29, 2021.
  61. ^ "Endocrine Society urges policymakers to follow science on transgender health: Texas custody case prompts unfounded claims". Endocrine Society (Press release). Washington, DC. October 28, 2019. from the original on June 11, 2021. Retrieved June 11, 2021.
  62. ^ "Criminalizing Gender Affirmative Care with Minors: Suggested Discussion Points With Resources to Oppose Transgender Exclusion Bills". American Psychological Association. from the original on 2021-06-29. Retrieved 2021-06-29.
  63. ^ "AACAP Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse Youth". American Academy of Child and Adolescent Psychiatry. 8 November 2019. from the original on 7 June 2021. Retrieved 29 June 2021.
  64. ^ Schmidt S (22 April 2021). "FAQ: What you need to know about transgender children". The Washington Post. from the original on 16 June 2021. Retrieved 29 June 2021.
  65. ^ Siddique H (17 September 2021). "Appeal court overturns UK puberty blockers ruling for under-16s 17 September 2021". Guardian. from the original on 17 September 2021. Retrieved 17 September 2021.
  66. ^ Milton J (23 February 2022). "Swedish health board wants doctors to stop prescribing life-saving puberty blockers". PinkNews. Retrieved 12 October 2022.
  67. ^ Ghorayshi A (28 July 2022). "England Overhauls Medical Care for Transgender Youth". The New York Times. Retrieved 12 October 2022.
  68. ^ Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N (2015). "Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development". Child and Adolescent Psychiatry and Mental Health. 9: 9. doi:10.1186/s13034-015-0042-y. PMC 4396787. PMID 25873995.
  69. ^ "Development of the diagnosis gender dysphoria" (PDF). Swedish National Board of Health and Welfare (in Swedish). Feb 2020. (PDF) from the original on 2021-03-08. Retrieved 13 March 2021.
  70. ^ Kozlowska K, Chudleigh C, McClure G, Maguire AM, Ambler GR (2021-01-12). "Attachment Patterns in Children and Adolescents With Gender Dysphoria". Frontiers in Psychology. 11: 582688. doi:10.3389/fpsyg.2020.582688. PMC 7835132. PMID 33510668.
  71. ^ D'Angelo R, Syrulnik E, Ayad S, Marchiano L, Kenny DT, Clarke P (January 2021). "One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria". Archives of Sexual Behavior. 50 (1): 7–16. doi:10.1007/s10508-020-01844-2. PMC 7878242. PMID 33089441.
  72. ^ George R. Brown, MD (July 20, 2011). "Chapter 165 Sexuality and Sexual Disorders". In Robert S. Porter, MD; et al. (eds.). The Merck Manual of Diagnosis and Therapy (19th ed.). Whitehouse Station, NJ, USA: Merck & Co., Inc. pp. 1740–1747. ISBN 978-0-911910-19-3.
  73. ^ Bockting W, Knudson G, Goldberg J (January 2006). "Counselling and Mental Health Care of Transgender Adults and Loved Ones". International Journal of Transgenderism. 9 (3–4): 35–82. doi:10.1300/J485v09n03_03. S2CID 71503744. As per Figure 1, delusions about sex or gender, dissociative disorders, thought disorders, or obsessive or compulsive features should be evaluated and treated prior to proceeding with hormone therapy or surgery. Thought disorders, dissociative disorders, and obsessive-compulsive disorders can, rarely, cause a transient wish for sex reassignment which disappears or significantly lessens when the underlying mental health condition is treated. It is important to treat these disorders before proceeding with hormones or surgery to ensure that the desire for alteration of primary or secondary sex characteristics is not a temporary desire. See also WPATH Standards of Care, version 7 2015-08-14 at the Wayback Machine, page 23: "The role of mental health professionals includes making reasonably sure that the gender dysphoria is not secondary to or better accounted for by other diagnoses." And the paradigmatic Dutch model 2022-06-09 at the Wayback Machine for consideration of comorbid conditions before proceeding with treatment for childhood onset.
  74. ^ "Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People" (PDF). World Professional Association for Transgender Health. pp. 28–29. (PDF) from the original on 18 March 2021. Retrieved 15 March 2021.
  75. ^ Altinay M, Anand A (August 2020). "Neuroimaging gender dysphoria: a novel psychobiological model". Brain Imaging and Behavior. 14 (4): 1281–1297. doi:10.1007/s11682-019-00121-8. PMID 31134582. S2CID 167207854. from the original on 2021-10-21. A recently published study (Colizzi et al. 2014), where 118 patients were followed before and 12 months after HRT revealed that 14% of the patients had comorbid Axis-I psychiatric diagnosis. Psychiatric distress and impairment were found to be higher in the beginning phase of the study but after HRT, there was a significant improvement in major depressive disorder, anxiety and functional impairment. Similarly, Fisher and colleagues' (Fisher et al. 2013) 2013 paper suggests that the dysfunction and impairment in the transgender population is highly associated with lack of HRT, which may suggest that at least a fraction of the impairment that was documented as comorbid Axis-I psychiatric disorders could in fact be impairment from GD. Finally, a metanalysis done by Dhejne and colleagues (Dhejne et al. 2016) reviewed 38 longitudinal studies that investigated psychiatric comorbidities pre and post gender affirmation treatments in transgender people with GD. The results of this analysis indicate that depression and GAD do have higher prevalence in transgender population but this finding was isolated to baseline (pre-gender affirmation treatments) where after gender affirmation therapies, rate of psychiatric comorbidities decreased to cisgender population levels
  76. ^ Baker KE, Wilson LM, Sharma R, Dukhanin V, McArthur K, Robinson KA (April 2021). "Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review". Journal of the Endocrine Society. 5 (4): bvab011. doi:10.1210/jendso/bvab011. PMC 7894249. PMID 33644622. This systematic review of 20 studies found evidence that gender-affirming hormone therapy may be associated with improvements in QOL scores and decreases in depression and anxiety symptoms among transgender people. Associations were similar across gender identity and age. The strength of evidence for these conclusions is low due to methodological limitations.
  77. ^ Wernick JA, Busa S, Matouk K, Nicholson J, Janssen A (November 2019). "A Systematic Review of the Psychological Benefits of Gender-Affirming Surgery". The Urologic Clinics of North America. Gender Affirming Surgery. 46 (4): 475–486. doi:10.1016/j.ucl.2019.07.002. PMID 31582022. S2CID 201997501. Retrieved 2021-12-27.
  78. ^ a b c Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. (November 2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology and Metabolism. 102 (11): 3869–3903. doi:10.1210/jc.2017-01658. PMID 28945902. In the future, we need more rigorous evaluations of the effectiveness and safety of endocrine and surgical protocols.Specifically, endocrine treatment protocols for GD/gender incongruence should include the careful assessment of the following: (1) the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development); [...] and (4) the risks and benefits of gender-affirming hormone treatment in older transgender people." "Future research is needed to ascertain the potential harm of hormonal therapies (176)." "The satisfaction rate with surgical reassignment of sex is now very high (187)." "Owing to the lack of controlled studies, incomplete follow-up, and lack of valid assessment measures, evaluating various surgical approaches and techniques is difficult." "Several postoperative studies report significant long-term psychological and psychiatric pathology (259–261)." "We need more studies with appropriate controls that examine long-term quality of life, psychosocial outcomes, and psychiatric outcomes to determine the long-term benefits of surgical treatment.
  79. ^ Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, Erwin PJ, Montori VM (February 2010). "Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes". Clinical Endocrinology. 72 (2): 214–231. doi:10.1111/j.1365-2265.2009.03625.x. PMID 19473181. S2CID 19590739. from the original on 2021-07-17. Retrieved 2021-07-17. The evidence in this review is of very low quality9, 10 due to the serious methodological limitations of included studies. Studies lacked bias protection measures such as randomization and control groups, and generally depended on self-report to ascertain the exposure (i.e. hormonal therapy was self-reported as opposed to being extracted from medical records). Our reliance on reported outcome measures may also indicate a higher risk of reporting bias within the studies. Statistical heterogeneity of the results was also significant.
  80. ^ Sutcliffe PA, Dixon S, Akehurst RL, Wilkinson A, Shippam A, White S, et al. (March 2009). "Evaluation of surgical procedures for sex reassignment: a systematic review". Journal of Plastic, Reconstructive & Aesthetic Surgery. 62 (3): 294–306, discussion 306–308. doi:10.1016/j.bjps.2007.12.009. PMID 18222742. from the original on 2021-07-17. Retrieved 2021-07-17. The evidence concerning gender reassignment surgery in both MTF and FTM transsexism has several limitations in terms of: (a) lack of controlled studies, (b) evidence has not collected data prospectively, (c) high loss to follow up and (d) lack of validated assessment measures. Some satisfactory outcomes were reported, but the magnitude of benefit and harm for individual surgical procedures cannot be estimated accurately using the current available evidence.
  81. ^ Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ (August 2008). "The treatment of adolescent transsexuals: changing insights". The Journal of Sexual Medicine. 5 (8): 1892–1897. doi:10.1111/j.1743-6109.2008.00870.x. PMID 18564158. from the original on 2021-04-13. Retrieved 2021-04-14.
  82. ^ de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT (October 2014). "Young adult psychological outcome after puberty suppression and gender reassignment". Pediatrics. 134 (4): 696–704. doi:10.1542/peds.2013-2958. PMID 25201798. S2CID 18155489. from the original on 2021-04-13. Retrieved 2021-04-14.
  83. ^ Zucker KJ (October 2019). "Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues". Archives of Sexual Behavior. 48 (7): 1983–1992. doi:10.1007/s10508-019-01518-8. PMID 31321594. S2CID 197663705. from the original on 2022-06-09. Retrieved 2021-04-14. In the Dutch model, several factors were identified in deeming adolescent eligibility for early biomedical treatment. According to Cohen-Kettenis, Delemarre-van de Waal, and Gooren (2008), these included the following: (1) the presence of gender dysphoria from early childhood on; (2) an exacerbation of the gender dysphoria after the first signs of puberty; (3) the absence of psychiatric comorbidity that would interfere with a diagnostic evaluation or treatment; (4) adequate psychological and social support during treatment; and (5) a demonstration of knowledge of the sex/gender reassignment process. Several studies have reported on the benefits of this therapeutic protocol in reducing gender dysphoria (e.g., de Vries et al., 2014, which is the best study to date). Of course, one should bear in mind some of the limitation to these outcome studies, including the fact that not all assessed adolescents were deemed eligible for the treatment protocol (and thus we know relatively little about the longer-term outcomes of these youth) and that study designs have not included alternative treatment options (such as psychosocial therapy) or even being assigned to a wait-list control condition
  84. ^ Haupt C, Henke M, Kutschmar A, Hauser B, Baldinger S, Saenz SR, Schreiber G (November 2020). "Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women". The Cochrane Database of Systematic Reviews. 2020 (11): CD013138. doi:10.1002/14651858.cd013138.pub2. PMC 8078580. PMID 33251587. We found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition.
  85. ^ Bustos VP, Bustos SS, Mascaro A, Del Corral G, Forte AJ, Ciudad P, et al. (March 2021). . Plastic and Reconstructive Surgery. Global Open. 9 (3): e3477. doi:10.1097/GOX.0000000000003477. PMC 8099405. PMID 33968550. Archived from the original on 2022-04-06. Retrieved 2022-04-15.
  86. ^ Janssen A, Leibowitz S (2018-05-22). Affirmative Mental Health Care for Transgender and Gender Diverse Youth: A Clinical Guide. Springer. p. 8. ISBN 978-3-319-78307-9. from the original on 2021-10-15. Retrieved 2021-08-06.
  87. ^ Coelho JS, Suen J, Clark BA, Marshall SK, Geller J, Lam PY (October 2019). "Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review". Current Psychiatry Reports. 21 (11): 107. doi:10.1007/s11920-019-1097-x. PMID 31617014. S2CID 204542613. Significantly higher rates of eating disorder symptoms were documented in transgender youth compared to cisgender youth.
  88. ^ a b Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS (March 2020). "Prevalence of Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review". Journal of Autism and Developmental Disorders. 50 (3): 695–706. doi:10.1007/s10803-019-04298-1. PMID 31732891. S2CID 208061795. from the original on 2022-06-09. Retrieved 2021-08-06.
