Gender dysphoria and management of transgender patients
Description
Terminology
- Gender identity - internal sense of gender; sex assigned at birth; gender incongruence - the two do not align
- Gender dysphoria - the distress arising from incongruence (DSM-5-TR)
- *ICD-11 moved "gender incongruence" out of the mental and behavioural disorders chapter* into conditions related to sexual health - incongruence itself is not a mental illness
- Trans woman / transfeminine - assigned male at birth, feminine identity
- Trans man / transmasculine - assigned female at birth, masculine identity
- Non-binary - not everyone wants full feminisation or masculinisation; goals must be individualised, and partial or lower-dose regimens are legitimate
Components of gender-affirming care
- Social affirmation (name, pronouns, documents)
- Hormone therapy
- Surgery (chest/breast, genital, facial, voice)
- Voice and communication therapy, hair removal
- Psychological support - for distress and comorbidity, not as gatekeeping
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