Gender Identity Issues

A person with a gender identity disorder strongly identifies with the other sex. The individual may identify to the point of believing that they are, in fact, a member of the other sex who is trapped in the wrong body.

Gender identity disorder (GID) is a condition in which a person has been assigned one gender (usually at birth), but identifies as belonging to another gender, or does not conform with the gender role their respective society prescribes to them.  It is a psychiatric term for what is widely known by other terms such as transsexuality, transgender, transvestism or cross-dressing. 

This disorder is different from transvestism or transvestic fetishism where cross-dressing occurs for sexual pleasure, but the transvestite does not identify with the other sex.  Transsexualism should also not be confused with the behavior of drag queens and drag kings.  Also, transvestic fetishism usually has little, if anything, to do with transsexualism. As a general rule, transsexual people tend to dress and behave in a manner consistent with the gender with which they identify.

People with gender identity disorder frequently report their feelings as "having always been there", and the disorder can be evident in early childhood. Most people know whether they have a gender identity problem by the time they reach adolescence, although in some cases it seems to appear in adulthood

A person with a gender identity disorder is a person who strongly identifies with the other sex. The individual may identify with the opposite sex to the point of believing that they are, in fact, a member of the other sex who is trapped in the wrong body. Adults with gender identity disorder sometimes live their lives as members of the opposite sex. They tend to be uncomfortable living in the world as a member of their own biologic or genetic sex. They often cross-dress and prefer to be seen in public as a member of the other sex. Some people with the disorder request sex-change surgery.

There are two components of Gender Identity Disorder, both of which must be present to make the diagnosis. There must be evidence of a strong and persistent gross-gender identification, which is the desire to be, or the insistence that one is, of the other sex. This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex. There must also be evidence of persistent discomfort about one’s assigned sex or a sense of inappropriateness in the gender role of that sex.

Gender identity disorder can affect children, adolescents, and adults. Individuals with gender identity disorder have strong cross-gender identification. They believe that they are, or should be, the opposite sex. They are uncomfortable with their sexual role and organs and may express a desire to alter their bodies. While not all persons with gender identity disorder are labeled as transsexuals, there are those who are determined to undergo sex change procedures or have done so, and, therefore, are classified as transsexual.

Many transgender people do not regard their cross-gender feelings and behaviors as a disorder. They question what a "normal" gender identity or a "normal" gender role is supposed to be. Sometimes, even the very existence of a "normal" gender identity or gender role is examined, and often rejected by sectors of modern gender studies. They often point out that not everyone who is born male is stereotypically masculine, and not everyone born female is stereotypically feminine.

The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has several criteria that must be met before a diagnosis of Gender Identity Disorder (302.85) can be given.   These criteria include:

1) There must be evidence of a strong and persistent cross-gender identification. This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex;
2) There must also be evidence of persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex;
3) The individual must not have a concurrent physical intersex condition (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia); and
4) There must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning.

In children, the disturbance is manifested by repeatedly stated desire to be, or insistence that he or she is, the other sex. In boys, preference for cross-dressing or simulating female attire.  In girls, insistence on wearing only stereotypical masculine clothing. There is usually strong and persistent preferences for cross-sex roles in make believe play or persistent fantasies of being the other sex, an intense desire to participate in the stereotypical games and pastimes of the other sex, and usually a strong preference for playmates of the other sex.  In boys, there is the assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities.  In girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing.

In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex. Additionally, the adolescent or adult has a preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex).

There are no recent studies to provide data on prevalence of Gender Identity Disorder. Data from smaller countries in Europe with access to total population statistics and referrals suggest that roughly 1 per 30,000 adult males and 1 per 100,000 adult females seek sex-reassignment surgery. However, since these numbers reflect only people who have sought medical treatment, they do not reflect the total numbers of people who have some experience of gender discontinuity.

The preponderance of evidence suggests that transgender behavior has a neurological etiology; however, clear and convincing evidence has yet to show whether the etiology of transgender is mental or physical.   Even given this uncertainty, little research into transgenderism or transsexual ism is actually being conducted, especially in North America.

A gender identity disorder causes the person to experience serious discomfort with his/her own biological sex orientation. The gender identity disorder can also causes problems for the person in school, work or social settings. The need for treatment is emphasized by the high rate of mental health problems, including depression, anxiety, and  and drug and alcohol addiction, as well as a higher suicide rate among untreated transsexual people than in the general population.  Many transgender and transsexual activists, and many caregivers, point out that these problems usually are not related to the gender identity issues themselves, but to problems that arise from dealing with those issues and social problems related to them.

Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex have typically been shown to be ineffective.  However, psychological therapy can help alter the course of gender identity disorder problems and can be critical in helping the person adjust. Today, most medical professionals who provide transgender transition services now recognize that when able to live out their daily lives with both a physical embodiment and a social expression that most closely matches their internal sense of self, transgender and transsexual individuals live successful, productive lives virtually indistinguishable from anyone else.

Counseling individuals with gender identity disorder should include an understanding of the differences between true transsexualism and other disorder issues such as transvestic fetishism, non-conformity to stereotypical sex role behaviors, gender dysphoria, and homosexuality. Patients and their families need to be educated about the complexities of these issues, the enduring nature of these disorders, and the challenges that gender disorders typically present.

It is generally accepted that a reasonable and effective course of treatment for transsexual people can be sex reassignment therapy.  This can includes hormonal treatment and surgery.  Sex reassignment surgery consists of procedures which transsexual women and men undergo in order to match their anatomical sex to their gender identity. While genital reassignment surgery (GRS) refers only to surgeries that correct genital anatomy, sex reassignment surgery (SRS) may refer to all surgical procedures undergone by transsexual patients.

Hormone therapy may also be helpful.  In male-to-female individuals, original sex characteristics can be suppressed, and breasts, increased body fat, and a more feminine body shape can be promoted.  In female-to-male individuals, facial and body hair promotion may be achieved with testosterone.

“Transgender transition services”, the various medical treatments and procedures that alter an individual's primary and/or secondary sexual characteristics, are now considered medically necessary interventions for many transgender persons.  Prior to this kind of surgery, the person usually goes through a long period of hormone therapy which attempts to suppress same sex characteristics and accentuate other sex characteristics. For instance, males that have gender identity disorder will be given the female hormone, estrogen. The estrogen causes the male breasts to enlarge, testes to become smaller, and body hair to diminish. Females with gender identity disorder will be given the male hormone, testosterone, to help them develop a lower voice and possibly a full beard. Following the hormone treatment, the adult will be asked to live in a cross-gender role before surgery to alter their genitalia or breasts is performed.  A team of health professionals, including the treating psychologist or psychiatrist, medical doctors, and several surgical specialists, oversee this transitioning process.

Because of the irreversible nature of the surgery, candidates for sex-change surgery are evaluated extensively and are often required to spend a period of time integrating themselves into the cross-gender role before the procedure begins. Counseling and peer support are also invaluable to transsexual individuals.

Follow up studies have shown positive results for many transsexuals who have undergone sex-change surgery. However, significant social, personal, and occupational issues may result from surgical sex changes, and the patient may require psychotherapy or counseling.

Speech therapy may help individuals use their voice in a manner more appropriate to their preferred sex.

For more information about sexual identity disorder and other sexual issues, please click on the linked websites listed below.

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