  89. ^ Kyriakou A, Nicolaides NC, Skordis N (March 2020). "Current approach to the clinical care of adolescents with gender dysphoria". Acta Bio-Medica. 91 (1): 165–175. doi:10.23750/abm.v91i1.9244. PMC 7569586. PMID 32191677.
  90. ^ Diagnostic and Statistical Manual of Mental Disorders 5. American Psychiatric Association. 2013. p. 454. ISBN 978-0-89042-555-8.
  91. ^ Harvey Marcovitch, ed. (2018). "Gender Identity Disorders". Black's Medical Dictionary (43rd ed.). New York: Bloomsbury. ISBN 9781472943064. from the original on 2022-06-09. Retrieved 2021-01-14.
  92. ^ a b c d e f Zucker KJ (October 2017). "Epidemiology of gender dysphoria and transgender identity". Sexual Health. 14 (5): 404–411. doi:10.1071/SH17067. PMID 28838353. S2CID 205237976. from the original on 2022-06-09. Retrieved 2020-12-22.
  93. ^ Conron KJ, Scott G, Stowell GS, Landers SJ (January 2012). "Transgender health in Massachusetts: results from a household probability sample of adults". American Journal of Public Health. American Public Health Association. 102 (1): 118–122. doi:10.2105/AJPH.2011.300315. OCLC 01642844. PMC 3490554. PMID 22095354. Between 2007 and 2009, survey participants aged 18 to 64 years in the Massachusetts Behavioral Risk Factor Surveillance System (MA-BRFSS; N = 28 662) were asked: "Some people describe themselves as transgender when they experience a different gender identity from their sex at birth. For example, a person born into a male body, but who feels female or lives as a woman. Do you consider yourself to be transgender?" ... We restricted the analytic sample to 28176 participants who answered yes or no to the transgender question (excluding n=364, 1.0% weighted who declined to respond. ... Transgender respondents (n=131; 0.5%; 95% confidence interval [CI]=0.3%, 0.6%) were somewhat younger and more likely to be Hispanic than were nontransgender respondents.
  94. ^ Clark TC, Lucassen MF, Bullen P, Denny SJ, Fleming TM, Robinson EM, Rossen FV (July 2014). "The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth'12)". The Journal of Adolescent Health. 55 (1): 93–99. doi:10.1016/j.jadohealth.2013.11.008. PMID 24438852. Whether a student was transgender was measured by the question, "Do you think you are transgender? This is a girl who feels like she should have been a boy, or a boy who feels like he should have been a girl (e.g., Trans, Queen, Fa'faffine, Whakawahine, Tangata ira Tane, Genderqueer)?" ... Over 8,000 students (n = 8,166) answered the question about whether they were transgender. Approximately 95% of students did not report being transgender (n=7,731; 94.7%), 96 students reported being transgender (1.2%), 202 reported not being sure (2.5%), and 137 did not understand the question (1.7%).
  95. ^ Landén M, Wålinder J, Lundström B (April 1996). "Prevalence, incidence and sex ratio of transsexualism". Acta Psychiatrica Scandinavica. 93 (4): 221–223. doi:10.1111/j.1600-0447.1996.tb10638.x. PMID 8712018. S2CID 26661088. On average, the male [to female]:female [to male] ratio in prevalence studies is estimated to be 3:1. However ... the incidence studies have shown a considerably lower male [to female] predominance. In Sweden and England and Wales, a sex ratio of 1:1 has been reported. In the most recent incidence data from Sweden, there is a slight male [to female] predominance among the group consisting of all applicants for sex reassignment, while in the group of primary [early onset] transsexuals there is no difference in incidence between men and women.
  96. ^ Chiniara, Lyne N.; Bonifacio, Herbert J.; Palmert, Mark R. (2018-06-19). "Characteristics of Adolescents Referred to a Gender Clinic: Are Youth Seen Now Different from Those in Initial Reports?". Hormone Research in Paediatrics. 89 (6): 434–441. doi:10.1159/000489608. ISSN 1663-2818. PMID 29920505. S2CID 49314194.
  97. ^ Thompson, Lucy; Sarovic, Darko; Wilson, Philip; Sämfjord, Angela; Gillberg, Christopher (2022-03-09). "A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology". PLOS Global Public Health. 2 (3): e0000245. doi:10.1371/journal.pgph.0000245. ISSN 2767-3375. PMC 10021877. PMID 36962334.
  98. ^ Koh J (2012). "[The history of the concept of gender identity disorder]". Seishin Shinkeigaku Zasshi = Psychiatria et Neurologia Japonica. 114 (6): 673–680. PMID 22844818.
  99. ^ Pauly IB (1993). "Terminology and Classification of Gender Identity Disorders". Journal of Psychology & Human Sexuality. 5 (4): 1–14. doi:10.1300/J056v05n04_01. S2CID 142954603.
  100. ^ Drescher, Jack, Transsexualism, Gender Identity Disorder and the DSM, Journal of Gay & Lesbian Mental Health 14, no. 2 (2010): 112.
  101. ^ Bryant KE (2007). The Politics of Pathology and the Making of Gender Identity Disorder. Ann Arbor, Michigan. p. 222. ISBN 978-0-549-26816-1.{{cite book}}: CS1 maint: location missing publisher (link)
  102. ^ a b Giordano S (2012). Children with Gender Identity Disorder: A Clinical, Ethical, and Legal Analysis. New Jersey: Routledge. p. 147. ISBN 978-0-415-50271-9.
  103. ^ a b Vasey PL, Bartlett NH (2007). "What can the Samoan "Fa'afafine" teach us about the Western concept of gender identity disorder in childhood?". Perspectives in Biology and Medicine. 50 (4): 481–490. doi:10.1353/pbm.2007.0056. PMID 17951883. S2CID 37437172.
  104. ^ Diagnostic and Statistical Manual of Mental Disorders 5. American Psychiatric Association. 2013. p. 457. ISBN 978-0-89042-555-8.
  105. ^ Lev AI (2004). Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families. Haworth Press. p. 172. ISBN 978-0-7890-2117-5. from the original on 2021-01-23. Retrieved 2020-11-11.
  106. ^ Rudacille D (February 2005). The Riddle of Gender: Science, Activism, and Transgender Rights. Pantheon. ISBN 978-0-375-42162-4.[page needed]
  107. ^ Zucker KJ, Spitzer RL (Jan–Feb 2005). "Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note". Journal of Sex & Marital Therapy. 31 (1): 31–42. doi:10.1080/00926230590475251. PMID 15841704. S2CID 22589255.
  108. ^ a b Hausman K (18 July 2003). "Controversy Continues to Grow Over DSM's GID Diagnosis". Psychiatric News. from the original on 2014-05-22. Retrieved 2014-05-22.
  109. ^ Mallon GP (2009). Social Work Practice with Transgender and Gender Variant Youth. New Jersey: Routledge. ISBN 978-0-415-99482-8.
  110. ^ Devan Cole. "Federal appeals court says Americans with Disabilities Act protections cover 'gender dysphoria,' handing a win to trans people". CNN. CNN. Retrieved 5 September 2022.
  111. ^ . People's rights/Transsexual people. U.K. Department for Constitutional Affairs. 2003. Archived from the original on May 11, 2008.
  112. ^ "La transsexualité ne sera plus classée comme affectation psychiatrique". Le Monde. May 16, 2009. from the original on February 26, 2018. Retrieved May 31, 2009.
  113. ^ "La France est très en retard dans la prise en charge des transsexuels". Libération (in French). May 17, 2011. from the original on November 30, 2014. Retrieved March 11, 2018. En réalité, ce décret n'a été rien d'autre qu'un coup médiatique, un très bel effet d'annonce. Sur le terrain, rien n'a changé.
  114. ^ Worley W (May 14, 2016). "Denmark will become first country to no longer define being transgender as a mental illness". The Independent. from the original on March 11, 2018. Retrieved March 22, 2018.
  115. ^ Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, et al. (October 2016). "Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations". World Psychiatry. 15 (3): 205–221. doi:10.1002/wps.20354. PMC 5032510. PMID 27717275.
  116. ^ a b Benestad, E.E.P. (October 2010). "From gender dysphoria to gender euphoria: An assisted journey". Sexologies. 19 (4): 225–231. doi:10.1016/j.sexol.2010.09.003. ISSN 1158-1360. Retrieved 2021-05-15.
  117. ^ Austin, Ashley; Papciak, Ryan; Lovins, Lindsay (2022-12-05). "Gender euphoria: a grounded theory exploration of experiencing gender affirmation". Psychology & Sexuality. 13 (5): 1406–1426. doi:10.1080/19419899.2022.2049632. ISSN 1941-9899. S2CID 247281003.
  118. ^ Collins D (2022-05-12). "Sex vs. Gender: What's the Difference and Why Does it Matter?". PsychCentral. from the original on 2022-06-02. Retrieved 2022-06-01.
  119. ^ Bradford NJ, Rider GN, Spencer KG (September 2021). "Hair removal and psychological well-being in transfeminine adults: associations with gender dysphoria and gender euphoria". The Journal of Dermatological Treatment. 32 (6): 635–642. doi:10.1080/09546634.2019.1687823. PMID 31668100. S2CID 204975343.
  120. ^ a b Beischel WJ, Gauvin SE, van Anders SM (2021-05-03). ""A little shiny gender breakthrough": Community understandings of gender euphoria". International Journal of Transgender Health. 23 (3): 274–294. doi:10.1080/26895269.2021.1915223. PMC 9255216. PMID 35799953.
  121. ^ a b c Kai, Jacobsen; Devor, Aaron (2022). "Moving From Gender Dysphoria to Gender Euphoria: Trans Experiences of Positive Gender-Related Emotions". Bulletin of Applied Transgender Studies. 1 (1–2): 119–143. doi:10.57814/GGFG-4J14. ISSN 2769-2124.
  122. ^ Huit, T. Zachary; Ralston, Allura L.; Haws, J. Kyle; Holt, Natalie R.; Hope, Debra A.; Puckett, Jae A.; Mocarski, Richard A.; Woodruff, Nathan (2021-11-04). "Psychometric Evaluation of the Transgender Congruence Scale". Sexuality Research and Social Policy. 20 (2): 491–504. doi:10.1007/s13178-021-00659-7. ISSN 1553-6610. S2CID 243792173. from the original on 2022-06-09. Retrieved 2022-05-06.
  123. ^ Kozee, Holly B.; Tylka, Tracy L.; Bauerband, L. Andrew (June 2012). "Measuring Transgender Individuals' Comfort With Gender Identity and Appearance: Development and Validation of the Transgender Congruence Scale". Psychology of Women Quarterly. 36 (2): 179–196. doi:10.1177/0361684312442161. ISSN 0361-6843. S2CID 10564167. from the original on 2021-12-23. Retrieved 2022-05-06.
  124. ^ Aman R (1986). Maledicta. Maledicta Press. ISBN 978-0-916500-29-0. from the original on 2022-06-02. Retrieved 2022-06-02.
  125. ^ Aman R (1988). Lillian Mermin Feinsilver Festschrift. Maledicta Press. ISBN 978-0-916500-29-0. from the original on 2022-06-02. Retrieved 2022-06-02.
  126. ^ Transsexualism: A Collection of Articles, Editorials, and Letters on the Subject of Male-to-female and Female-to-male Transsexualism Edited from the TV-TS Tapestry Journal, Issues 39-52. International Foundation for Gender Education. 1988. from the original on 2022-06-02. Retrieved 2022-06-02.
  127. ^ a b Transsexualism: A Collection of Articles, Editorials, and Letters on the Subject of Male-to-female and Female-to-male Transsexualism Edited from the TV-TS Tapestry Journal, Issues 39-52. University of Michigan: International Foundation for Gender Education. 1988. from the original on 2022-06-02. Retrieved 2022-06-02.
  128. ^ Femme Mirror. 1990. from the original on 2022-06-02. Retrieved 2022-06-02.
  129. ^ MacKenzie GO (1994). Transgender Nation. Popular Press. ISBN 978-0-87972-596-9. from the original on 2022-06-02. Retrieved 2022-06-02.
