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Disorders of gender identity: what to do and who should do it?

  • James Barrett (a1)
Summary

Transsexualism is not usually indicative of psychopathology. In carefully selected individuals, with multidisciplinary support, a change of social gender role and cross-sex hormone treatment greatly improves the psychological and social state. Sustained improvement merits gender reassignment surgery. The key is early referral with subsequent primary care cooperation in the treatment plan.

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References
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1 Wilson, P, Sharp, C, Carr, S. The prevalence of gender dysphoria in Scotland: a primary care study. Br J Gen Pract 1999; 49: 991–2.
2 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (5th edn) (DSM-5). APA, 2013.
4 Burchill, J. Transsexuals should cut it out. Observer 2013; 13 January.
5 Haraldsen, IR, Dahl, AA. Symptom profiles of gender dysphoric patients of transsexual type compared to patients with personality disorders and healthy adults. Acta Psychiatr Scand 2000; 102: 276–81
6 Levine, SB. Psychiatric diagnosis of patients requesting sex reassignment surgery. J Sex Marital Ther 1980; 6: 164–73.
7 Barrett, J. Transsexual and Other Disorders of Gender Identity: A Practical Guide to Management: 157–90. Radcliffe, 2007.
8 Royal College of Psychiatrists. Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria (College Report CR181). RCPsych, 2013.
9 Seal, LJ, Franklin, S, Richards, C, Shishkareva, A, Sinclaire, C, Barrett, J. Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal regimens. J Clin Endocrinol Metab 2012; 97: 4422–8.
10 Bellringer, J. Photo Gallery. GenderXchange, 2013 (www.genderxchange.co.uk).
11 St Peter's Andrology Centre. Gender Reconstruction. St Peter's Andrology Centre, 2013 (www.andrology.co.uk).
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Disorders of gender identity: what to do and who should do it?

  • James Barrett (a1)
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eLetters

Disorders of gender identity: Ethical and Legal issues

Anubhav Rathi, Senior resident
28 March 2014

The editorial by James Barrett is an excellent one highlighting the main problems which are faced by the clinician treating a person having Gender Identity Disorder (GID). The author has mentioned that usually GID is not associated with psychopathology. However, some studies have shown high rates of psychiatric co-morbidities (both present and lifetime) in persons with GID [1,2]. These patients need careful screening and evaluation by a multidisciplinary team consisting of a psychiatrist, clinical psychologist, urologist, gynaecologist(in anatomically female patient), forensic expert, social worker, lawyer and immediate family members. Clinical experience has shown that many patients who are suffering from psychiatric disorders and who want to undergo sex reassignment treatment may again demand restoration of their original sex.They may also go for litigation. There is need of formulation of expert guidelines for treatment of GID. The ethical and legal issues (depending on the laws of the land) associated with GID should also be considered while framing such guidelines.

References:1. Heylens G, et al. Psychiatric characteristics in transsexual individuals: multicentre study in four European countries. Br J PsychiatryFebruary 2014 204:151-156.2. Hepp U, et al.Psychiatric comorbidity in gender identity disorder. J Psychosom Res 2005; 58: 259-261

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Conflict of interest: None declared

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