Variants of Gender Differentiation in Somatic Disorders of Sex Development: Recommendations for Version 7 of the World Professional Association for Transgender Health's<i>Standards of Care</i>

Meyer‐Bahlburg, Heino F. L.

doi:10.1080/15532730903439476

Cited by 28 publications

(16 citation statements)

References 42 publications

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“…Psychiatrists and psychologists approached individuals seeking medical services for gender transition idiosyncratically, withoutconsistencyinregardtorecommending,orattemptingtodissuade the use of, hormonal and surgical treatments. Several recent reviews andpolicy papers (Drescher, 2010;Lev,2009;Meyer-Bahlburg, 2009;Zucker, 2010) have described the intertwined clinical and political difficulties that existed in that era.…”

Section: Mental Health Evaluation Options Prior To Hormonal Therapymentioning

confidence: 98%

“…Among individuals who meet DSM-IV-TR criteria Aand Bfor GID, those who have a DSD differ markedly in several respects from those who do not. These differences include variations in presentation, medicalimplications, andclinicalcontext (Meyer-Bahlburg, 2009). As a consequence, the fourth edition of the DSM-IV-TR (American Psychiatric Association, 2000) placed individuals with gender dysphoria and a DSD under the category GIDNOS, rather than under the more specifically defined term, GID.…”

Section: Overviewmentioning

confidence: 98%

“…Legal and medical gender reassignment of individuals with a DSD may therefore take place at much younger ages than in persons with GID in the absence of a DSD. The evolution of clinical thinking and management guidelines concerning the indications for gonadectomy and genital surgery in infancy, and current controversies in these areas, are discussed in several recent reviews (Diamond & Beh, 2008;Frimberger & Gearhart, 2005;Hughes et al, 2006;Meyer-Bahlburg, 2009;Preves,2003;Reiner, 2004;Speiser et al, 2010;Sytsma, 2006;Wiesemann et al, 2010). Decisions regarding hormonal and surgical procedures are complicated by the highly variable somatic presentations of the many diverse DSD conditions.…”

Section: Overviewmentioning

confidence: 98%

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Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder

et al. 2012

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Both the diagnosis and treatment of Gender Identity Disorder (GID) are controversial. Although linked, they are separate issues and the DSM does not evaluate treatments. The Board of Trustees (BOT) of the American Psychiatric Association (APA), therefore, formed a Task Force charged to perform a critical review of the literature on the treatment of GID at different ages, to assess the quality of evidence pertaining to treatment, and to prepare a report that included an opinion as to whether or not sufficient credible literature exists for development of treatment recommendations by the APA. The literature on treatment of gender dysphoria in individuals with disorders of sex development was also assessed. The completed report was accepted by the BOT on September 11, 2011. The quality of evidence pertaining to most aspects of treatment in all subgroups was determined to be low; however, areas of broad clinical consensus were identified and were deemed sufficient to support recommendations for treatment in all subgroups. With subjective improvement as the primary outcome measure, current evidence was judged sufficient to support recommendations for adults in the form of an evidence-based APA Practice Guideline with gaps in the empirical data supplemented by clinical consensus. The report recommends that the APA take steps beyond drafting treatment recommendations. These include issuing position statements to clarify the APA's position regarding the medical necessity of treatments for GID, the ethical bounds of treatments of gender variant minors, and the rights of persons of any age who are gender variant, transgender or transsexual.

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Section: Mental Health Evaluation Options Prior To Hormonal Therapymentioning

confidence: 98%

Section: Overviewmentioning

confidence: 98%

Section: Overviewmentioning

confidence: 98%

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Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder

et al. 2012

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“…The Standards of Care of the World Professional Association of Transgender Health (WPATH), a professional organization in the field of gender dysphoria, is potentially useful in guiding the assessment and treatment process. [64][65]…”

Section: Childhoodmentioning

confidence: 99%

Psychological Aspects of the Treatment of Patients with Disorders of Sex Development

2012

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Research on the psychological development of persons with Disorders of Sex Development (DSD) has focused on understanding the influence of atypical sex hormone exposure during steroid-sensitive periods of prenatal brain development on the process of psychosexual differentiation (i.e., gender identity, gender role, and sexual orientation). In contrast, analysis of clinical management strategies has focused on gender assignment and the desirability and timing of genital surgery. This review focuses on the psychological issues that confront clinicians managing the care of persons born with DSD and their families. Particular attention is paid to processes and factors that potentially mediate or moderate psychosocial and psychosexual outcomes within and across developmental stages.

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“…Disorders of sexual development (e.g., congenital adrenal hyperplasia, androgen insensitivity syndrome), also known as intersex conditions, rarely present with gender dysphoria, 2 although chronic symptoms may later develop in some patients.…”

Section: What Diagnoses Should Be Considered?mentioning

confidence: 99%

Gender dysphoria in a 39-year-old man

Feldman

Spencer

2013

CMAJ

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A 39-year-old married man with a history of depression presents to his primary physician requesting estrogen. He explains that he has felt "more like a girl" since his early teen years and states that he can no longer tolerate living this way. A physical examination shows mild gynecomastia and diminished body hair. The patient declines a genital examination. What diagnoses should be considered?The primary diagnoses to consider are gender dysphoria, transvestic disorder (formerly known as transvestic festishism) and depression with psychosis."Transgender" is an adjective used to describe a diverse group of people who cross or transcend culturally defined categories of gender.1 Transgender people may or may not have gender dysphoria. Gender dysphoria refers to distress caused by a discrepancy between a person's gender identity and the physical or genital sex the person was assigned at birth.1 People with persistent gender dysphoria may meet criteria for a formal mental health diagnosis that benefits from treatment.1 Formerly known as gender identity disorder, this diagnosis is now designated gender dysphoria in the Diagnostic Statistical Manual of Mental Disorders, fifth edition (DSM-5), and is characterized by a marked and durable (≥ 6 mo) incongruence be tween one's experienced or expressed gender and one's assigned gender. It is associated with clinically significant distress or impairment in social, occupational or other areas of functioning, or with a substantially increased risk of suffering, distress or disability.Health care providers should consider transvestic disorder and depression with psychosis if the patient reports gender dysphoria that is intermittent and paired with sexual arousal, shows impaired reality testing or has active psychosis. Disorders of sexual development (e.g., congenital adrenal hyperplasia, androgen insensitivity syndrome), also known as intersex conditions, rarely present with gender dysphoria, 2 although chronic symptoms may later develop in some patients. 1How should this patient be assessed? Patients who are questioning their gender may be unsure how to express their concerns or may present with confusion about their sexual orientation. Sensitive questioning is needed to create an environment conducive to discussing concerns relating to gender. Because patients can be appropriately fearful of negative consequences should they disclose their gender dysphoria, 3 they may present initially with depression or anxiety. Transgender people, in dealing with social stigma, can be at risk for higher rates of suicidal ideation stemming from societal, peer or family rejection. 4 Patients with gender dysphoria will often seek hormone therapy to relieve their symptoms. The physical changes in this patient, for example, are more likely due to the use of feminizing hormones than to an underlying pathology. Transgender people may self-medicate with nonprescribed hormones, often procured over the Internet, because of fear of the medical system or lack of access to health care providers well-ver...

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Variants of Gender Differentiation in Somatic Disorders of Sex Development: Recommendations for Version 7 of the World Professional Association for Transgender Health'sStandards of Care

Cited by 28 publications

References 42 publications

Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder

Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder

Psychological Aspects of the Treatment of Patients with Disorders of Sex Development

Gender dysphoria in a 39-year-old man

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