Gender Identity Disorder: Diagnosis and Treatment

There are many well-known phrases that make bigger implications than we realise – such as boys will be boys – but what happens when boys want to be girls, or vice versa? Gender Identity Disorder (GID) can play a huge role in an individual’s sexual health, and overall wellbeing, with people feeling that their body does not match who they are on the inside. Also known as gender identity confusion, gender dysphoria, transgenderism and transsexualism, the condition can cause some people to use clothing and cosmetics to explore this identity, while others may choose to change their appearance with hormones or even surgery.


According to noted wellness writer Maria Trimarchi, ‘Mental health professionals believe there are three components that make up our gender identity: our sexual orientation, behaviour and mannerism preferences, and core gender identity (that gut feeling we have about the gender we identify with). In most of us, these three components and our anatomy align as male or female. For some, however, these components don’t all match up. The cause of gender identity disorder is still being debated. Theories suggest it is caused by genetic abnormalities, endocrine problems like a testosterone or oestrogen imbalance in the womb, social factors like parenting or some combination of issues.’ But at what age do parents begin to see symptoms of GID in children?


There are five steps to diagnosing GID: diagnostic assessment, psychotherapy, real-life experience, hormone therapy and surgery. Trimarchi explains, ‘The process begins when a person consults a mental health professional, who performs sessions of psychotherapy and formulates a diagnosis. To become a candidate for gender reassignment surgery, a person must first be diagnosed with Gender Identity Disorder (GID) or gender dysphoria. The International Classification of Diseases-10 (ICD-10) lists gender identity disorder as a disorder and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) lists gender dysphoria.’


The reason why diagnosis is important is because there is a wide range of variables that fall under the GID umbrella, and prospective candidates for gender reassignment surgery must work with a mental health professional for the right diagnosis. Once the diagnosis is complete, there are three phases left for patients who wish to undergo surgery:


1. Hormone therapy


2. Real-Life Experience, or the Real-Life Test


3. Surgery to change genitalia and other sex characteristics


Trimarchi notes, ‘Not all transgender people need all three phases of therapy; each path to gender reassignment is tailored to the person…Before a patient can begin hormone therapy or breast surgery, a mental health professional must write a letter of recommendation to the physician providing medical treatment. In addition to the letter, the World Professional Association for Transgender Health’s Standards of Care require several eligibility and readiness criteria for hormone therapy.’ To undergo hormone therapy, you must:


  • Be 18 years of age
  • Understand what the medical ability of hormones, as well as their social benefits and risks
  • Have either a minimum of three months of psychotherapy or a documented three month real-life experience
  • Show stable or improved mental health
  • Demonstrate ability to take hormones in a responsible manner


Trimarchi details, ‘The Real-Life Experience immerses the individual into life as his or her preferred gender. The candidate is required to maintain full or part-time employment (or attend school full or part-time), legally change his or her first name to one that is gender appropriate and prove that people other than the therapist and doctor know his or her desired gender. After 12 months of continuous and successful hormone therapy and Real-Life Experience, the individual is eligible for genital surgery. Two letters of recommendation, usually one from the mental health professional and one from the hormone-prescribing physician, are required for surgery.’

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