GENDER DYSPHORIA

Semester - V
Psycho-Pathology
APSY-351
(2021-2025)

Gender Dysphoria

Subaha Faisal | Roll no. 44 (leader)

Laiba Shamshad | Roll no. 15
Muskan Shafqat | Roll no. 32
Eman Fatima | Roll no. 33
Saher Ilyas | Roll no. 40
Hafsa Fiaz | Roll no. 75
Aiman Sadiq | Roll no. 85

Submitted to Ms. Uzma Raza

Submitted by Group V
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GENDER DYSPHORIA
Gender dysphoria is a feeling of discomfort or distress that might occur in people whose gender
identity differs from their sex assigned at birth or sex-related physical characteristics. Gender
Dysphoria occurs in people who are transgender (trans). It causes emotional distress due to
differences between a person’s gender identity and physical appearance.
For example: transgender and gender diverse people might experience gender dysphoria at
some point in their lives.
Explanation of Gender Dysphoria
People with gender dysphoria commonly identify as transgender. Gender nonconformity is not the
same thing as gender dysphoria and does not always lead to dysphoria or distress. Gender dysphoria
describes a sense of unease regarding the mismatch between assigned gender and gender identity.
This feeling affects many — but not all — transgender people before they begin living as their
authentic selves (transition and gender expression). And it can occur at any point during life, from
childhood to adulthood.

Gender Dysphoria and Gender Identity

Gender dysphoria is the dysphoria (distress) a person experiences as a result of the sex and gender
they were assigned at birth. 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.
The current term is more descriptive than the term in DSM-IV, gender identity disorder, and
focuses on dysphoria as a clinical problem, not identity per sex. In DSM-5 the categorization of
gender dysphoria includes five criteria.
DSM-5 Categorization:
i. A marked incongruence between one's experienced gender and their assigned
gender, lasting for at least 6 months.
ii. A strong desire to be treated as the other gender or to have the physical
characteristics of the other gender.
iii. A significant distress or impairment in social, occupational, or other important areas
of functioning caused by the incongruence.
iv. The condition is no better explained by another medical or mental health condition.
v. The condition is not a result of a developmental disorder or physical intersex
conditions.

Signs of Gender Dysphoria

Gender Dysphoria in Children

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➢ Girls with Gender Dysphoria:

•
May express the wish to be a boy, assert they are a boy, or assert they will grow up to be
a man.
• Prefer boy’s clothing and hairstyles, are often perceived by strangers as boys and may ask
to be called by boy’s name.
• Display intense negative reactions to parental attempts to have them wear dresses or
other feminine attire.
• Play traditional boyhood games and contact sports and prefer boys as their playmates.
• They show little interest in stereotypically feminine toys like dolls, doll houses,
makeup boxes etc.
➢ Boys with Gender Dysphoria:
• They wish to be a girl or assert they are a girl or will grow up as a woman.
• They have a preference for dressing in girl’s or women's clothes or many improvised
clothing from available materials like aprons, scarves, long hair or skirts.
• These children may play the role of a female figure (e.g. playing “mother”).
• Stereotypically female-typed dolls (e.g. Barbie) are often favourite toys.
• girls prefer as their playmates and avoid rough and tumble play and have little interest in
masculine toys.
Gender Dysphoria in Adolescents or Adults:
Gender dysphoria often becomes more noticeable during puberty when secondary sex
characteristics develop, and they show these types of behaviours:
• They may adopt the behaviour, clothing, and mannerisms of the experienced gender.
• A strong desire for primary and secondary sex characteristics of other genders.
• A strong desire to be or to be treated as another gender.
• Exploration of gender identity involving questioning, experimenting, and seeking
support.
• Some seek professional help for gender transition.
• In treatment some use counselling and therapy to explore and understand one’s gender
identity.
• Hormone therapy or gender-affirming surgeries are used for seeking physical changes.
• Try to join a supportive group or community to face the criticism and become part of
communities like LGBTQ.

