As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.
Gender dysphoria (previously, Gender Identity Disorder) is a mental health condition that exists for people who demonstrate or express distress or discomfort with their gender identity. This diagnosis is estimated to affect less than 1% of the population.
Changes and Controversy
There is still much controversy over the diagnosis of Gender Dysphoria. A previous iteration of the diagnosis labeled the condition Gender Identity Disorder. This was changed to Gender Dysphoria due to advocates lobbying that the term “disorder” increased stigma for those who may be dealing with cross-gender identities.
Still, some believe that Gender Dysphoria should not even be classified as a mental disorder, regardless of the terminology. This coincides with the precedence set by the removal of homosexuality as mental health condition in the early 1970s.
Other experts and specialists advocate for the conditions to be used as diagnoses because they enable people to receive necessary medical care and gender affirmative treatment, — especially when it comes to coverage by managed care (insurance) companies. Without this care and treatment, many people living with Gender Dysphoria might see an exacerbation in the dysphoria and may even experience increased rates of depression or suicidal thoughts and behavior.
You may be living with Gender Dysphoria if you experience the following:
- An incongruence with one’s experience of internal sense of gender and the primary (such as sexual organs) or secondary sexual characteristics (body shape, voice, etc.)
- A desire to rid one’s self of primary or secondary sex characteristic due to the experienced incongruence
- A desire and preference to express the primary and/or secondary sex characteristics of the “other” gender
- Feeling the need to be the “other” gender
- A strong desire to be treated as another gender than the one that was assigned corresponding to sex at birth
- An sense that one has feelings more typical of the other gender
- These beliefs cause significant distress or disruption in an individual’s life
Intersex people (those born with ambiguous sex organs and/or genetic sex variances) may also experience gender dysphoria.
The described criteria is for adolescents and adults. There are differences in the expression of Gender Dysphoria in children.
Treatment
Medical Interventions
Depending on a person’s needs and preferences, there are a range of medical interventions to cope with Gender Dysphoria. For those who seek to transition genders or affirm a gender identity that they were not assigned at birth, hormone replacement therapy is one of the most common treatments. In children, puberty suppression may be an indicated form of hormone treatment. These medications (Leuprolide or Depot Lupron, Supprelin or Histrelin) are designed to inhibit the effects of puberty by suppressing luteinizing hormone (LH) and follicle stimulating hormones (FSH). These medications are most often delivered via injection or implanted underneath the skin to slowly release the treatment over the period of a year (Supprelin or Histrelin).
For individuals who transition after onset of puberty, there are still a range of options for gender affirmative care. Hormone Replacement Therapy is a very common form of treatment in those who desire to medically transition to another gender. Various forms of estrogen therapy are helpful in assisting those who desire to express more feminine sex characteristics. One medication is called Estradiol, which can be taken by mouth. Other forms of estrogen replacement are intramuscular shots and hormone patches. Anti-androgen medications, such as Spironolactone, are often recommended and are highly prescribed due to their affordability and accessibility.
For those who wish to express more masculine sex characteristics (such as transgender men), testosterone is the most common form of hormone treatment. It is most often prescribed in the form of intramuscular injection and goes by the name Depo-Testosterone. Those with Gender Dysphoria who are prescribed hormone injections must undergo injection training with licensed medical providers as they will be completing injections yourself, often on a weekly or biweekly basis. In some instances, Depo-Provera may be prescribed to stop menstruation and Finastride may be recommended to combat hair loss.
Surgery
Those who wish to undergo surgery to affirm their gender identity do have options to consider. It should be noted that the standards of care, and insurance reimbursement differ by jurisdiction. WPATH standards are the foundation for gender affirmative medical care. A trans-affirmative physician will be knowledgeable about these regulations and standards and will speak with you candidly about the process of obtaining affirmative care and the implications. In some jurisdictions, this means that there may be a waiting period or other steps to complete.
Breast removal (or mastectomy) and chest reconstruction, breast augmentation (implants), hysterectomies, and genital reconstruction are prevalent procedures for those who choose to medically transition via surgery.
As with any medical treatment, an individual's health and medical history must be carefully considered by a licensed medical physician. Depending on these factors, and your preferences, your doctor will create a treatment plan that works best for you.It should be noted that not all individuals with Gender Dysphoria will decide to medically or surgically transition. This is a highly individual choice and one that can be explored and supported through psychotherapy.
