Managing disclosure of gender dysphoria

A visual summary of managing patients disclosing gender dysphoria, encouraging cooperation and respect to get the best experiences and outcomes for patients

It can be very distressing for a person to tell a health professional about conflict between their sense of self and the sexual characteristics they were born with. They will need reassurance, and careful guidance about what kinds of treatment are available.

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About 0.6% of the population identifies as transgender according to healthcare records, although the actual number might be higher. In the 50 years since UK NHS services started, more than 130 000 people have changed social gender role. A variety of doctors, including non-specialists, might at some time in their career be approached for help by someone with gender dysphoria.

Transhealth – how to talk to patients about pronouns

Transgender authors share their experiences of healthcare and the important messages they’d like doctors to know

Two articles published on the bmj aim to help doctors treat patients who request support with their gender identity.

Firstly a practice pointer on how to refer to gender clinic, and secondly a What Your Patient Is Thinking article about trans people’s experiences in the healthcare system.

In this podcast, two of the authors of that patient experience article, Emma-Ben and Reubs, join us to discuss identity, pronouns and what genderqueer means.

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Man and woman, boy and girl

The differentiation and dimorphism of gender identity from conception to maturity

The differentiation and dimorphism of gender identity from conception to maturity.

Baltimore : Johns Hopkins University Press, 1972 book that combines experimental and clinical data in this report on human development and the relation of sexual differentiation and social roles.

In Man and Woman, Boy and Girl, John Money and Anke Ehrhardt offer a comprehensive account of sexual differentiation using genetics, embryology, endocrinology and neuro-endocrinology, psychology, and anthropology. Their multidisciplinary approach to gender identity avoids the old arguments over nature versus nurture. Money and Ehrhardt focus instead on the interaction of hereditary endowment and environmental influence. Money and Ehrhardt’s work will lead many readers to the conclusion that the differences between man and man, or woman and woman, can be as great as between man and woman.

This was required reading in my human sexuality class in college. I thought it was well presented and researched. It defies some of the gender role and gender identification theories by explaining the gender spectrum in very graphic terms. It will make some people VERY uncomfortable, but it makes a valid point I believe, there are many ways to define gender and how individuals identify with their gender. It does not support the popular theory that we are born genetically predisposed to a particular sexual orientation. Instead the book suggests that regardless of how male or how female you may be genetically you may choose which sex you prefer in your physical or emotional relationships. Blasphemy to some, but it goes a long way to clearing up some of the ambiguity about gender roles and gender identification.

Jonathan Van Voorhees, August 4, 2015.

Gender Dysphoria, Transsexualism, and Disorders of Sexual Differentiation in DES Sons

DES Sons International Network slideshow presentation, 2004

by Scott P. Kerlin, Ph.D.

DES Sons International Network

The Presence of Gender Dysphoria, Transsexualism, and Disorders of Sexual Differentiation in Males Prenatally Exposed to Diethylstilbestrol: Initial Evidence from a 5-Year Study.

Sources:

More DES DiEthylStilbestrol Resources

Hormonal contributions to sexually dimorphic behavioral development in humans

DES-exposed male subjects appeared to be feminized and/or demasculinized

image of dancing-statues
This 1991 study confirms that DES-exposed male subjects appeared to be feminized and/or demasculinized, and there is some evidence that exposed female subjects were masculinized. Dancing statues image by Dixie Lawrence.

1991 Study Abstract

Nineteen studies on the behavioral effects of prenatal exposure to hormones administered for the treatment of at-risk human pregnancy are reviewed. Because the role of prenatal exposure to hormones in the development of human behavioral sex differences is potentially confounded by society’s differential treatment of the sexes, comparisons between exposed and unexposed subjects were evaluated and summarized separately for male and female subjects.

Therefore, this review focuses on data for individuals whose prenatal hormone environments were atypical relative to what is normal for their own sex. Overall, it appears that prenatal exposure to androgen-based synthetic progestin exerted a masculinizing and/or defeminizing influence on human behavioral development, whereas prenatal exposure to natural progesterone and progesterone-based synthetic progestin had a feminizing and/or demasculinizing influence, particularly among female subjects.