Causes of Gender Dysphoria

Many factors cause gender dysphoria, some of which include;
1. Biological factors
2. Psychological factors
3. Socio-economic factors
1. Biological factors:
In the studies of Gender Dysphoria, GD is associated with factors such as prenatal stress, prenatal
infections, genetic and hormonal disorders, cerebrovascular diseases, and central nervous system

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disorders. Evidence suggests that gene expression, size, and number of neural cells and
functions within the brain structure correlate with transsexualism. Some studies suggest a
relationship between prenatal toxoplasma infection and the development of schizophrenia and
GD; however, there is no direct evidence for this case. In a follow-up study on 7 adult patients with
congenital toxoplasmosis, one patient with GD was diagnosed and underwent transgender surgery.
Therefore, toxoplasma infection can be a common risk factor for both diseases.
• Neurological factors: Sexual differentiation of the embryos, such as the appearance of
genital organs, occurs in the first 3 months of pregnancy, but sexual differentiation in the
human brain begins in the second half of pregnancy. Therefore, it is assumed that these two
processes may independently contribute to GD in an individual. The (BSTc), or the central
subdivision of the bed nucleus of the stria terminalis, is sexually dimorphic. It is a brain
area that is essential for sexual behaviour and is twice as large in men than in women. A
female-sized BSTc was found in male-to-female transsexuals. The size of the BSTc was not
influenced by sex hormones in adulthood and was independent of sexual orientation.
2. Psychological factors:
There is no evidence that the postnatal social environment has any effect on gender identity or
sexual orientation. However, Gender Dysphoria (GD) patients may be associated with psychiatric
disorders such as anxiety and depression. Studies conducted in Amsterdam, Ghent, Hamburg, and
Oslo showed that 70% of people with GD had more emotional and anxiety disorders. In one study
from Iran, the three most common illnesses in people with GD were major depressive disorder
(33.7%), and phobias (20.5%). Hence, it was found that the majority of patients with GD also
suffered from psychological illnesses.
• Sexual abuse: in children is recognized as the cause of various types of psychiatric
disorders, including impulsivity disorders, stress disorders, and sexual dysfunction, with these
effects extending throughout their adult lives. Growing evidence suggests a relationship
between childhood abuse and adult psychological damage. In a study in Florence, 109
patients who met the criteria for Gender Dysphoria (GD) due to emotional abuse,
negligence, gross abuse, and sexual abuse were interviewed. The results showed that a large
number of people had a history of being abused during childhood; therefore, neglect and
abuse in childhood can cause GD.
3. Socio-economic factors:
Environmental factors such as family, lifestyle, cultural, and social values may also predispose a
person to becoming transgender.
• Parenting: Psychosocial factors, such as the role of the father in the first years of life, the
mother's death, and the absence of sexual role models of the same sex as the child, as well as
parents' explicit or implicit encouragement of behaving like the opposite sex, are involved in
the development of GD in children. The evaluation of a 6-year-old girl diagnosed with GD,
who was adopted as a stepchild, showed that the relationship between the child and parents,
especially the mother, influenced the natural development of the child in addition to the
development of this disorder.

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Prevalence
➢ While GD appears to be rare, the number of people being diagnosed with the condition is
increasing, due to growing public awareness.
➢ No accurate number of how many suffer from GID.
➢ More prevalent in boys than in girls.
➢ 1 in 11,900 males; and 1 in 30,400 females.
➢ Increasing in North America, 59% in 1992. The country with the highest percentage of
transexual individuals is Germany or Sweden.

Client Patterns of Gender Dysphoria

In order o more effectively assess and treat those with gender dysphoria, clinical theorists have tried
to distinguish the most common patterns of the disorder encountered in clinical practice.
The three patterns of gender dysphoria for which people most commonly seek treatment:
1. Female-to-Male gender dysphoria,
2. Male-to-Female gender dysphoria: androphilic type, and
3. Male-to-Female gender dysphoria: autogynephilic type.

1. Female-to-Male Gender Dysphoria:

People with a female-to-male gender dysphoria pattern are born female but appear or behave in a
stereotypically masculine manner from early on—often as young as 3 years of age or younger. As
children, they always play rough games or sports, prefer the company of boys, hate “girlish”
clothes, and state their wish to be male. As adolescents, they become disgusted by the physical
changes of puberty and are sexually attracted to females. However, lesbian relationships do not feel
like a satisfactory solution to them because they want other women to be attracted to them as males,
not as females.
2. Male-to-Female Gender Dysphoria: Androphilic type
The term “androphilic” means attracted to males. People with an androphilic type of male-to-
female gender dysphoria are born male but appear or behave in a stereotypically female manner
from birth. As children, they are viewed as effeminate, pretty, and gentle; avoid rough games; and
hate to dress in boys’ clothing. As adolescents, they become sexually attracted to males, and they
often come out as gay and develop gay relationships. But by adulthood, it often becomes clear to
them that such gay relationships do not truly address their gender dysphoric feelings because they
want to be with heterosexual men who are attracted to them as women.
3. Female-to-Male Gender Dysphoria: Autogynephilic type
The term “autogynephilic” means attracted to oneself as a female. People with an
autogynephilic type of male-to-female gender dysphoria are not sexually attracted to males; rather,
they are attracted to the idea of themselves being female. Persons with this form of gender
dysphoria behave in a stereotypically masculine manner as children, start to enjoy dressing in
female clothing during childhood, and after puberty become sexually aroused when they cross-
dress. They are attracted to females during and beyond adolescence. These persons have desires
of becoming female that become increasingly intense and overwhelming during adulthood.

