In this post, Antonella Mazziotta, MSc student at the Institute for Mental Health at the University of Birmingham, discusses Gender Dysphoria. Gender Dysphoria is a topic not so well understood by scientists and society with this being reflected in the type of treatments and stigma around LGBTQ+ communities. Antonella's research interests include exploring Gender Dysphoria in childhood as well as language comprehension and production in Mental Health conditions.
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| Antonella Mazziotta |
I had the opportunity to observe how dysphoria affects transgender people, especially children, and how society plays a vital role in the psychological outcomes of treatment for young people. This led to my interest in researching the pathological features of Gender Dysphoria. Do we believe that transgender children are aware of their inner identity or simply confused and therefore have a mental disorder?
The DSM-IV called this condition ‘Gender Identity Disorder’ which was changed to ‘Gender Dysphoria’ in its latest edition, the DSM-5, because of its unethical and controversial label. The diagnosis of Gender Dysphoria in adolescents consists of symptoms signaling discomfort of the patient with their biological sex and an incongruence between their assigned gender and the expressed one. Therefore, to better understand Gender Dysphoria, the condition and its possible underlying causes we need to start from the basics. What do we mean by biological sex and gender?
Biologically speaking, sex is defined by chromosomes: XX for female and XY for male. However, there is only one set of genes (called SRY) in the Y chromosome that are important to defining the individuals’ sex. It is proven by research that SRY genes can escape from the Y chromosome and ‘jump’ into the X chromosome. It is very complicated science, and we’ll leave this type of research to geneticists, but this gives us a possible hint on where Gender Dysphoria might arise biologically. This means that we have a genetic sex, a chromosomal sex and hormonally altered male, female or non-binary sex.
The DSM-IV called this condition ‘Gender Identity Disorder’ which was changed to ‘Gender Dysphoria’ in its latest edition, the DSM-5, because of its unethical and controversial label. The diagnosis of Gender Dysphoria in adolescents consists of symptoms signaling discomfort of the patient with their biological sex and an incongruence between their assigned gender and the expressed one. Therefore, to better understand Gender Dysphoria, the condition and its possible underlying causes we need to start from the basics. What do we mean by biological sex and gender?
Biologically speaking, sex is defined by chromosomes: XX for female and XY for male. However, there is only one set of genes (called SRY) in the Y chromosome that are important to defining the individuals’ sex. It is proven by research that SRY genes can escape from the Y chromosome and ‘jump’ into the X chromosome. It is very complicated science, and we’ll leave this type of research to geneticists, but this gives us a possible hint on where Gender Dysphoria might arise biologically. This means that we have a genetic sex, a chromosomal sex and hormonally altered male, female or non-binary sex.
Philosophically speaking though, gender is the inner perception of identity, the one felt by the patient which is not necessarily represented by their physical characteristics. Gender Dysphoria, most of the times, starts in childhood when children begin to understand the basic differences between genders around the age of 3. This phenomenon has been numerously documented in accounts of transgender adults that describe the discomfort with their natal sex from a very young age.
Treatments for Gender Dysphoria are complex, distressing and sometimes also inhumane. There is not a specific treatment for this condition, only a series of hormone therapies which consist of blocking the natural development of the natal sex organs to allow the child to experience the desired gender for at least two years. However, such intervention can lead to a loss of fertility and hence the inability to have biological offspring in the future, in addition to the psychological confusion that such therapy may cause.
Treatments for Gender Dysphoria are complex, distressing and sometimes also inhumane. There is not a specific treatment for this condition, only a series of hormone therapies which consist of blocking the natural development of the natal sex organs to allow the child to experience the desired gender for at least two years. However, such intervention can lead to a loss of fertility and hence the inability to have biological offspring in the future, in addition to the psychological confusion that such therapy may cause.
Finally, to complete the transition process, the patient must undertake sex reassignment surgery which is also necessary by law to be finally recognised with the desired gender. This suggests that this whole process of gender reassignment is not seen as a relief for the patient rather as a relief for policy makers. As expected, a requirement of this gravity by the law created rancour in the LGBTQ+ community which considered such process unethical and a human rights violation. Not all transgender people want to permanently change their natal sex with surgery and the problem is definitely not in their genitals for a percentage of transgenders.
Going back to the starting question we can conclude by saying that perhaps societal ideologies are partly responsible for such interventions and requirements. Such treatments can be psychologically distressing during early life. In addition, recent research is unravelling the possibility of a comorbidity between Autistic Spectrum Disorder and Gender Dysphoria which should be furthered investigated to better understand both conditions (9-10).
I urge you to ask yourselves some questions. Do people with Gender Dysphoria need treatment? Is there a lack of understanding of the differences between sex and gender in society? Can we really consider Gender Dysphoria in children a phase where there is confusion about identity? Or are we just trying to accommodate society’s beliefs about what is considered normal and abnormal? Education and early prevention seem to be key, especially in those classrooms from which transgender children are normally excluded. Goal directed groups in each classroom can help both parents and children to accept diversity and practice equality.
Going back to the starting question we can conclude by saying that perhaps societal ideologies are partly responsible for such interventions and requirements. Such treatments can be psychologically distressing during early life. In addition, recent research is unravelling the possibility of a comorbidity between Autistic Spectrum Disorder and Gender Dysphoria which should be furthered investigated to better understand both conditions (9-10).
I urge you to ask yourselves some questions. Do people with Gender Dysphoria need treatment? Is there a lack of understanding of the differences between sex and gender in society? Can we really consider Gender Dysphoria in children a phase where there is confusion about identity? Or are we just trying to accommodate society’s beliefs about what is considered normal and abnormal? Education and early prevention seem to be key, especially in those classrooms from which transgender children are normally excluded. Goal directed groups in each classroom can help both parents and children to accept diversity and practice equality.