  130. ^ Feinberg L (1999-10-10). Trans Liberation: Beyond Pink or Blue. Beacon Press. ISBN 978-0-8070-7951-5. from the original on 2022-06-02. Retrieved 2022-06-02.
  131. ^ Gittelson N (1979). Dominus: A Woman Looks at Men's Lives. Harcourt Brace Jovanovich. ISBN 978-0-15-626118-0. from the original on 2022-06-02. Retrieved 2022-06-02.
  132. ^ Kriegel L (1979). On Men and Manhood. Hawthorn Books. ISBN 978-0-8015-0248-4. from the original on 2022-06-02. Retrieved 2022-06-02.
  133. ^ a b Califia P (1997). Sex Changes: The Politics of Transgenderism. Cleis Press. ISBN 978-1-57344-072-1. from the original on 2022-06-02. Retrieved 2022-06-02.
  134. ^ Allen MP (1989). Transformations: Crossdressers and Those who Love Them. Dutton. ISBN 978-0-525-24820-0. from the original on 2022-06-02. Retrieved 2022-06-02.
  135. ^ The Tartan Skirt: Magazine of the Scottish TV/TS Group. ADF Editorial Services. 1994. from the original on 2022-06-02. Retrieved 2022-06-02.
  136. ^ Prosser J (1998). Second Skins: The Body Narratives of Transsexuality. Columbia University Press. ISBN 978-0-231-10934-5. from the original on 2022-06-02. Retrieved 2022-06-02.
  137. ^ Ashley F (November 2021). "The Misuse of Gender Dysphoria: Toward Greater Conceptual Clarity in Transgender Health". Perspectives on Psychological Science. 16 (6): 1159–1164. doi:10.1177/1745691619872987. PMID 31747342. S2CID 208214158.
  138. ^ Ashley F, Ells C (December 2018). "In Favor of Covering Ethically Important Cosmetic Surgeries: Facial Feminization Surgery for Transgender People". The American Journal of Bioethics. 18 (12): 23–25. doi:10.1080/15265161.2018.1531162. PMID 31159694. S2CID 81006262.
  139. ^ Ashley F (July 2019). "Gatekeeping hormone replacement therapy for transgender patients is dehumanising". Journal of Medical Ethics. 45 (7): 480–482. doi:10.1136/medethics-2018-105293. PMID 30988174. S2CID 117715087.
  140. ^ Tebbe, Elliot A; Budge, Stephanie L (September 26, 2022). "Factors that drive mental health disparities and promote well-being in transgender and nonbinary people". National Library of Medicine.
  141. ^ Tebbe EA, Budge SL (September 2022). "Factors that drive mental health disparities and promote well-being in transgender and nonbinary people". Nature Reviews Psychology. 1 (12): 694–707. doi:10.1038/s44159-022-00109-0. PMC 9513020. PMID 36187743.
  142. ^ Connor A (2019-01-25). "The joy that comes from embracing trans identity shouldn't be so rare". The Guardian. from the original on 2022-06-02. Retrieved 2022-06-02.
  143. ^ a b Dezfouli L (19 January 2019). "Review: Gender Euphoria, Midsumma Festival". ArtsHub Australia. from the original on 2022-06-02. Retrieved 2022-06-02.
  144. ^ "Gender Euphoria review (Melbourne International Arts Festival)". Daily Review: Film, stage and music reviews, interviews and more. 2019-10-17. from the original on 2022-03-28. Retrieved 2022-06-02.
  145. ^ Woodhead C (2019-10-16). "A joyful and poignant celebration of difference". The Age. from the original on 2022-06-02. Retrieved 2022-06-02.
  146. ^ Ridout A (2015-10-28). Gender Euphoria: Photography, Fashion, and Gender Nonconformity in The East Village (Master of Arts thesis). Louisiana State University and Agricultural and Mechanical College. doi:10.31390/gradschool_theses.3825.

Further reading

  • Conway L (June 26, 2014). "Successful TransMen: Links and Photos". ai.eecs.umich.edu. Retrieved December 2, 2014.
  • Conway L (February 5, 2011). "Transsexual Women's Successes: Links and Photos". ai.eecs.umich.edu. Retrieved December 2, 2014.
  • Jacques J. "A Transgender Journey". The Guardian. Retrieved December 2, 2014.
  • Sharp VM, Lewis CB, Lieven NM. "Bell v Tavistock" (PDF). In the High Court of Justice Administrative Court Divisional Court ([2020] EWHC 3274 (Admin)): CO/60/2020. Archived (PDF) from the original on 2022-10-09.
  • World Professional Association for Transgender Health (2012). (PDF). Harry Benjamin International Gender Dysphoria Association. Archived from the original (PDF) on September 24, 2014. Includes a description of ICD-10 criteria.

External links

  • – An alternative to the Benjamin Standards of Care proposed by the International Conference on Transgender Law and Employment Policy.

December 23, 2023
gender, dysphoria, distress, person, experiences, mismatch, between, their, gender, identity, their, personal, sense, their, gender, their, assigned, birth, term, replaced, previous, diagnostic, label, gender, identity, disorder, 2013, with, release, diagnosti. Gender dysphoria GD is the distress a person experiences due to a mismatch between their gender identity their personal sense of their own gender and their sex assigned at birth 5 6 The term replaced the previous diagnostic label of gender identity disorder GID in 2013 with the release of the diagnostic manual DSM 5 The condition was renamed to remove the stigma associated with the term disorder 7 Gender dysphoriaOther namesGender identity disorderSpecialtyPsychiatry psychology SymptomsDistress related to one s assigned gender sex and or sex characteristics 1 2 3 ComplicationsEating disorders suicide depression anxiety social isolation 4 Differential diagnosisVariance in gender identity or expression that is not distressing 1 3 TreatmentTransitioning psychotherapy 2 3 MedicationHormones e g androgens antiandrogens estrogens People with gender dysphoria commonly identify as transgender 8 Gender nonconformity is not the same thing as gender dysphoria 9 and does not always lead to dysphoria or distress 10 The causes of gender incongruence are unknown but a gender identity likely reflects genetic biological environmental and cultural factors 11 12 13 Diagnosis can be given at any age although gender dysphoria in children and adolescents may manifest differently than in adults 14 Complications may include anxiety depression and eating disorders 8 Treatment for gender dysphoria includes social transitioning and often includes hormone replacement therapy HRT and or gender affirming surgeries and psychotherapy 2 3 Some researchers and transgender people argue for the declassification of the condition because they say the diagnosis pathologizes gender variance and reinforces the binary model of gender 15 However this declassification could carry implications for healthcare accessibility as HRT and gender affirming surgery could be deemed cosmetic by insurance providers as opposed to medically necessary treatment thereby affecting coverage 16 Contents 1 Signs and symptoms 2 Causes 3 Diagnosis 4 Treatment 4 1 Children 4 2 Psychological treatments 4 3 Biological treatments 5 Comorbidities 6 Epidemiology 7 History 8 Society and culture 8 1 Classification as a disorder 9 Gender euphoria 10 See also 11 References 12 Further reading 13 External linksSigns and symptomsDistress arising from an incongruence between a person s felt gender and assigned sex gender usually at birth is the cardinal symptom of gender dysphoria 17 18 No particular sexual orientation indicates gender dysphoria 19 20 A 2021 review in Dialogues in Clinical Neuroscience found no relation to sexual orientation but acknowledged that historically the two were often erroneously conflated 21 The British National Health Service also stated gender dysphoria is not related to sexual orientation 22 Gender dysphoria in those assigned male at birth AMAB tends to follow one of two broad trajectories early onset or late onset Early onset gender dysphoria is behaviorally visible in childhood but may temporarily subside leading the person to identify as gay or homosexual for a period of time followed by recurrence of gender dysphoria A 2016 review in the Archives of Sexual Behavior states this group is usually sexually attracted to members of their natal sex in adulthood commonly identifying as heterosexual Late onset gender dysphoria does not include visible signs in early childhood but some report having had wishes to be the opposite sex in childhood that they did not report to others 23 Likewise according to the review transgender people assigned male at birth who experience late onset gender dysphoria will usually be attracted to women and may identify as lesbians or bisexual while those with early onset will usually be attracted to men 23 The review states a similar pattern occurs in those assigned female at birth AFAB with those experiencing early onset GD being most likely to be attracted to women and those with late onset being most likely to be attracted to men and identify as gay 23 24 Symptoms of GD in children include preferences for opposite sex typical toys games activities or playmates as well as a great dislike of their own genitalia 25 Some children may also experience social isolation from their peers anxiety loneliness and depression 4 In adolescents and adults symptoms include the desire to be and to be treated as a different gender 25 Adults with GD are at increased risk for stress isolation anxiety depression poor self esteem and suicide 4 Transgender people are also at heightened risk for eating disorders 26 and substance abuse 27 According to the American Psychiatric Association 28 those who experience gender dysphoria later in life often report having secretly hidden their gender dysphoric feelings from others when they were younger 29 CausesSee also Causes of gender incongruence The specific causes of gender dysphoria remain unknown and treatments targeting the etiology or pathogenesis of gender dysphoria do not exist 30 Evidence from studies of twins suggests that genetic factors play a role in the development of gender dysphoria 11 12 Gender identity is thought to likely reflect a complex interplay of biological environmental and cultural factors 13 DiagnosisThe American Psychiatric Association permits a diagnosis of gender dysphoria in adolescents or adults if two or more of the following criteria are experienced for at least six months duration 25 A strong desire to be of a gender other than one s assigned gender A strong desire to be treated as a gender other than one s assigned gender A significant incongruence between one s experienced or expressed gender and one s sexual characteristics A strong desire for the sexual characteristics of a gender other than one s assigned gender A strong desire to be rid of one s sexual characteristics due to incongruence with one s experienced or expressed gender A strong conviction that one has the typical reactions and feelings of a gender other than one s assigned genderIn addition the condition must be associated with clinically significant distress or impairment 25 The DSM 5 moved this diagnosis out of the sexual disorders category and into a category of its own 25 The diagnosis was renamed from gender identity disorder to gender dysphoria after criticisms that the former term was stigmatizing 31 Subtyping by sexual orientation was deleted The diagnosis for children was separated from that for adults as gender dysphoria in children The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing or ability to express it if they have insight 32 Other specified gender dysphoria or unspecified gender dysphoria can be diagnosed if a person does not meet the criteria for gender dysphoria but still has clinically significant distress or impairment 25 Intersex people are no longer excluded from the diagnosis of GD 33 The International Classification of Diseases ICD 11 lists 3 conditions related to gender identity 34 Gender incongruence of adolescence or adulthood HA60 Gender incongruence of childhood HA61 Gender incongruence unspecified HA6Z ICD 11 defines gender incongruence as a marked and persistent incongruence between an individual s experienced gender and the assigned sex with no requirement for significant distress or impairment 34 TreatmentTreatment for a person diagnosed with GD may include psychological counseling supporting the individual s gender expression or hormone therapy or surgery This may involve physical transition resulting from medical interventions such as hormonal treatment genital surgery electrolysis or laser hair removal chest breast surgery or other reconstructive surgeries 35 The goal of treatment may simply be to reduce problems resulting from the person s transgender status for example counseling the patient in order to reduce guilt associated with cross dressing 36 Guidelines have been established to aid clinicians The World Professional Association for Transgender Health WPATH Standards of Care are used by some clinicians as treatment guidelines Others use guidelines outlined in Gianna Israel and Donald Tarver s Transgender Care 37 Guidelines for treatment generally follow a harm reduction model 38 39 40 Children Main article Gender dysphoria in children Medical scientific and governmental organizations have opposed conversion therapy defined as treatment viewing gender nonconformity as pathological and something to be changed instead supporting approaches that affirm children s diverse gender identities 41 42 43 People are more likely to keep having gender dysphoria the more intense their gender dysphoria cross gendered behavior and verbal identification with the desired experienced gender are i e stating that they are a different gender rather than wish to be a different gender 44 Professionals who treat gender dysphoria in children sometimes prescribe puberty blockers to delay the onset of puberty until a child is believed to be old enough to make an informed decision on whether hormonal or surgical gender reassignment is in their best interest 45 46 Short term side effects of puberty blockers include headaches fatigue insomnia muscle aches and changes in breast tissue mood and weight 47 Research on the long term effects on brain development cognitive function fertility and sexual function is limited 48 49 50 A review published in Child and Adolescent Mental Health found that puberty blockers are reversible and that they are associated with such positive outcomes as decreased suicidality in adulthood improved affect and psychological functioning and improved social life 51 According to the American Psychiatric Association Due to the dynamic nature of puberty development lack of gender affirming interventions i e social psychological and medical is not a neutral decision youth often experience worsening dysphoria and negative impact on mental health as the incongruent and unwanted puberty progresses Trans affirming treatment such as the use of puberty suppression is associated with the relief of emotional distress and notable gains in psychosocial and emotional development in trans and gender diverse youth 14 In its position statement published December 2020 the Endocrine Society stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression hormone therapy and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care They noted a decrease in suicidal ideation among youth who have access to gender affirming care and comparable levels of depression to cisgender peers among socially transitioned pre pubertal youth 52 In its 2017 guideline on treating those with gender dysphoria it recommends puberty blockers be started when the child has started puberty Tanner Stage 2 for breast or genital development and cross sex hormones be started at 16 though they note there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD gender incongruence They recommend a multidisciplinary team of medical and mental health professionals manage the treatment for those under 18 and recommend monitoring clinical pubertal development every 3 to 6 months and laboratory parameters every 6 to 12 months during sex hormone treatment 53 The World Professional Association for Transgender Health s Standards of Care 8 published in 2022 declare puberty blocking medication as medically necessary and recommends them for usage in transgender adolescents once the patient has reached Tanner stage 2 of development and state that longitudinal data shows improved outcomes for transgender patients who receive them 54 Some medical professionals disagree that adolescents are cognitively mature enough to make a decision with regard to hormone therapy or surgery and advise that irreversible genital procedures should not be performed on individuals under the age of legal consent in their respective country 55 A review commissioned by the UK Department of Health found that there was very low certainty of quality of evidence about puberty blocker outcomes in terms of mental health quality of life and impact on gender dysphoria 56 The Finnish government commissioned a review of the research evidence for treatment of minors and the Finnish Ministry of Health concluded that there are no research based health care methods for minors with gender dysphoria 57 Nevertheless they recommend the use of puberty blockers for minors on a case by case basis and the American Academy of Pediatrics state that pubertal suppression in children who identify as TGD transgender and gender diverse generally leads to improved psychological functioning in adolescence and young adulthood 58 In the United States several states have introduced or are considering legislation that would prohibit the use of puberty blockers in the treatment of transgender children 59 The American Medical Association 60 the Endocrine Society 61 the American Psychological Association 62 the American Academy of Child and Adolescent Psychiatry 63 and the American Academy of Pediatrics 64 oppose bans on puberty blockers for transgender children In the UK in the case of Bell v Tavistock an appeal court overturning the original decision ruled that children under 16 could give consent to receiving puberty blockers 65 In 2022 the National Board of Health and Welfare in Sweden issued new guidelines recommending that puberty blockers only be given in exceptional cases and said that their use was grounded in uncertain science Instead they recommended child psychiatric treatment psychosocial interventions and suicide prevention measures to be offered by clinicians 66 67 Psychological treatments Main article Psychotherapy Until the 1970s psychotherapy was the primary treatment for gender dysphoria and generally was directed to helping the person adjust to their assigned sex Psychotherapy is any therapeutic interaction that aims to treat a psychological problem Psychotherapy may be used in addition to biological interventions although some clinicians use only psychotherapy to treat gender dysphoria 30 Psychotherapeutic treatment of GD involves helping the patient to adapt to their gender incongruence or to explorative investigation of confounding co occurring 68 69 70 71 mental health issues Attempts to alleviate GD by changing the patient s gender identity to reflect assigned sex have been ineffective and are regarded as conversion therapy by most health organizations 41 72 1741 Biological treatments Main article Sex reassignment therapy Biological treatments physically alter primary and secondary sex characteristics to reduce the discrepancy between an individual s physical body and gender identity 73 Biological treatments for GD are typically undertaken in conjunction with psychotherapy however the WPATH Standards of Care state that psychotherapy should not be an absolute requirement for biological treatments 74 Hormonal treatments have been shown to reduce a number of symptoms of psychiatric distress associated with gender dysphoria 75 A WPATH commissioned systematic review of the outcomes of hormone therapy found evidence that gender affirming hormone therapy may be associated with improvements in quality of life scores and decreases in depression and anxiety symptoms among transgender people The strength of the evidence was low due to methodological limitations of the studies undertaken 76 Some literature suggests that gender affirming surgery is associated with improvements in quality of life and decreased incidence of depression 77 Those who choose to undergo sex reassignment surgery report high satisfaction rates with the outcome though these studies have limitations including risk of bias lack of randomization lack of controlled studies self reported outcomes and high loss to follow up 78 79 80 For adolescents much is unknown including persistence Disagreement among practitioners regarding treatment of adolescents is in part due to the lack of long term data 20 Young people qualifying for biomedical treatment according to the Dutch model 81 82 including having GD from early childhood on which intensifies at puberty and absence of psychiatric comorbidities that could challenge diagnosis or treatment found reduction in gender dysphoria although limitations to these outcome studies have been noted such as lack of controls or considering alternatives like psychotherapy 83 In its position statement published December 2020 the Endocrine Society stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression hormone therapy and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care They noted a decrease in suicidal ideation among youth who have access to gender affirming care and comparable levels of depression to cisgender peers among socially transitioned pre pubertal youth 52 In its 2017 guideline on treating those with gender dysphoria it recommends puberty blockers be started when the child has started puberty Tanner Stage 2 for breast or genital development and cross sex hormones be started at 16 though they note there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD gender incongruence They recommend a multidisciplinary team of medical and mental health professionals manage the treatment for those under 18 They also recommend monitoring clinical pubertal development every 3 to 6 months and laboratory parameters every 6 to 12 months during sex hormone treatment 53 A review published in Child and Adolescent Mental Health found that puberty blockers are fully reversible and that they are associated with such positive outcomes as decreased suicidality in adulthood improved affect and psychological functioning and improved social life 51 More rigorous studies are needed to assess the effectiveness safety and long term benefits and risks of hormonal and surgical treatments 78 For instance a 2020 Cochrane review found insufficient evidence to determine whether feminizing hormones were safe or effective due to the lack of completed studies that met their inclusion criteria 84 Several studies have found significant long term psychological and psychiatric pathology after surgical treatments 78 In 2021 a review published in Plastic and Reconstructive Surgery found that less than 1 of people who undergo gender affirming surgery regret the decision It concluded that There is an extremely low prevalence of regret in transgender patients after GAS We believe this study corroborates the improvements made in regard to selection criteria for GAS However there is high subjectivity in the assessment of regret and lack of standardized questionnaires which highlight the importance of developing validated questionnaires in this population 85 ComorbiditiesAmong youth around 20 to 30 of individuals attending gender clinics meet the DSM criteria for an anxiety disorder 86 Gender dysphoria is also associated with an increased risk of eating disorders in transgender youth 87 A widely held view among clinicians is that there is an over representation of neurodevelopmental conditions amongst individuals with GD although this view has been questioned due to the low quality of evidence 88 Studies on children and adolescents with gender dysphoria have found a high prevalence of autism spectrum disorder ASD traits or a confirmed diagnosis of ASD Adults with gender dysphoria attending specialist gender clinics have also been shown to have high rates of ASD traits or an autism diagnosis as well 89 It has been estimated that children with ASD were over four times as likely to be diagnosed with GD 88 with ASD being reported from 6 to over 20 of teens referring to gender identity services 20 EpidemiologySee also Transgender Population figures and prevalence and Transsexual Prevalence Different studies have arrived at different conclusions about the prevalence of gender dysphoria The DSM 5 estimates that about 0 005 to 0 014 of people assigned male at birth 5 14 per 100k and 0 002 to 0 003 of people assigned female at birth 2 3 per 100k are diagnosable with gender dysphoria 90 According to Black s Medical Dictionary gender dysphoria occurs in one in 30 000 male births and one in 100 000 female births 91 Studies in European countries in the early 2000s found that about 1 in 12 000 natal male adults 8 per 100k and 1 in 30 000 3 per 100k natal female adults seek out sex reassignment surgery 92 Studies of hormonal treatment or legal name change find higher prevalence than sex reassignment with for example a 2010 Swedish study finding that 1 in 7 750 13 per 100k adult natal males and 1 in 13 120 8 per 100k adult natal females requested a legal name change to a name of the opposite gender 92 Studies that measure transgender status by self identification find even greater prevalence of gender identity different from sex assigned at birth although some of those who identify as transgender or gender nonconforming may not experience clinically significant distress and so do not have gender dysphoria A study in New Zealand found that 1 in 3 630 natal males 13 per 100k and 1 in 22 714 4 per 100k natal females have changed their legal gender markers 92 A survey of Massachusetts adults found that 0 5 500 per 100k identify as transgender 92 93 A national survey in New Zealand of 8 500 randomly selected secondary school students from 91 randomly selected high schools found 1 2 1 200 per 100k of students responded yes to the question Do you think you are transgender 94 Outside of a clinical setting the stability of transgender or non binary identities is unknown 92 Research indicates that among people who transition in adulthood individuals are up to three times more likely to be male assigned at birth However among people transitioning in childhood the sex ratio is closer to 1 1 95 The prevalence of gender dysphoria in children remains uncertain due to the lack of formal prevalence studies 44 A 2022 literature review reported that approximately 36 of adolescents assessed in specialized gender clinics were natal males and 63 were natal females One study highlighted in the review found no significant change in these proportions from 2014 2016 96 However when comparing more recent data with earlier studies there has been a shift favoring natal females ratio of 1 3 as opposed to nearly equal proportions in earlier studies ratios of 0 8 0 9 1 97 HistoryNeither the DSM I 1952 nor the DSM II 1968 contained a diagnosis analogous to gender dysphoria Gender identity disorder first appeared as a diagnosis