Grasping Gender Dysphoria

You were assigned female at birth but you are very much a male. In the past, you have suffered panic attacks and depression as a result. You feel isolated, like no one in the world could possibly understand what you are going through. You may suffer from gender dysphoria.

Gender dysphoria is an unease that arises from one’s gender not matching the sex they were assigned at birth. According to the Pew Research Center, about 5 percent of young adults say their gender is different than the sex they were assigned at birth.

The condition has been used to describe transgender individuals. According to the diagnostic definition, transgender patients must have a “marked difference” in their identified gender and their biological gender. That sense must continue for at least six months and manifest itself in various ways including “strong desires to be treated as the other gender or to rid of one’s sex characteristics, or a strong conviction that one has feelings and reactions typical of the other gender.”

When determining whether or not a child is transgender, health care provider will look at three factors: the child’s insistence, persistence and consistence. For instance, it’s not “I want to be a girl” but “I am a girl.” Gender identity is a core part in who we are and it’s usually established in toddlerhood. It’s not a choice or lifestyle.

It has nothing to do with sexual identity, but with the gender one feels internally. Patients have a sense they are the “wrong” gender and have the wrong body parts.

Gender identity is not sexual identity: Within the gender identity, a person may be gay, lesbian, straight or asexual. The range of experiences, and possible medical treatments, can make talking about transgender issues confusing and complicated.

Being prepubescent may be an advantage because children do not have an established sense of what is expected, or even what is considered “normal.” When psychiatrists introduce these concepts to youths, they are more accepting.

The mission for psychiatrists is to provide a supportive environment. That is a far cry from past treatments decades ago. Some doctors used to do “reparative” therapy, telling the patient he or she wasn’t gay or transgender. They would practice a wait-and-see approach, which was damaging because it didn’t support the child.

For transgender patients, counseling and mental health professionals can help navigate the added complexity of going through adolescence as a transgender person, with the usual teenage questions revolving around sexuality, safety and social issues. Even asking some one out on a date can be fraught for a transgender teen, particularly if others do not know that the teen is transgender.

The most important thing for transgender patients is family acceptance. Many of the worst outcomes including suicide, self-harm, addiction or running away, are related to not being accepted as their chosen gender.

The standard of treatment for gender dysphoria is hormone blockers, which suppress secondary sex characteristics such as vocal changes, facial hair or breast development. The most commonly used ones are the gonadotropin releasing hormone analogs (GnRHa) which has been used to delay puberty in transgender teenagers since the mid-1990s.

Medical experts say that blocking physical development can make a big difference in a patient’s future body. Once a male goes through puberty, the size of one’s hands, feet, jaw and greater height cannot be changed, nor the narrow width of the pelvis. For a woman, lower height and broader hips cannot be changed.

Please note that some hormone blockers may have side effects such as joint pain, compromised immune systems and mental health issues. The results are reversible if you choose to stop taking this medication.

But most of all, by delaying puberty, the treatment allows transgender adolescents more time to explore their gender identity and help them transition before developing biological sexual characteristics that do not align with their identity.

To actively develop the traits of the identified sex, older patients can take cross-sex hormones. This is part of the gender affirming care that so many transgender patients need.

This is not a whim. This is basic to who the person is. We need to stop punishing transgender adolescents for not feeling comfortable within their own bodies.