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Treatments for Gender Dysphoria

Treatment can help people who have gender dysphoria explore their gender identity and find the
gender role that feels comfortable for them, easing distress. However, treatments should be
individualized what might help one person might not help another.
Types of Treatment for Gender Dysphoria
Treatment options for gender dysphoria include;
1. Changes in Gender Expression and Role
2. Hormone therapy
3. Behavioural therapy
4. Surgery
1. Changes in Gender Expression and Role
This might involve living part-time or full-time in another gender role that is consistent with your
gender identity.
2. Behavioural Therapy
Behavioural therapy isn't intended to alter your gender identity. Instead, therapy can help you
explore gender concerns and find ways to lessen gender dysphoria. Therapy might be helpful during
many stages of your life.
Therapy might include individual, couples, family and group counselling to help you:
• Explore and integrate your gender identity
• Become comfortable expressing your gender identity
• Accept yourself and build a support network
• Increase your well-being and quality of life
• Address the mental and emotional health concerns that stem from the stress resulting from
experiencing prejudice and discrimination because of your gender identity (minority stress)
• Develop a plan to address social and legal issues related to your transition and coming out to
loved ones, friends, colleagues and other close contacts
• Make decisions about your medical treatment options
3. Hormonal Therapy
Many adults with gender dysphoria receive psychotherapy but a large number of them further seek
to address their concerns through biological interventions (hormone therapy and surgery). For
example, many transgender adults change their sexual characteristics through hormone treatments.
• Physicians prescribe the female sex hormone estrogen for male-assigned patients, causing
breast development, loss of body and facial hair, and changes in body fat distribution. Some
such patients also go to speech therapy, raising their tenor voice to alto through training.
(Feminizing Hormone Therapy)
• In contrast, treatments with the male sex hormone testosterone are given to female-
assigned patients with gender dysphoria, resulting in a deeper voice, increased muscle
mass, and changes in facial and body hair. (Masculinizing Hormone Therapy)

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These approaches enable many persons with the disorder to lead a fulfilling life in the gender
that fits them.
4. Surgery
For others, however, therapy is not enough, and they seek out one of the most controversial
practices in medicine: sexual reassignment, or sex change surgery. This surgery, which is usually
preceded by 1 to 2 years of hormone therapy involves;
• For male-assigned persons, partial removal of the penis and restructuring of its
remaining parts into a clitoris and vagina, is a procedure called vaginoplasty. In addition,
some individuals undergo face-changing plastic surgery known as facial feminization
surgery.
• For female-assigned persons, surgery may include bilateral mastectomy and
hysterectomy. The procedure for creating a functioning penis, called phalloplasty, is
performed in some cases, but it is not perfected. Alternatively, doctors have developed a
silicone prosthesis that can give patients the appearance of having male genitals.

Criteria for Surgical Procedures

The World Professional Association for Transgender Health provides the following criteria for
hormonal and surgical treatment of gender dysphoria:
➢ Persistent, well-documented gender dysphoria.
➢ Capacity to make a fully informed decision and consent to treatment.
➢ Legal age in a person's country or, if younger, following the standard of care for children and
adolescents.
➢ If significant medical or mental concerns are present, they must be reasonably well-
controlled
Challenges and Complications of Gender Dysphoria
• people with gender dysphoria suffer from high levels of stigmatization.
• Discrimination and victimization.
• Negative self-image.
• Increased rates of mental health disorders.
• Increased rates of suicide.
• Adolescents face often bullying.
• Living in agony and confusion and social concerns.
• Harassment and teasing.
• Relationship difficulties.
• Inter-personal conflicts.
• Rejection from society.
• Poor self-esteem.
• Symptoms of depression, anxiety, and substance use disorder.
• Negative sense of well-being.

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