Psychotherapy
Individual psychotherapy with clients living with Gender Dysphoria may take on many different forms or perspectives. Many clients living with Gender Dysphoria experience expected rejection and social avoidance. A therapist may use a traditional psychodynamic perspective to help their client develop insight and awareness of their thoughts and perspectives. Similarly, therapists with a Cognitive Behavior Therapy framework may help you better understand these thoughts and potentially develop new ways of thinking. They might also encourage you to engage in behaviors, such as exposure, to help you desensitize yourself to avoided situations and find new ways of engaging with other community members.
Given the rates of violence towards transgender and gender nonconforming individuals, your therapist may also work with you on developing a safety plan when out in the community as well.
One of the principles of LGBTQ Affirmative Psychotherapy is to help those living with Gender Dysphoria better understand themselves, develop language to describe their experiences, understand what it means to be transgender, as well as come out to both themselves and others.
“Coming out” is a process by which LGBTQ people come to understand their gender or sexual identities to themselves, others, and the social community at large. There is a wide range of how someone with Gender Dysphoria might seek to come out. A therapist will provide ongoing support during what can be a challenging, yet liberating and ongoing process. Your therapist will work with you to determine your best course of action and identify potential challenges and ways to address barriers to internal peace. Additionally, a therapist may ultimately help you explore options related to legal and or medical transition and provide ongoing support and resources in these areas.
Support Groups
Given the social isolation that is often experienced by those living with Gender Dysphoria (who may come to identify and express a gender other than the one assigned at birth), your therapist may recommend community and other supportive resources, such as support or social groups to help reintegrate you into the community. These groups will offer much-needed emotional support for an individual with Gender Dysphoria as well as present an opportunity to develop meaningful relationships that are affirming of your gender identity and expression.
Family Therapy
Family therapy can be an incredibly power adjunct to individual therapy for those who experience familial disruption due to their Gender Dysphoria, or others responses to its expression. For adolescents and adults, a therapist may want to explore the idea of family reunification if there has been some separation or disconnect among family members following disclosure (coming out) of their loved one dealing with Gender Dysphoria. Family therapy can represent a safe space for family members to be heard and learn new ways of communicating with one another.
For younger people dealing with Gender Dysphoria, family therapy may center around continuing to ensure that the young person feels supported. Family therapy may give caregivers the language to understand what their loved one is experiencing and also give them the education and tools to support their child and their process with Gender Dysphoria. For families, or family members, who do not agree with gender affirming care, family therapy may center on helping that person reduce harmful or otherwise rejecting behaviors towards their child or loved one. Moderating reactions from rejecting caregivers can be extremely important as research has indicated that those with highly rejecting families are more likely to consider and attempt suicide.
Therapeutic Note
Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.
Questions for my therapist:
- I’m a man who played with girl’s toys when I was younger, does that mean I’m transgender or that I have Gender Dysphoria?
- Does having Gender Dysphoria mean I am “transgender”?
- How can I best support a loved one who told me they were transgender?
- Can a person have gender dysphoria and not seek medical transition?
- How can I talk to my family about my feelings about my gender?
Sources:
American Psychiatric Association. "Gender Dysphoria." Desk Reference to the Diagnostic Criteria From DSM-5®. Washington: American Psychiatric Publishing, 2014. 215-218.
Haas, A. P., PhD, Rodgers, P. L., PhD, & Herman, J. L., PhD. (2014, January). Suicide Attempts among Transgender and Gender Non-Conforming Adults: Findings of the National Transgender Discrimination Survey. Retrieved July 17, 2017, from https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf
Rood, B. A., Reisner, S. L., Surace, F. I., Puckett, J. A., Maroney, M. R., & Pantalone, D. W. (2016). Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals. Transgender Health, 1(1), 151-164. doi:10.1089/trgh.2016.0012
Ryan, C., PhD, ACSW. (n.d.). A Practitioner’s Resource Guide: Helping Families to Support Their LGBT Children. Retrieved July 17, 2017, from https://store.samhsa.gov/shin/content/PEP14-LGBTKIDS/PEP14-LGBTKIDS.pdf
Selva, K., MD. (n.d.). Puberty Blockers and Puberty Inhibitors. Retrieved July 17, 2017, from https://www.transactiveonline.org/resources/youth/puberty-blockers.php
Trans 101 for Trans People. (2016, April 17). Retrieved July 17, 2017, from http://openmindedhealth.com/transgender-101-trans-people/
What is Gender Dysphoria? (n.d.). Retrieved July 18, 2017, from https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria