Diagnosis Critical in Adolescent Gender Dysphoria

▸ Sexual orientation: sexual attraction of one person toward another person of the same sex or the opposite sex.

▸ Gender identity: concept of one's self as male or female.

▸ Gender role: society's expected behaviors for males and females.

▸ Gender dysphoria: distress related to one's gender identity and sex at birth.

▸ Gender identity disorder: a DSM-IV diagnosis. Criteria include strong identification with the opposite gender, persistent discomfort with one's own sex, inappropriate behavior in his or her existing gender role, and significant distress in important areas of daily functioning.

▸ Transsexual: usually refers to someone with gender dysphoria who is in the process of or desires sex-changing medical procedures.

▸ Transgender: refers to someone who is gender dysphoric but may not be interested in sex-changing medical procedures or may not meet the diagnostic criteria for gender identity disorder.

▸ MF: an anatomic male who identifies with women and wishes to become a woman.

▸ FM: an anatomic female who identifies with men and wishes to become a man.

Source: Dr. O'Malley

Sex Change: One Step at a Time

If and when an adolescent makes the choice to change his or her sex, the steps toward sex and gender reassignment should begin with a thorough psychiatric assessment and discussion of plans for the future. Among the steps are the following:

▸ A clinician determines whether the adolescent meets the DSM-IV criteria for gender identity disorder, and assesses his or her personal and social stability and levels of support from family and friends.

▸ If he or she meets the assessment criteria, the adolescent starts to live in a cross-gender role and initiates reversible hormone treatments. The fully reversible hormones suppress estrogen and testosterone and delay the physical changes of puberty. Reversible hormone treatments usually do not begin unless the adolescent is aged at least 16 years. Many experts also believe that the adolescent should be in at least Tanner stage 2 of development before initiating hormones.

▸ If he or she still desires change, the adolescent continues living in a cross-gender role and proceeds to partly reversible hormone treatment, which takes about 1 year for females working to become male and 1.5 years for males working to become female.

The difference in duration reflects the sense that it is more difficult for males who want to be females to pass as women than it is for women to pass as men. In fact, many adolescent girls can start to look like males relatively quickly.

Most physicians recommend that the adolescent wait until age 18 to receive the partly reversible hormone treatment, since these hormones masculinize or feminize the body and could lead to surgery to reverse the results, such as breast development in males.

▸ The final step is a continuation of hormones and a referral for sex change surgery.

Source: Dr. O'Malley