Gender Dysphoria (Gender Identity Disorder)

Aditya to Aditi: ‘A woman soul trapped in man’s body…’

It was another busy OPD day. Last client… “Good Evening Aditya (Name changed)! How can I help you my friend”.   Aditya broke down into tears. “Doctor, I want to end my life. I feel my life is not worth living”.  I passed on a glass of water to Aditya and was waiting for him to ventilate his feelings. Aditya spoke, “I am not happy being a man. I feel, I am a woman soul trapped in a man’s body. I belong to a small town from interiors of Maharashtra. Nobody understands what I am going through… please let me die.”

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Aditya was a young male client who was suffering from Gender Dysphoria (Gender Identity Disorder). He was uncomfortable with his biological male gender role since childhood.  On inquiry, He always disliked dressing male clothes. As he grew up into adolescence, his distress about being male increased. Aditya was not comfortable with the change in his voice and mustache. He expressed his feelings to his parents but parents turned deaf ear to his plea… He joined classical dance classes and started developing interest in cooking. His anxiety decreased being into this female gender roles. One day he expressed wish to change his sex by undergoing sex re-assignment surgery to his family members. He could not convince his family and was out caste from the community.

Diagnostic and Statistical Manual of Mental Disorder 5 (DSM 5) describes Gender Dysphoria (earlier known as Gender Identity Disorder) as ‘a definite mismatch between the assigned gender and experienced/expressed gender for at least 6 months duration as characterized by at least two or more of the following features –

1.    Mismatch between experienced or expressed gender and gender manifested by primary and/or secondary sex characteristics at puberty

2.    Persistent desire to rid oneself of the primary or secondary sexual characteristics of the biological sex at puberty.

3.    Strong desire to possess the primary and/or secondary sex characteristics of the other gender

4.    Desire to belong to the other gender

5.    Desire to be treated as the other gender

6.    Strong feeling or conviction that he or she is reacting or feeling in accordance with the identified gender.

Published prevalence of gender dysphoria range from 1.9 to 4.72 per 100000 populationwith a male to female ratio of 3:1. (1) Number of people diagnosed with this condition is increasing due to increasing awareness among population. Christine Jorgensen was the first person to become widely known in the United States for having sex reassignment surgery in 1951. In 2015, is an American television personality and retired Olympic gold medal-winning decathlete made headlines and appeared on Vanity fair magazine for her transformation from Bruce Jenner to Caitlyn Jenner.

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Gender dysphoria involves a conflict between a person’s physical or biological gender and the gender with which they identify. People with gender dysphoria may be very uncomfortable with the gender they were assigned, sometimes described as being uncomfortable with their body (particularly developments during puberty) or being uncomfortable with the expected roles of their assigned gender. Often other people do not understand the wish to be of another gender, and this can cause difficulties in relationships with friends and family. It may cause stressanxiety or depression. Gender dysphoria is associated with high levels of stigmatization, discrimination and victimization, contributing to negative self-image and increased rates of other mental disorders.

A person has to undergo Real Life Experience (RLE) i.e. living life of opposite desired sex for a period of 1 year so he/she does not regret the decision of sex change in later life. Sex reassignment surgery, hormonal replacement therapy, speech therapy, skin and hair treatment are the treatment available after evaluation and treatment by a psychiatrist. Primary as well as secondary mental disorders needs to be ruled out by a psychiatrist before undergoing above irreversible treatments.

Dr. Chetan Vispute

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