in the DSM III 1980 where it appeared under psychosexual disorders but was used only for the childhood diagnosis Adolescents and adults received a diagnosis of transsexualism homosexual heterosexual or asexual type The DSM III R 1987 added Gender Identity Disorder of Adolescence and Adulthood Non Transsexual Type GIDAANT 98 99 100 DSM V 2013 replaced gender identity disorder GID with gender dysphoria GD to avoid the stigma of the term disorder 1 Society and culture nbsp A sign at a trans rights rally Gender is like that old jumper from my cousin It was given to me and it doesn t fit Researchers disagree about the nature of distress and impairment in people with GD Some authors have suggested that people with GD suffer because they are stigmatized and victimized 15 101 and that if society had less strict gender divisions transgender people would suffer less 102 Some controversy surrounds the creation of the GD diagnosis with Davy et al stating that although the creators of the diagnosis state that it has rigorous scientific support it is impossible to scrutinize such claims since the discussions methodological processes and promised field trials of the diagnosis have not been published 33 Some cultures have three or more defined genders The existence of accepted social categories other than man or woman may alleviate the distress associated with cross gender identity For example in Samoa the fa afafine a group of feminine males are mostly socially accepted The fa afafine appear similar to transgender women in terms of their lifelong identities and gendered behavior but experience far less distress than do transgender women in Western cultures This suggests that the distress of gender dysphoria is mostly not caused by the cross gender identity itself but by difficulties encountered from social disapproval by one s culture 103 Overall it is unclear whether or not gender dysphoria persists in cultures with third gender categories 104 Classification as a disorder The psychiatric diagnosis of gender identity disorder now gender dysphoria was introduced in DSM III in 1980 Arlene Istar Lev and Deborah Rudacille have characterized the addition as a political maneuver to re stigmatize homosexuality 105 106 Homosexuality was declassified as a mental disorder in the DSM II in 1974 By contrast Kenneth Zucker and Robert Spitzer argue that gender identity disorder was included in DSM III because it met the generally accepted criteria used by the framers of DSM III for inclusion 107 Some researchers including Spitzer and Paul J Fink contend that the behaviors and experiences seen in transsexualism are abnormal and constitute a dysfunction 108 The American Psychiatric Association stated that gender nonconformity is not the same thing as gender dysphoria 9 and that gender nonconformity is not in itself a mental disorder The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition 1 Individuals with gender dysphoria may or may not regard their own cross gender feelings and behaviors as a disorder Advantages and disadvantages exist to classifying gender dysphoria as a disorder 3 Because gender dysphoria had been classified as a disorder in medical texts such as the previous DSM manual the DSM IV TR under the name gender identity disorder many insurance companies are willing to cover some of the expenses of sex reassignment therapy Without the classification of gender dysphoria as a medical disorder sex reassignment therapy may be viewed as a cosmetic treatment rather than medically necessary treatment and may not be covered 16 In the United States transgender people are less likely than others to have health insurance and often face hostility and insensitivity from healthcare providers 109 Gender dysphoria being a disorder also means it is covered by the Americans with Disabilities Act which may aid transgender people in accessing legal protections they otherwise may be unable to 110 Some researchers and transgender people support declassification of the condition because they say the diagnosis pathologizes gender variance and reinforces the binary model of gender 15 An analysis of the Samoan third gender fa afafine suggests that the DSM IV TR diagnostic component of distress is not inherent in the cross gender identity rather it is related to social rejection and discrimination suffered by the individual 103 Psychology professor Darryl Hill insists that gender dysphoria is not a mental disorder but rather that the diagnostic criteria reflect psychological distress in children that occurs when parents and others have trouble relating to their child s gender variance 108 Transgender people have often been harassed socially excluded and subjected to discrimination abuse and violence including murder 4 102 In December 2002 the British Lord Chancellor s office published a Government Policy Concerning Transsexual People document that categorically states What transsexualism is not It is not a mental illness 111 In May 2009 the government of France declared that a transsexual gender identity will no longer be classified as a psychiatric condition 112 but according to French trans rights organizations beyond the impact of the announcement itself nothing changed 113 Denmark made a similar statement in 2016 114 In the ICD 11 GID is reclassified as gender incongruence a condition related to sexual health 34 The working group responsible for this recategorization recommended keeping such a diagnosis in ICD 11 to preserve access to health services 115 Gender euphoriaThis section relies excessively on references to primary sources Please improve this section by adding secondary or tertiary sources Find sources gender euphoria history of the term news newspapers books scholar JSTOR June 2022 Learn how and when to remove this template message nbsp In 1990 Virginia Prince ended an article wishing her readers gender euphoria Gender euphoria GE is a term for the satisfaction enjoyment or relief felt by trans and non binary people when they feel their gender expression matches their personal gender identity 92 116 117 Psych Central s definition is deep joy when your internal gender identity matches your gender expression 118 It is proposed that feelings of gender euphoria require societal acceptance of gender expression 116 In academics and the medical field a consensus has not yet been reached on a precise definition of the term as it has been mainly used within a social context 119 120 The first attempt to rigorously define gender euphoria through an online survey took place in 2021 conducted by Will Beischel Stephanie Gauvin and Sari van Anders 120 121 Transgender congruence is also used to ascribe transgender individuals feeling genuine authentic and comfortable with their gender identity and external appearance 122 123 The term gender euphoria has been used by the transgender community since at least the mid 1970s 121 Originally it referred to the feeling of joy arising from fulfilling a mix of gender roles which was different from the concept of gender dysphoria which is used to describe individuals who wished to medically transition to a different sex 121 In the 1980s the term was published in trans contexts coming up in interviews with trans people 124 125 126 For example in a 1988 interview with a trans man the subject states I think that day Dr Charles Ilhenfeld administered my first shot of the wonder drug must have been one of the peak experiences of my life talk about gender euphoria 127 The interview indicates he is referring to testosterone 127 Other figures including Mariette Pathy Allen and Virginia Prince have used the term in their work In 1990 Virginia Prince used the phrase in the trans magazine Femme Mirror ending an article with from here on you can enjoy GENDER EUPHORIA HAVE A GOOD LIFE 128 Starting in 1991 a monthly newsletter named Gender Euphoria was released 129 featuring articles about transgender topics Leslie Feinberg read the newsletter to better understand the transgender community 130 However there are instances in which gender euphoria has been used with a different meaning such as in 1979 when the Black feminist Michele Wallace used it to describe the male privilege present in Black men 131 132 The term has been embraced as part of a movement to stop pathologizing being transgender 133 In 1989 Mariette Pathy Allen published an unnamed transgender person s quote in her photography book Transformations The shrinks may call it gender dysphoria but for some of us it s gender euphoria and we re not going to apologize anymore 134 The movement to focus on the positive side of gender expression was also advocated for in 1994 when the Scottish TV TS periodical The Tartan Skirt wrote Let s accentuate the positive discard the negative and promote the new condition of Gender Euphoria 135 In 1997 Patrick Califia described transgender activists picketing using signs that read Gender Euphoria NOT Gender Dysphoria and handing out thousands of leaflets at protests 133 The following year in 1998 Second Skins The Body Narratives of Transsexuality reported The transactivist group Transexual Menace is campaigning to have the diagnosis Gender Identity Disorder removed entirely from the Diagnostic and Statistical Manual of Mental Disorders Gender Euphoria NOT Gender Dysphoria its slogans invert the pathologizing of transgender offering pride in queer difference as an alternative to the psychiatric story 136 Similarly Florence Ashley has advocated for the medical field to focus on helping patients achieve gender euphoria instead of treating patients on the basis of gender dysphoria 137 138 They argue that currently in order for individuals to receive gender affirming care they must be diagnosed with gender dysphoria which is not always accessible and entails people must be experiencing significant distress before they can fully express their own gender identity 139 Ashley s stance that gender euphoria does not need to be preceded by a clinical diagnosis of gender dysphoria and that gender euphoria is complex is echoed by Elliot Tebbe and Stephanie Budge in their 2022 Nature Reviews Psychology 140 article in which they write Gender euphoria is not merely the absence of gender dysphoria but rather a conglomeration of positive emotions and subjective well being in response to being affirmed in one s gender 141 Gender euphoria has also been expressed through art In 2019 the Midsumma festival in Australia hosted Gender Euphoria a cabaret focusing on bliss in transgender experiences including musical ballet and burlesque performances 142 143 144 145 A reviewer described it as triumphant honest unpretentious touching and a vital celebration 143 Moreover photography in the East Village in Manhattan has served as means to express gender euphoria contrasting fashion photography which is said to reinforce the gender binary 146 See alsoList of transgender related topics Transmedicalism Gender transitioning Detransition ICD 11 Gender incongruenceReferences a b c d Gender Dysphoria PDF American Psychiatric Publishing Archived PDF from the original on December 29 2016 Retrieved December 24 2016 a b c Maddux JE Winstead BA 2015 Psychopathology Foundations for a Contemporary Understanding Routledge pp 464 465 ISBN 978 1317697992 Archived from the original on 2020 06 05 Retrieved 2019 12 26 a b c d e Coleman E 2011 Standards of Care for the Health of Transsexual Transgender and Gender Nonconforming People Version 7 PDF International Journal of Transgenderism Routledge Taylor amp Francis Group 13 4 165 232 doi 10 1080 15532739 2011 700873 S2CID 39664779 Archived from the original PDF on August 2 2014 Retrieved August 30 2014 a b c d Davidson MR 2012 A Nurse s Guide to Women s Mental Health Springer Publishing Company p 114 ISBN 978 0 8261 7113 9 Human Rights Campaign Sexual Orientation and Gender Identity Definitions Archived from the original on 2015 11 25 Retrieved 2021 06 13 Morrow DF Messinger L eds 2006 Sexual Orientation and Gender Expression in Social Work Practice working with gay lesbian bisexual and transgender people New York Columbia University Press p 8 ISBN 978 0 231 50186 6 Gender identity refers to an individual s personal sense of identity as masculine or feminine or some combination thereof American Psychiatric Association DSM 5 Fact Sheets Updated Disorders Gender Dysphoria Archived 2016 12 29 at the Wayback Machine Washington D C American Psychiatric Association 2013 2 DSM 5 aims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than their assigned gender It replaces the diagnostic name gender identity disorder with gender dysphoria as well as makes other important clarifications in the criteria a b Russo J Coker JK King JH 2017 DSM 5 and Family Systems Springer Publishing Company p 352 ISBN 978 0826183996 Archived from the original on 2021 04 19 Retrieved 2020 12 03 People meeting criteria for Gender Dysphoria most often identify themselves as trans or transgender Trans or transgender can be used as umbrella terms to include the broad spectrum of persons whose gender identity differs from the assigned gender APA 2013 a b Ranna Parekh What Is Gender Dysphoria American Psychiatric Publishing Archived from the original on January 14 2020 Retrieved November 20 2018 World Professional Association for Transgender Health WPATH Standards of Care for the Health of Transsexual Transgender and Gender Nonconforming People Archived 2015 08 14 at