The data on prenatal exposure to synthetic estrogen derive primarily from subjects exposed to diethylstibestrol (DES). DES-exposed male subjects appeared to be feminized and/or demasculinized, and there is some evidence that exposed female subjects were masculinized. These findings are discussed in the context of prenatal hormonal contributions to sexually dimorphic behavioral development both within and between the sexes. Recommendations for the conduct of future research in developmental behavioral endocrinology are presented.

Sources and more information
  • Hormonal contributions to sexually dimorphic behavioral development in humans, Reinisch JM1, Ziemba-Davis M, Sanders SA, Psychoneuroendocrinology. 1991;16(1-3):213-78., NCBI PMID: 1961841, 1991.
More DES DiEthylStilbestrol Resources

What is Androgen Insensitivity Syndrome (AIS) and what it means to be intersex?

What It’s Really Like to Be Intersex.

image of dalea
Musician Dalea talks about how having an atypical body taught her to love herself.

Intersex people are born with a mix of anatomical sex traits (chromosomes, reproductive organs, or genitals). Sometimes they are apparent at birth, sometimes they’re discovered later in life. I have Androgen Insensitivity Syndrome (AIS).

AIS manifests in different ways, yet the key factor is that during gestation, the unborn child develops a resistance to androgens (male hormones), which help build both males and females in the womb. AIS women are born with XY chromosomes, a female appearance, and internal gonads (they can be called testes). AIS variations go from being completely undetectable on the outside at birth, to visible variations on the genitals when the androgen insensitivity is partial. This means that on the outside, a body can look completely like a regular female on one side of the spectrum, to having noticeable traits of both on the other.

My mother was a nurse and when I was born, there were indications of my variation. So my family knew almost right away that something was up. At first it was attributed to a fertility medication that my mom took, called diethylstilbestrol (DES), which caused a lot of issues in babies and mothers until it was taken off the market in the late ’70s. ”

Dalea spoke with Cosmopolitan reporter Kira Peikoff about growing up different, struggling with her body image, and eventually learning how to embrace herself exactly as she is.

Read What It’s Really Like to Be Intersex, Cosmopolitan, APR 16, 2015.

Read DES studies on gender identity.

Child transgender referrals to the NHS quadrupled in five years

Rise in child transgender referrals

transgenders image
The number of children referrred to the NHS as a result of transgender feelings and confusion about their gender has quadrupled in five years. 2013 Rally for Transgender Equality image by Ted Eytan.

The number of children aged 10 or under who have been referred to the NHS because of transgender feelings has more than quadrupled in five years, according to new figures.
The Tavistock and Portman NHS Trust said referrals over the period included 47 children aged five or under, and two children just three years old.
The trust – UK’s only centre specialising in gender issues in under 18s – said that in total, the number of under 11s referred to the unit has risen from 19 in 2009-10 to 77 in 2014-15.
Parents said they had sought help after children became deeply distressed about their gender.

Sources and more information

  • Rise in child transgender referrals, telegraph, 07 Apr 2015.
  • Referrals for young transgender people increase, bbc, 5 February 2015.
  • How to find an NHS gender identity clinic, nhs.
  • Think your child might be transgender?, nhs.

The Link between DES Exposure and MTF Transsexuality

DES is probably the unacknowledged cause of most cases of MTF transsexuality among those born prior to the mid-1970s. Does Dr. Keith Ablow knows?

What if DES was the unacknowledged cause of most cases of MTF transsexuality among those born prior to the mid-1970s…

Brynn Tannehill
Brynn Tannehill is parent, writer, scientist, and advocate for trans inclusion in the military.

In January 2014, Dr. Keith Ablow, psychiatrist and member of the Fox News Medical A-Team, dismissed any biological origins of gender dysphoria, stating he was “Not convinced’ being TransGender exists“…

Few day later, Brynn Tannehill, Director of Advocacy, SPART*A, published a paper with no less than 15 studies showing a biological origin of gender dysphoria… One of them is a mention about DES:
In this study, more than 150 individuals with confirmed or suspected prenatal diethylstilbestrol (DES) exposure reported moderate to severe feelings of gender dysphoria across the lifespan.”

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