Gender Dysphoria Clinical Presentation

Updated: Apr 24, 2019
  • Author: Mohammed A Memon, MD; Chief Editor: Glen L Xiong, MD  more...
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Presentation

History

Criteria required for the diagnosis of gender dysphoria are outline in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). [1] Making the diagnosis can be complicated because the results of psychological testing are not conclusive. Some individuals distort information in order to gain access to sexual reassignment surgery (SRS). Accordingly, the diagnostic process must be extensive and thus is necessarily time-consuming.

The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People by the World Professional Association for Transgender Health (WPATH-SOC), [3] formerly known as the Benjamin Standards of Care, outline a 2-phase diagnostic process for patients seeking SRS:

  • Phase I - A formal diagnosis is made on the basis of DSM-5 or International Classification of Diseases (ICD) criteria; risk factors are estimated in an effort to ensure that the individual can tolerate the life changes that SRS will bring

  • Phase II - The individual’s ability to live in the desired sex role is tested because he or she will have to live permanently in that role; the family is informed, and the patient’s name is changed; assessment of whether to administer hormone therapy is made; psychotherapy is required

The diagnostic process for adolescents seeking SRS includes all of the above, as well as the following:

  • The patient must show a lifelong cross-gender identity that increased at puberty

  • Serious psychopathology must be absent

  • The person must be able to function socially without significant problems

Preliminary follow-up observations include the following:

  • Heterosexual transsexuals appear to have poorer outcomes than homosexual transsexuals do

  • Gender-confused individuals (patients who do not meet the full criteria for transsexualism), transvestites, effeminate homosexuals, older individuals, and those resisting transsexualism generally have poorer post-SRS functioning

  • Patients who have undergone female-to-male SRS tend to do better than those who have undergone male-to-female SRS