Gender Dysphoria in Adults

Abstract

Gender dysphoria (GD), a term that denotes persistent discomfort with one's biologic sex or assigned gender, replaced the diagnosis of gender identity disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. Subtypes of GD in adults, defined by sexual orientation and age of onset, have been described; these display different developmental trajectories and prognoses. Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality. Causal mechanisms in GD are incompletely understood, but genetic, neurodevelopmental, and psychosocial factors probably all contribute. Treatment of GD in adults, although largely standardized, is likely to evolve in response to the increasing diversity of persons seeking treatment, demands for greater client autonomy, and improved understanding of the benefits and limitations of current treatment modalities.

The primary health care of transgender adults

“…2,11,14,15 Among adults with gender dysphoria, most well-designed studies report a 30-40% prevalence of current psychopathology and a 50-80% prevalence of lifetime psychopathology, 2 much higher than the prevalence seen in controls and the general population.…”

“…23 Personality disorders also occur with higher frequency in transgender populations than in the general population, with a 20-60% prevalence reported from well-designed studies. 2 As with other mental health conditions, the presence of a personality disorder may complicate the diagnosis, but is not necessarily a contraindication to transition. This population is likely to need greater support, and benefit from proactive engagement of mental health professionals and strategies to promote engagement.…”

“…The cause of gender dysphoria (or gender congruence for that matter) is unknown, but most scientific evidence suggests, and most experts believe, it has a biological basis. 2 Gender dysphoria poses challenges to the medical model; the diagnosis is framed within the domains of the mental health professionals. Management, however, usually involves medical interventions such as endocrine therapy or surgery, very often with mental health support.…”

“…Overall, transition improves the symptoms of dysphoria and quality of life in~80% of transwomen and transmen. 2 Endocrine therapy is associated with a significantly better quality of life, greater self-esteem, better mood, 4 and reductions in psychological distress. 5 Regret about gender transition is uncommon, [6][7][8] experienced by 2.2% of those in a large Swedish cohort study, 8 and the proportion of those who experienced regret was lowest among those who commenced transition in the current era.…”

“…Deaths from hormone treatments and gender surgery, however, are rare. [11][12][13][14] Endocrine therapies for transgender people are generally safe and effective, 2,3,8,12 and complications from endocrine therapies are not significant contributors to mortality in observational and cohort studies. 11,14 This implies that delivering specialised endocrine and surgical interventions alone is insufficient to reduce health disparity, and primary health care is likely to be an important contributor for effecting meaningful improvements in the health of transgender populations.…”