the Wayback Machine ver 7 2011 5 only some gender nonconforming people experience gender dysphoria at some point in their lives a b Heylens G De Cuypere G Zucker KJ Schelfaut C Elaut E Vanden Bossche H et al March 2012 Gender identity disorder in twins a review of the case report literature The Journal of Sexual Medicine 9 3 751 757 doi 10 1111 j 1743 6109 2011 02567 x PMID 22146048 Of 23 monozygotic female and male twins nine 39 1 were concordant for GID in contrast none of the 21 same sex dizygotic female and male twins were concordant for GID a statistically significant difference P 0 005 These findings suggest a role for genetic factors in the development of GID a b Diamond Milton 2013 Transsexuality Among Twins Identity Concordance Transition Rearing and Orientation International Journal of Transgenderism 14 1 24 38 doi 10 1080 15532739 2013 750222 S2CID 144330783 Combining data from the present survey with those from past published reports 20 of all male and female monozygotic twin pairs were found concordant for transsexual identity The responses of our twins relative to their rearing along with our findings regarding some of their experiences during childhood and adolescence show their identity was much more influenced by their genetics than their rearing a b Rosenthal SM December 2014 Approach to the patient transgender youth endocrine considerations The Journal of Clinical Endocrinology and Metabolism 99 12 4379 4389 doi 10 1210 jc 2014 1919 PMID 25140398 a b Position Statement on Treatment of Transgender Trans and Gender Diverse Youth PDF Archived PDF from the original on 2020 12 07 a b c Bryant K 2018 Gender Dysphoria Encyclopaedia Britannica Online Archived from the original on April 18 2020 Retrieved August 16 2018 a b Ford Z APA Revises Manual Being Transgender is No Longer a Mental Disorder ThinkProgress Archived from the original on February 2 2013 Retrieved April 7 2013 Zucker KJ Lawrence AA Kreukels BP 2016 Gender Dysphoria in Adults Annual Review of Clinical Psychology 12 217 247 doi 10 1146 annurev clinpsy 021815 093034 PMID 26788901 For DSM 5 a reconceptualization was articulated in which identity per se was not considered a sign of a mental disorder Rather it was the incongruence between one s felt gender and assigned sex gender usually at birth leading to distress and or impairment that was the core feature of the diagnosis Lev Arlene Istar 2013 Gender Dysphoria Two Steps Forward One Step Back Clinical Social Work Journal 41 3 288 296 doi 10 1007 s10615 013 0447 0 S2CID 144556484 Despite some misgivings I think that the change in nomenclature from the DSM IV to the DSM 5 is a step forward that is removing the concept of gender as the site of the disorder and placing the focus on issues of distress and dysphoria Thompson Lucy Sarovic Darko 2022 A PRISMA systematic review of adolescent gender dysphoria literature 1 Epidemiology PLOS Global Public Health 2 3 e0000245 doi 10 1371 journal pgph 0000245 PMC 10021877 PMID 36962334 S2CID 247379163 a b c Kaltiala Heino R Bergman H Tyolajarvi M Frisen L 2018 03 02 Gender dysphoria in adolescence current perspectives Adolescent Health Medicine and Therapeutics 9 31 41 doi 10 2147 AHMT S135432 PMC 5841333 PMID 29535563 for the majority of adolescent onset cases GD presented in the context of severe mental disorders and general identity confusion In such situations appropriate treatment for psychiatric comorbidities may be warranted before conclusions regarding gender identity can be drawn There is still no clear consensus regarding hormonal treatment for adolescents because long term data are unavailable In a nationwide long term follow up study of adult cases psychiatric morbidity suicide attempts and suicide mortality persisted as elevated after juridical and medical SR Crocq MA 2021 How gender dysphoria and incongruence became medical diagnoses a historical review Dialogues in Clinical Neuroscience 23 1 44 51 doi 10 1080 19585969 2022 2042166 PMC 9286744 PMID 35860172 Gender Dysphoria 23 October 2017 Archived from the original on October 22 2022 Retrieved October 23 2022 a b c Guillamon A Junque C Gomez Gil E October 2016 A Review of the Status of Brain Structure Research in Transsexualism Archives of Sexual Behavior 45 7 1615 1648 doi 10 1007 s10508 016 0768 5 PMC 4987404 PMID 27255307 Diagnostic and Statistical Manual of Mental Disorders Fifth ed Arlington VA American Psychiatric Publishing 2013 pp 451 460 ISBN 978 0 89042 554 1 a b c d e f American Psychiatry Association 2013 Diagnostic and Statistical Manual of Mental Disorders DSM 5 5th ed Washington DC and London American Psychiatric Publishing pp 451 460 ISBN 978 0 89042 555 8 Diemer EW Grant JD Munn Chernoff MA Patterson DA Duncan AE August 2015 Gender Identity Sexual Orientation and Eating Related Pathology in a National Sample of College Students The Journal of Adolescent Health 57 2 144 149 doi 10 1016 j jadohealth 2015 03 003 PMC 4545276 PMID 25937471 Harmon A amp Oberleitner M G 2016 Gender dysphoria In Gale Ed Gale encyclopedia of children s health Infancy through adolescence 3rd ed Farmington MI Gale Turban Jack What is Gender Dysphoria American Psychiatric Association Retrieved October 23 2023 Expert Q amp A Gender Dysphoria a b Gijs L Brawaeys A 2007 Surgical Treatment of Gender Dysphoria in Adults and Adolescents Recent Developments Effectiveness and Challenges Annual Review of Sex Research 18 178 224 Gender Dysphoria in Children American Psychiatric Association May 4 2011 Archived from the original on March 14 2012 Retrieved July 3 2011 P 00 Gender Dysphoria in Children American Psychiatric Association Archived from the original on March 14 2012 Retrieved April 2 2012 a b Davy Z Toze M 2018 What Is Gender Dysphoria A Critical Systematic Narrative Review Transgender Health Mary Ann Liebert Inc Publishers 3 1 159 169 doi 10 1089 trgh 2018 0014 PMC 6225591 PMID 30426079 a b c Gender incongruence ICD 11 icd who int WHO Archived from the original on August 1 2018 Retrieved August 28 2018 NHS Treatment Gender dysphoria NHS 2016 Archived from the original on November 2 2013 Retrieved January 10 2019 Leiblum S 2006 Principles and Practice of Sex Therapy Fourth Edition The Guilford Press pp 488 9 ISBN 978 1 59385 349 5 Heyes C J amp Latham J R 2018 Trans surgeries and cosmetic surgeries The politics of analogy Transgender Studies Quarterly 5 2 174 189 Committee On Adolescence July 2013 Office based care for lesbian gay bisexual transgender and questioning youth Pediatrics 132 1 198 203 doi 10 1542 peds 2013 1282 PMID 23796746 However adolescents with multiple or anonymous partners having unprotected intercourse or having substance abuse issues should be tested at shorter intervals www glma org Compendium of Health Profession Association LGBT Policy amp Position Statements PDF GLMA 2013 Archived PDF from the original on November 9 2020 Retrieved August 27 2013 APA Policy Statements on Lesbian Gay Bisexual amp Transgender Concerns PDF American Psychological Association 2011 Archived PDF from the original on January 21 2022 Retrieved August 27 2013 Be it further resolved that APA recognizes the efficacy benefit and necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments a b Health and Medical Organization Statements on Sexual Orientation Gender Identity Expression and Reparative Therapy lambdalegal org Lambda Legal Archived from the original on 2017 06 15 Retrieved 2022 01 14 Policy and Position Statements on Conversion Therapy Human Rights Campaign Archived from the original on 27 April 2017 Retrieved 12 April 2017 American Psychiatric Association December 2018 Position Statement on Therapies Focused on Attempts to Change Sexual Orientation Reparative or Conversion Therapies PDF American Psychiatric Association Archived from the original PDF on 10 December 2021 While many might identify as questioning queer or a variety of other identities reparative or conversion therapy is based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill and should change APA encourages legislation which would prohibit the practice of reparative or conversion therapies that are based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill references omitted a b Ristori J Steensma TD 2 January 2016 Gender dysphoria in childhood International Review of Psychiatry 28 1 13 20 doi 10 3109 09540261 2015 1115754 PMID 26754056 S2CID 5461482 The Transgendered Child A Handbook for Families and Professionals Brill and Pepper 2008 full citation needed page needed Alleyne R 15 April 2011 Puberty blocker for children considering sex change The Telegraph Archived from the original on 2022 01 11 Retrieved 1 December 2020 Puberty Blockers www stlouischildrens org Retrieved 18 August 2022 As children line up at gender clinics families confront many unknowns Reuters 6 October 2022 Retrieved 10 October 2022 Rosenthal SM December 2016 Transgender youth current concepts Annals of Pediatric Endocrinology amp Metabolism 21 4 185 192 doi 10 6065 apem 2016 21 4 185 PMC 5290172 PMID 28164070 The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization compromised fertility and unknown effects on brain development de Vries AL Cohen Kettenis PT 2012 Clinical management of gender dysphoria in children and adolescents the Dutch approach Journal of Homosexuality 59 3 301 320 doi 10 1080 00918369 2012 653300 PMID 22455322 S2CID 11731779 a b Rew L Young CC Monge M Bogucka R February 2021 Review Puberty blockers for transgender and gender diverse youth a critical review of the literature Child and Adolescent Mental Health 26 1 3 14 doi 10 1111 camh 12437 PMID 33320999 S2CID 229282305 Archived from the original on 2022 05 20 Retrieved 2022 06 05 Positive outcomes were decreased suicidality in adulthood improved affect and psychological functioning and improved social life a b Transgender Health An Endocrine Society Position Statement www endocrine org The Endocrine Society 15 December 2020 Retrieved 15 June 2022 a b Hembree WC Cohen Kettenis PT Gooren L Hannema SE Meyer WJ Murad MH et al November 2017 Endocrine Treatment of Gender Dysphoric Gender Incongruent Persons An Endocrine Society Clinical Practice Guideline The Journal of Clinical Endocrinology and Metabolism 102 11 3869 3903 doi 10 1210 jc 2017 01658 PMID 28945902 Coleman E Radix AE Bouman WP Brown GR de Vries AL Deutsch MB et al 2022 Standards of Care for the Health of Transgender and Gender Diverse People Version 8 International Journal of Transgender Health 23 Suppl 1 S1 S259 doi 10 1080 26895269 2022 2100644 PMC 9553112 PMID 36238954 Maddux JE Winstead BA 2015 Psychopathology Foundations for a Contemporary Understanding Routledge pp 464 465 ISBN 978 1317697992 Evidence review Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria Archived from the original on 2 April 2021 Retrieved 2 April 2021 The critical outcomes for decision making are the impact on gender dysphoria mental health and quality of life The quality of evidence for these outcomes was assessed as very low certainty using modified GRADE Finnish guidelines for treatment of child and adolescent gender dysphoria PDF Council for Choices in Health Care COHERE March 2021 Archived PDF from the original on 3 December 2020 Retrieved 22 April 2021 p 6 Terveydenhuoltolain mukaan 8 terveydenhuollon toiminnan on perustuttava nayttoon ja hyviin hoito ja toimintakaytantoihin Alaikaisten osalta tutkimusnayttoon perustuvia terveydenhuollon menetelmia ei ole According to the Health Care Act Section 8 health care activities must be based on evidence and good care and operating practices There are no research based health care methods for minors translation provided by Wikipedia Rafferty J October 2018 Ensuring Comprehensive Care and Support for Transgender and Gender Diverse Children and Adolescents Pediatrics 142 4 e20182162 doi 10 1542 peds 2018 2162 PMID 30224363 Archived from the original on 2019 07 19 Retrieved 2021 06 11 Safer JD 17 February 2020 Controversial pubertal blocker legislation may bring unintended consequences for children Healio Archived from the original on 30 December 2020 Retrieved 15 December 2020 AMA fights to protect health care for transgender patients State Advocacy Update American Medical Association March 26 2021 Archived from the original on June 29 2021 Retrieved June 29 2021 Endocrine Society urges policymakers to follow science on transgender health Texas custody case prompts unfounded claims Endocrine Society Press release Washington DC October 28 2019 Archived from the original on June 11 2021 Retrieved June 11 2021 Criminalizing Gender Affirmative Care with Minors Suggested Discussion Points With Resources to Oppose Transgender Exclusion Bills American Psychological Association Archived from the original on 2021 06 29 Retrieved 2021 06 29 AACAP Statement Responding to Efforts to ban Evidence Based Care for Transgender and Gender Diverse Youth American Academy of Child and Adolescent Psychiatry 8 November 2019 Archived from the original on 7 June 2021 Retrieved 29 June 2021 Schmidt S 22 April 2021 FAQ What you need to know about transgender children The Washington Post Archived from the original on 16 June 2021 Retrieved 29 June 2021 Siddique H 17 September 2021 Appeal court overturns UK puberty blockers ruling for under 16s 17 September 2021 Guardian Archived from the original on 17 September 2021 Retrieved 17 September 2021 Milton J 23 February 2022 Swedish health board wants doctors to