This article will continue our look at gender identity issues with the help of Mark A. Yarhouse. Gender dysphoria refers to a substantive dissatisfaction with being one or the other gender. The unhappiness involves being raised to such a clinical significant level that the individual’s functioning becomes markedly disrupted in day to day life. Gender dysphoria ,when diagnosed in children, involves exhibiting at least 6 of 8 symptoms:
“A strong desire to be of the other gender or an insistence that one is the other gender.
In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing.
A strong preference for cross-gender roles in make-believe play or fantasy play.
A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
A strong preference for the playmates of the other gender.
In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.
A strong dislike of one’s sexual anatomy.
A strong desire for the primary and/or secondary characteristics that match one’s experienced gender.”
The reason the DSM-5 uses the phrase “assigned gender” is because of concern for intersex individuals who are not unambiguously male or female in sex. Indeed, gender is oftentimes assigned by a doctor in cases of individuals with ambiguous genitalia.
Gender dysphoria in children sometimes resolves itself during adolescence. This is not always the case, however. The DSM-5 diagnoses an adolescent or adult with gender dysphoria if 2 of the 6 following symptoms are present:
“A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics or in young adolescents, the anticipated sex characteristics).
A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).
A strong desire for the primary and/or secondary sex characteristics of the other gender.
A strong desire to be the other gender (or some alternative gender different from one’s assigned gender).
A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).”
Treatment of gender dysphoria is quite challenging and controversial. While most cases of incongruence of gender resolve by adolescence or adulthood, this is not always the case. Some undergo sex reassignment surgery or even pubertal suppression. The four primary means of treating gender dysphoria are:
“1 resolution of gender dysphoria through intervention to decrease cross-gender identification.
2. watchful waiting.
3. facilitation of the gender identity of the preferred sex in anticipation of an adult identification.
4. intervention to block hormones until a child (now a teen) can decide about gender identity in later adolescence).”
Gender dysphoria is relatively uncommon. Approximately 0.005 to 0.014 percent of adult males and 0.002 to 0.003 percent of adult females suffer from it. However, these estimates are restricted to those seeking clinical treatment, and other studies estimate that between 1 in 10,000 to 1 in 13,000 males and 1 to 20,000 to 1 in 34,000 women suffer from it. Self-identification as transgender is a great deal more common. Between 1 in 215 and 1 in 300 individuals identified themselves as transgender in one study. Gender dysphoria appears to e more common among men than women, with a ratio of anywhere between 3:1 to 5:1.
While most children who suffer from gender dysphoria resolve these issues, they do tend to identify as homosexual or bisexual in their adolescence. Between 63 to 100 percent of biological males and 32 percent to 50 percent of biological females identify as either gay, lesbian or bisexual in adulthood. Rather than actively or deliberately facilitating a transition, ‘watchful waiting” involves merely observing cross-gender behavior and allowing it. Thus, it is not really a form of psychosocial intervention, but is instead abstention from one.
Recently, puberty suppression has sometimes been administered to older children and adolescents. This involves the use of hormone blockers, such as gonadotropin-releasing hormone analogs, to delay puberty. Children between the ages of 10 to 13 are given injections of these hormone blockers which prevent the gonads from making either testosterone or estrogen. This prevents the anticipated changes at puberty. Males will not grow facial hair or body hair and their voices will not deepen, and girls will not develop breasts or begin their menstrual cycle.