stop prescribing life saving puberty blockers PinkNews Retrieved 12 October 2022 Ghorayshi A 28 July 2022 England Overhauls Medical Care for Transgender Youth The New York Times Retrieved 12 October 2022 Kaltiala Heino R Sumia M Tyolajarvi M Lindberg N 2015 Two years of gender identity service for minors overrepresentation of natal girls with severe problems in adolescent development Child and Adolescent Psychiatry and Mental Health 9 9 doi 10 1186 s13034 015 0042 y PMC 4396787 PMID 25873995 Development of the diagnosis gender dysphoria PDF Swedish National Board of Health and Welfare in Swedish Feb 2020 Archived PDF from the original on 2021 03 08 Retrieved 13 March 2021 Kozlowska K Chudleigh C McClure G Maguire AM Ambler GR 2021 01 12 Attachment Patterns in Children and Adolescents With Gender Dysphoria Frontiers in Psychology 11 582688 doi 10 3389 fpsyg 2020 582688 PMC 7835132 PMID 33510668 D Angelo R Syrulnik E Ayad S Marchiano L Kenny DT Clarke P January 2021 One Size Does Not Fit All In Support of Psychotherapy for Gender Dysphoria Archives of Sexual Behavior 50 1 7 16 doi 10 1007 s10508 020 01844 2 PMC 7878242 PMID 33089441 George R Brown MD July 20 2011 Chapter 165 Sexuality and Sexual Disorders In Robert S Porter MD et al eds The Merck Manual of Diagnosis and Therapy 19th ed Whitehouse Station NJ USA Merck amp Co Inc pp 1740 1747 ISBN 978 0 911910 19 3 Bockting W Knudson G Goldberg J January 2006 Counselling and Mental Health Care of Transgender Adults and Loved Ones International Journal of Transgenderism 9 3 4 35 82 doi 10 1300 J485v09n03 03 S2CID 71503744 As per Figure 1 delusions about sex or gender dissociative disorders thought disorders or obsessive or compulsive features should be evaluated and treated prior to proceeding with hormone therapy or surgery Thought disorders dissociative disorders and obsessive compulsive disorders can rarely cause a transient wish for sex reassignment which disappears or significantly lessens when the underlying mental health condition is treated It is important to treat these disorders before proceeding with hormones or surgery to ensure that the desire for alteration of primary or secondary sex characteristics is not a temporary desire See also WPATH Standards of Care version 7 Archived 2015 08 14 at the Wayback Machine page 23 The role of mental health professionals includes making reasonably sure that the gender dysphoria is not secondary to or better accounted for by other diagnoses And the paradigmatic Dutch model Archived 2022 06 09 at the Wayback Machine for consideration of comorbid conditions before proceeding with treatment for childhood onset Standards of Care for the Health of Transsexual Transgender and Gender Nonconforming People PDF World Professional Association for Transgender Health pp 28 29 Archived PDF from the original on 18 March 2021 Retrieved 15 March 2021 Altinay M Anand A August 2020 Neuroimaging gender dysphoria a novel psychobiological model Brain Imaging and Behavior 14 4 1281 1297 doi 10 1007 s11682 019 00121 8 PMID 31134582 S2CID 167207854 Archived from the original on 2021 10 21 A recently published study Colizzi et al 2014 where 118 patients were followed before and 12 months after HRT revealed that 14 of the patients had comorbid Axis I psychiatric diagnosis Psychiatric distress and impairment were found to be higher in the beginning phase of the study but after HRT there was a significant improvement in major depressive disorder anxiety and functional impairment Similarly Fisher and colleagues Fisher et al 2013 2013 paper suggests that the dysfunction and impairment in the transgender population is highly associated with lack of HRT which may suggest that at least a fraction of the impairment that was documented as comorbid Axis I psychiatric disorders could in fact be impairment from GD Finally a metanalysis done by Dhejne and colleagues Dhejne et al 2016 reviewed 38 longitudinal studies that investigated psychiatric comorbidities pre and post gender affirmation treatments in transgender people with GD The results of this analysis indicate that depression and GAD do have higher prevalence in transgender population but this finding was isolated to baseline pre gender affirmation treatments where after gender affirmation therapies rate of psychiatric comorbidities decreased to cisgender population levels Baker KE Wilson LM Sharma R Dukhanin V McArthur K Robinson KA April 2021 Hormone Therapy Mental Health and Quality of Life Among Transgender People A Systematic Review Journal of the Endocrine Society 5 4 bvab011 doi 10 1210 jendso bvab011 PMC 7894249 PMID 33644622 This systematic review of 20 studies found evidence that gender affirming hormone therapy may be associated with improvements in QOL scores and decreases in depression and anxiety symptoms among transgender people Associations were similar across gender identity and age The strength of evidence for these conclusions is low due to methodological limitations Wernick JA Busa S Matouk K Nicholson J Janssen A November 2019 A Systematic Review of the Psychological Benefits of Gender Affirming Surgery The Urologic Clinics of North America Gender Affirming Surgery 46 4 475 486 doi 10 1016 j ucl 2019 07 002 PMID 31582022 S2CID 201997501 Retrieved 2021 12 27 a b c Hembree WC Cohen Kettenis PT Gooren L Hannema SE Meyer WJ Murad MH et al November 2017 Endocrine Treatment of Gender Dysphoric Gender Incongruent Persons An Endocrine Society Clinical Practice Guideline The Journal of Clinical Endocrinology and Metabolism 102 11 3869 3903 doi 10 1210 jc 2017 01658 PMID 28945902 In the future we need more rigorous evaluations of the effectiveness and safety of endocrine and surgical protocols Specifically endocrine treatment protocols for GD gender incongruence should include the careful assessment of the following 1 the effects of prolonged delay of puberty in adolescents on bone health gonadal function and the brain including effects on cognitive emotional social and sexual development and 4 the risks and benefits of gender affirming hormone treatment in older transgender people Future research is needed to ascertain the potential harm of hormonal therapies 176 The satisfaction rate with surgical reassignment of sex is now very high 187 Owing to the lack of controlled studies incomplete follow up and lack of valid assessment measures evaluating various surgical approaches and techniques is difficult Several postoperative studies report significant long term psychological and psychiatric pathology 259 261 We need more studies with appropriate controls that examine long term quality of life psychosocial outcomes and psychiatric outcomes to determine the long term benefits of surgical treatment Murad MH Elamin MB Garcia MZ Mullan RJ Murad A Erwin PJ Montori VM February 2010 Hormonal therapy and sex reassignment a systematic review and meta analysis of quality of life and psychosocial outcomes Clinical Endocrinology 72 2 214 231 doi 10 1111 j 1365 2265 2009 03625 x PMID 19473181 S2CID 19590739 Archived from the original on 2021 07 17 Retrieved 2021 07 17 The evidence in this review is of very low quality9 10 due to the serious methodological limitations of included studies Studies lacked bias protection measures such as randomization and control groups and generally depended on self report to ascertain the exposure i e hormonal therapy was self reported as opposed to being extracted from medical records Our reliance on reported outcome measures may also indicate a higher risk of reporting bias within the studies Statistical heterogeneity of the results was also significant Sutcliffe PA Dixon S Akehurst RL Wilkinson A Shippam A White S et al March 2009 Evaluation of surgical procedures for sex reassignment a systematic review Journal of Plastic Reconstructive amp Aesthetic Surgery 62 3 294 306 discussion 306 308 doi 10 1016 j bjps 2007 12 009 PMID 18222742 Archived from the original on 2021 07 17 Retrieved 2021 07 17 The evidence concerning gender reassignment surgery in both MTF and FTM transsexism has several limitations in terms of a lack of controlled studies b evidence has not collected data prospectively c high loss to follow up and d lack of validated assessment measures Some satisfactory outcomes were reported but the magnitude of benefit and harm for individual surgical procedures cannot be estimated accurately using the current available evidence Cohen Kettenis PT Delemarre van de Waal HA Gooren LJ August 2008 The treatment of adolescent transsexuals changing insights The Journal of Sexual Medicine 5 8 1892 1897 doi 10 1111 j 1743 6109 2008 00870 x PMID 18564158 Archived from the original on 2021 04 13 Retrieved 2021 04 14 de Vries AL McGuire JK Steensma TD Wagenaar EC Doreleijers TA Cohen Kettenis PT October 2014 Young adult psychological outcome after puberty suppression and gender reassignment Pediatrics 134 4 696 704 doi 10 1542 peds 2013 2958 PMID 25201798 S2CID 18155489 Archived from the original on 2021 04 13 Retrieved 2021 04 14 Zucker KJ October 2019 Adolescents with Gender Dysphoria Reflections on Some Contemporary Clinical and Research Issues Archives of Sexual Behavior 48 7 1983 1992 doi 10 1007 s10508 019 01518 8 PMID 31321594 S2CID 197663705 Archived from the original on 2022 06 09 Retrieved 2021 04 14 In the Dutch model several factors were identified in deeming adolescent eligibility for early biomedical treatment According to Cohen Kettenis Delemarre van de Waal and Gooren 2008 these included the following 1 the presence of gender dysphoria from early childhood on 2 an exacerbation of the gender dysphoria after the first signs of puberty 3 the absence of psychiatric comorbidity that would interfere with a diagnostic evaluation or treatment 4 adequate psychological and social support during treatment and 5 a demonstration of knowledge of the sex gender reassignment process Several studies have reported on the benefits of this therapeutic protocol in reducing gender dysphoria e g de Vries et al 2014 which is the best study to date Of course one should bear in mind some of the limitation to these outcome studies including the fact that not all assessed adolescents were deemed eligible for the treatment protocol and thus we know relatively little about the longer term outcomes of these youth and that study designs have not included alternative treatment options such as psychosocial therapy or even being assigned to a wait list control condition Haupt C Henke M Kutschmar A Hauser B Baldinger S Saenz SR Schreiber G November 2020 Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women The Cochrane Database of Systematic Reviews 2020 11 CD013138 doi 10 1002 14651858 cd013138 pub2 PMC 8078580 PMID 33251587 We found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition Bustos VP Bustos SS Mascaro A Del Corral G Forte AJ Ciudad P et al March 2021 Regret after Gender affirmation Surgery A Systematic Review and Meta analysis of Prevalence Plastic and Reconstructive Surgery Global Open 9 3 e3477 doi 10 1097 GOX 0000000000003477 PMC 8099405 PMID 33968550 Archived from the original on 2022 04 06 Retrieved 2022 04 15 Janssen A Leibowitz S 2018 05 22 Affirmative Mental Health Care for Transgender and Gender Diverse Youth A Clinical Guide Springer p 8 ISBN 978 3 319 78307 9 Archived from the original on 2021 10 15 Retrieved 2021 08 06 Coelho JS Suen J Clark BA Marshall SK Geller J Lam PY October 2019 Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth a Scoping Review Current Psychiatry Reports 21 11 107 doi 10 1007 s11920 019 1097 x PMID 31617014 S2CID 204542613 Significantly higher rates of eating disorder symptoms were documented in transgender youth compared to cisgender youth a b Thrower E Bretherton I Pang KC Zajac JD Cheung AS March 2020 Prevalence of Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria A Systematic Review Journal of Autism and Developmental Disorders 50 3 695 706 doi 10 1007 s10803 019 04298 1 PMID 31732891 S2CID 208061795 Archived from the original on 2022 06 09 Retrieved 2021 08 06 Kyriakou A Nicolaides NC Skordis N March 2020 Current approach to the clinical care of adolescents with gender dysphoria Acta Bio Medica 91 1 165 175 doi 10 23750 abm v91i1 9244 PMC 7569586 PMID 32191677 Diagnostic and Statistical Manual of Mental Disorders 5 American Psychiatric Association 2013 p 454 ISBN 978 0 89042 555 8 Harvey Marcovitch ed 2018 Gender Identity Disorders Black s Medical Dictionary 43rd ed New York Bloomsbury ISBN 9781472943064 Archived from the original on 2022 06 09 Retrieved 2021 01 14 a b c d e f Zucker KJ October 2017 Epidemiology of gender dysphoria and transgender identity Sexual Health 14 5 404 411 doi 10 1071 SH17067 PMID 28838353 S2CID 205237976 Archived from the original on 2022 06 09 Retrieved 2020 12 22 Conron KJ Scott G Stowell GS Landers SJ January 2012 Transgender health in Massachusetts results from a household probability sample of adults American Journal of Public Health American Public Health Association 102 1 118 122 doi 10 2105 AJPH 2011 300315 OCLC 01642844 PMC 3490554 PMID 22095354 Between 2007 and 2009 survey participants aged 18 to 64 years in the Massachusetts Behavioral Risk Factor Surveillance System MA BRFSS N 28 662 were asked Some people describe themselves as transgender when they experience a different gender identity from their sex at birth For example a person born into a male body but who feels female or lives as a woman Do you consider yourself to be transgender We restricted the analytic sample to 28176 participants who answered yes or no to the transgender question excluding n 364 1 0 weighted who declined to respond Transgender respondents n 131 0 5 95 confidence interval CI 0 3 0 6 were somewhat younger and more likely to be Hispanic than were nontransgender respondents Clark TC Lucassen MF Bullen P Denny SJ Fleming TM Robinson EM Rossen FV July 2014 The health and well being of transgender high school students results from the New Zealand adolescent health survey Youth 12 The Journal of Adolescent Health 55 1 93 99 doi 10 1016 j jadohealth 2013 11 008 PMID 24438852 Whether a student was transgender was measured by the question Do you think you are transgender This is a girl who feels like she should have been a boy or a boy who feels like he should have been a girl e g Trans Queen Fa faffine Whakawahine Tangata ira Tane Genderqueer Over 8 000 students n 8 166 answered the question about whether they were transgender Approximately 95 of students did not report being transgender n 7 731 94 7 96 students reported being transgender 1 2 202 reported not being sure 2 5 and 137 did not understand the question 1 7 Landen M Walinder J Lundstrom B April 1996 Prevalence incidence and sex ratio of transsexualism Acta Psychiatrica Scandinavica 93 4 221 223 doi 10 1111 j 1600 0447 1996 tb10638 x PMID 8712018 S2CID 26661088 On average the male to female female to male ratio in prevalence studies is estimated to be 3 1 However the incidence studies have shown a considerably lower male to female predominance In Sweden and England and Wales a sex ratio of 1 1 has been reported In the most recent incidence data from Sweden there is a slight male to female predominance among the group consisting of all applicants for sex reassignment while in the group of primary early onset transsexuals there is no difference in incidence between men and women Chiniara Lyne N Bonifacio Herbert J Palmert Mark R 2018 06 19 Characteristics of Adolescents Referred to a Gender Clinic Are Youth Seen Now Different from Those in Initial Reports Hormone Research in Paediatrics 89 6 434 441 doi 10 1159 000489608 ISSN 1663 2818 PMID 29920505 S2CID 49314194 Thompson Lucy Sarovic Darko Wilson Philip Samfjord Angela Gillberg Christopher 2022 03 09 A PRISMA systematic review of adolescent gender dysphoria literature 1 Epidemiology PLOS Global Public Health 2 3 e0000245 doi 10 1371 journal pgph 0000245 ISSN 2767 3375 PMC 10021877 PMID 36962334 Koh J 2012 The history of the concept of gender identity disorder Seishin Shinkeigaku Zasshi Psychiatria et Neurologia Japonica 114 6 673 680 PMID 22844818 Pauly IB 1993 Terminology and Classification of Gender Identity Disorders Journal of Psychology amp Human Sexuality 5 4 1 14 doi 10 1300 J056v05n04 01 S2CID 142954603 Drescher Jack Transsexualism Gender Identity Disorder and the DSM Journal of Gay amp Lesbian Mental Health 14 no 2 2010 112 Bryant KE 2007 The Politics of Pathology and the Making of Gender Identity Disorder Ann Arbor Michigan p 222 ISBN 978 0 549 26816 1 a href Template Cite book html title Template Cite book cite book a CS1 maint location missing publisher link a b Giordano S 2012 Children with Gender Identity Disorder A Clinical Ethical and Legal Analysis New Jersey Routledge p 147 ISBN 978 0 415 50271 9 a b Vasey PL Bartlett NH 2007 What can the Samoan Fa afafine teach us about the Western concept of gender identity disorder in childhood Perspectives in Biology and Medicine 50 4 481 490 doi 10 1353 pbm 2007 0056 PMID 17951883 S2CID 37437172 Diagnostic and Statistical Manual of Mental Disorders 5 American Psychiatric Association 2013 p 457 ISBN 978 0 89042 555 8 Lev AI 2004 Transgender Emergence Therapeutic Guidelines for Working with Gender Variant People and Their Families Haworth Press p 172 ISBN 978 0 7890 2117 5 Archived from the original on 2021 01 23 Retrieved 2020 11 11 Rudacille D February 2005 The Riddle of Gender Science Activism and Transgender Rights Pantheon ISBN 978 0 375 42162 4 page needed Zucker KJ Spitzer RL Jan Feb 2005 Was the gender identity disorder of childhood diagnosis introduced into DSM III as a backdoor maneuver to replace homosexuality A historical note Journal of Sex amp Marital Therapy 31 1 31 42 doi 10 1080 00926230590475251 PMID 15841704 S2CID 22589255 a b Hausman K 18 July 2003 Controversy Continues to Grow Over DSM s GID Diagnosis Psychiatric News Archived from the original on 2014 05 22 Retrieved 2014 05 22 Mallon GP 2009 Social Work Practice with Transgender and Gender Variant Youth New Jersey Routledge ISBN 978 0 415 99482 8 Devan Cole Federal appeals court says Americans with Disabilities Act protections cover gender dysphoria handing a win to trans people CNN CNN Retrieved 5 September 2022 Government Policy concerning Transsexual People People s rights Transsexual people U K Department for Constitutional Affairs 2003 Archived from the original on May 11 2008 La transsexualite ne sera plus classee comme affectation psychiatrique Le Monde May 16 2009 Archived from the original on February 26 2018 Retrieved May 31 2009 La France est tres en retard dans la prise en charge des transsexuels Liberation in French May 17 2011 Archived from the original on November 30 2014 Retrieved March 11 2018 En realite ce decret n a ete rien d autre qu un coup mediatique un tres bel effet d annonce Sur le terrain rien n a change Worley W May 14 2016 Denmark will become first country to no longer define being transgender as a mental illness The Independent Archived from the original on March 11 2018 Retrieved March 22 2018 Reed GM Drescher J Krueger RB Atalla E Cochran SD First MB et al October 2016 Disorders related to sexuality and gender identity in the ICD 11 revising the ICD 10 classification based on current scientific evidence best clinical practices and human rights considerations World Psychiatry 15 3 205 221 doi 10 1002 wps 20354 PMC 5032510 PMID 27717275 a b Benestad E E P October 2010 From gender dysphoria to gender euphoria An assisted journey Sexologies 19 4 225 231 doi 10 1016 j sexol 2010 09 003 ISSN 1158 1360 Retrieved 2021 05 15 Austin Ashley Papciak Ryan Lovins Lindsay 2022 12 05 Gender euphoria a grounded theory exploration of experiencing gender affirmation Psychology amp Sexuality 13 5 1406 1426 doi 10 1080 19419899 2022 2049632 ISSN 1941 9899 S2CID 247281003 Collins D 2022 05 12 Sex vs Gender What s the Difference and Why Does it Matter PsychCentral Archived from the original on 2022 06 02 Retrieved 2022 06 01 Bradford NJ Rider GN Spencer KG September 2021 Hair removal and psychological well being in transfeminine adults associations with gender dysphoria and gender euphoria The Journal of Dermatological Treatment 32 6 635 642 doi 10 1080 09546634 2019 1687823 PMID 31668100 S2CID 204975343 a b Beischel WJ Gauvin SE van Anders SM 2021 05 03 A little shiny gender breakthrough Community understandings of gender euphoria International Journal of Transgender Health 23 3 274 294 doi 10 1080 26895269 2021 1915223 PMC 9255216 PMID 35799953 a b c Kai Jacobsen Devor Aaron 2022 Moving From Gender Dysphoria to Gender Euphoria Trans Experiences of Positive Gender Related Emotions Bulletin of Applied Transgender Studies 1 1 2 119 143 doi 10 57814 GGFG 4J14 ISSN 2769 2124 Huit T Zachary Ralston Allura L Haws J Kyle Holt Natalie R Hope Debra A Puckett Jae A Mocarski Richard A Woodruff Nathan 2021 11 04 Psychometric Evaluation of the Transgender Congruence Scale Sexuality Research and Social Policy 20 2 491 504 doi 10 1007 s13178 021 00659 7 ISSN 1553 6610 S2CID 243792173 Archived from the original on 2022 06 09 Retrieved 2022 05 06 Kozee Holly B Tylka Tracy L Bauerband L Andrew June 2012 Measuring Transgender Individuals Comfort With Gender Identity and Appearance Development and Validation of the Transgender Congruence Scale Psychology of Women Quarterly 36 2 179 196 doi 10 1177 0361684312442161 ISSN 0361 6843 S2CID 10564167 Archived from the original on 2021 12 23 Retrieved 2022 05 06 Aman R 1986 Maledicta Maledicta Press ISBN 978 0 916500 29 0 Archived from the original on 2022 06 02 Retrieved 2022 06 02 Aman R 1988 Lillian Mermin Feinsilver Festschrift Maledicta Press ISBN 978 0 916500 29 0 Archived from the original on 2022 06 02 Retrieved 2022 06 02 Transsexualism A Collection of Articles Editorials and Letters on the Subject of Male to female and Female to male Transsexualism Edited from the TV TS Tapestry Journal Issues 39 52 International Foundation for Gender Education 1988 Archived from the original on 2022 06 02 Retrieved 2022 06 02 a b Transsexualism A Collection of Articles Editorials and Letters on the Subject of Male to female and Female to male Transsexualism Edited from the TV TS Tapestry Journal Issues 39 52 University of Michigan International Foundation for Gender Education 1988 Archived from the original on 2022 06 02 Retrieved 2022 06 02 Femme Mirror 1990 Archived from the original on 2022 06 02 Retrieved 2022 06 02 MacKenzie GO 1994 Transgender Nation Popular Press ISBN 978 0 87972 596 9 Archived from the original on 2022 06 02 Retrieved 2022 06 02 Feinberg L 1999 10 10 Trans Liberation Beyond Pink or Blue Beacon Press ISBN 978 0 8070 7951 5 Archived from the original on 2022 06 02 Retrieved 2022 06 02 Gittelson N 1979 Dominus A Woman Looks at Men s Lives Harcourt Brace Jovanovich ISBN 978 0 15 626118 0 Archived from the original on 2022 06 02 Retrieved 2022 06 02 Kriegel L 1979 On Men and Manhood Hawthorn Books ISBN 978 0 8015 0248 4 Archived from the original on 2022 06 02 Retrieved 2022 06 02 a b Califia P 1997 Sex Changes The Politics of Transgenderism Cleis Press ISBN 978 1 57344 072 1 Archived from the original on 2022 06 02 Retrieved 2022 06 02 Allen MP 1989 Transformations Crossdressers and Those who Love Them Dutton ISBN 978 0 525 24820 0 Archived from the original on 2022 06 02 Retrieved 2022 06 02 The Tartan Skirt Magazine of the Scottish TV TS Group ADF Editorial Services 1994 Archived from the original on 2022 06 02 Retrieved 2022 06 02 Prosser J 1998 Second Skins The Body Narratives of Transsexuality Columbia University Press ISBN 978 0 231 10934 5 Archived from the original on 2022 06 02 Retrieved 2022 06 02 Ashley F November 2021 The Misuse of Gender Dysphoria Toward Greater Conceptual Clarity in Transgender Health Perspectives on Psychological Science 16 6 1159 1164 doi 10 1177 1745691619872987 PMID 31747342 S2CID 208214158 Ashley F Ells C December 2018 In Favor of Covering Ethically Important Cosmetic Surgeries Facial Feminization Surgery for Transgender People The American Journal of Bioethics 18 12 23 25 doi 10 1080 15265161 2018 1531162 PMID 31159694 S2CID 81006262 Ashley F July 2019 Gatekeeping hormone replacement therapy for transgender patients is dehumanising Journal of Medical Ethics 45 7 480 482 doi 10 1136 medethics 2018 105293 PMID 30988174 S2CID 117715087 Tebbe Elliot A Budge Stephanie L September 26 2022 Factors that drive mental health disparities and promote well being in transgender and nonbinary people National Library of Medicine Tebbe EA Budge SL September 2022 Factors that drive mental health disparities and promote well being in transgender and nonbinary people Nature Reviews Psychology 1 12 694 707 doi 10 1038 s44159 022 00109 0 PMC 9513020 PMID 36187743 Connor A 2019 01 25 The joy that comes from embracing trans identity shouldn t be so rare The Guardian Archived from the original on 2022 06 02 Retrieved 2022 06 02 a b Dezfouli L 19 January 2019 Review Gender Euphoria Midsumma Festival ArtsHub Australia Archived from the original on 2022 06 02 Retrieved 2022 06 02 Gender Euphoria review Melbourne International Arts Festival Daily Review Film stage and music reviews interviews and more 2019 10 17 Archived from the original on 2022 03 28 Retrieved 2022 06 02 Woodhead C 2019 10 16 A joyful and poignant celebration of difference The Age Archived from the original on 2022 06 02 Retrieved 2022 06 02 Ridout A 2015 10 28 Gender Euphoria Photography Fashion and Gender Nonconformity in The East Village Master of Arts thesis Louisiana State University and Agricultural and Mechanical College doi 10 31390 gradschool theses 3825 Further readingConway L June 26 2014 Successful TransMen Links and Photos ai eecs umich edu Retrieved December 2 2014 Conway L February 5 2011 Transsexual Women s Successes Links and Photos ai eecs umich edu Retrieved December 2 2014 Jacques J A Transgender Journey The Guardian Retrieved December 2 2014 Sharp VM Lewis CB Lieven NM Bell v Tavistock PDF In the High Court of Justice Administrative Court Divisional Court 2020 EWHC 3274 Admin CO 60 2020 Archived PDF from the original on 2022 10 09 World Professional Association for Transgender Health 2012 Standards of Care for Gender Identity Disorders PDF Harry Benjamin International Gender Dysphoria Association Archived from the original PDF on September 24 2014 Includes a description of ICD 10 criteria External linksHealth Law Standards of Care for Transsexualism An alternative to the Benjamin Standards of Care proposed by the International Conference on Transgender Law and Employment Policy The Lord Chancellor s Department Government Policy concerning Transsexual People Retrieved from https en wikipedia org w index php title Gender dysphoria amp oldid 1189870854, wikipedia, wiki, book, books, library,

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