Gender dysphoria involves a person experiencing distress due to a mismatch between their gender identity and sex assigned at birth. It was previously referred to as gender identity disorder but now focuses on dysphoria. Treatment may involve psychotherapy, hormone therapy, and sometimes sexual reassignment surgery. The causes are unclear but may involve genetic or hormonal factors influencing brain development before birth.

1. MUHAMMAD MUSAWAR ALI
MPHIL, ICAP
PSYCHMMUSAWARALI@GMAIL.COM

2. GENDER DYSPHORIA
 In DSM- V Gender Dysphoria has replaced Gender
Identity Disorder.
 The current term is more descriptive than the previous
DSM-IV term gender identity disorder and focuses on
dysphoria as the clinical problem, not identity per se
 Gender Dysphoria can be diagnosed at two different life
stages, either during Childhood and adolescence or
adulthood

3. GENDER DYSPHORIA
Definition
 Gender dysphoria refers to the distress that may
accompany the incongruence between one's
experienced or expressed gender and one's
assigned gender. Although not all individuals will
experience distress as a result of such
incongruence, many are distressed if the desired
physical interventions
by means of hormones and/or
surgery are not available.

4. Gender dysphoria is discomfort with ones
sex-relevant physical characteristics or
with one’s assigned gender
Duration of at least 6 months

5. GENDER DYSPHORIA IN CHILDREN
girls with gender dysphoria
 May express the wish to be a boy, assert they are
a boy, or assert they will grow up to be a man.
 prefer boys' clothing and hairstyles, are often
perceived by strangers as boys, and may ask to
be called by a boy's name.
 Display intense negative reactions to parental
attempts to have them wear dresses or other
feminine attire.
 Some may refuse to attend school or social
events where such clothes are required.

6. These girls may demonstrate
marked cross-gender
identification in role-playing,
dreams, and fantasies.
Contact sports, rough-and-tumble
play, traditional boyhood games,
and boys as playmates are most
often preferred.
They show little interest in
stereotypically feminine toys
(e.g., dolls) or activities (e.g.,
feminine dress-up or role-play).

7. BOYS WITH GENDER DYSPHORIA
 The wish to be a girl or assert they are a girl or
that they will grow up to be a woman.
 They have a preference for dressing in girls' or
women's clothes or may improvise clothing from
available materials
 e.g., using towels, aprons, and scarves for long
hair or skirts).
 These children may role play female figures (e.g.,
playing "mother") and often are intensely
interested in female fantasy figures.

8.  Traditional feminine activities,
stereotypical games, and pastimes
(e.g., "playing house"; drawing
feminine pictures; watching
television or videos of favorite
female characters) are most often
preferred.
 Stereotypical female-type dolls
(e.g.. Barbie) are often favorite
toys, and girls are their preferred
playmates. They avoid rough-and-
tumble play and competitive sports
and have little interest in
stereotypically masculine toys
(e.g., cars, trucks).

9. GENDER DYSPHORIA IN ADOLESCENTS
AND ADULTS
young adolescents with gender
dysphoria:
 Clinical features may resemble those
of children or adults with the
condition, depending on
developmental level.
 As secondary sex characteristics of
young adolescents are not yet fully
developed, these individuals may
not state dislike of them, but they
are concerned about imminent
physical changes.

10. ADULTS WITH GENDER
DYSPHORIA
 The discrepancy between experienced gender and
physical sex characteristics is often, but not always,
accompanied by a desire to be rid of primary and/or
secondary sex characteristics and/or a strong desire to
acquire some primary / secondary sex characteristics of
the other gender.
 They may adopt the behavior,
clothing, and mannerisms of the
experienced gender.
 They feel uncomfortable being
regarded by others, or functioning
in society, as members of their
assigned gender.

11. CONTINUE……….
 Some adults may have a strong
desire to be of a different gender
and treated as such, and they may
have an inner certainty to feel and
respond as the experienced gender
without seeking medical treatment
to alter body characteristics.
 They may find other ways to
resolve the incongruence between
experienced/ expressed and
assigned gender by partially living
in the desired role or by adopting a
gender role neither conventionally
male nor conventionally female.

13. PSYCHIATRIC AND BIOLOGICAL CAUSES
 It was traditionally thought to be a
psychiatric condition meaning a mental
ailment. Now there is evidence that the
disease may not have origins in the brain
alone.
 Studies suggest that gender dysphoria
may have biological causes associated
with the development of gender identity
before birth.
 More research is needed before the
causes of gender dysphoria can be fully
understood.

14. GENETIC CAUSES OF BIOLOGICAL SEX
Hormonal causes
 Hormones that trigger the development of sex and
gender in the womb may not function adequately.
 For example, anatomical sex from the genitals may
be male, while the gender identity that comes from
the brain could be female.
 This may result from the excess female hormones
from the mother’s system or by the fetus's
insensitivity to the hormones.

15. ANDROGEN RECEPTOR
 The research suggests reduced androgen and androgen
signaling contributes to the female gender identity of
male-to-female transsexuals.
 The authors say that a decrease in testosterone levels in
the brain during development might prevent complete
masculinization of the brain in male-to-female
transsexuals and thereby cause a more feminized brain
and a female gender identity

16. Other causes of gender dysphoria
 The loss of a female-specific CYP17 allele
distribution pattern is associated with FtM
transsexuality
 There may be chromosomal abnormalities that
may lead to gender dysphoria.
 Sometimes defects in normal human bonding
and child rearing may be contributing factor to
gender identity disorders.

17. LEARNING THEORY
 Learning theory and concepts derived from it tend to favor a
causative model in which the primary attachment figure(s) is
(are) postulated to exert an exogenous-reinforcing, active-
manipulative effect on the development of features typifying the
opposite sex.
 This explanatory approach ascribes primary importance to a
desire on the parent’s part for the child to be of the opposite sex.
A high rate of psychological abnormalities in the parents of
children with GD has been reported in more than one study . It
is essential, therefore, to explore thoroughly the
psychopathology of the child’s attachment figures and their
"sexual world view," including any sexually traumatizing
experiences they may have undergone, in order to discover any
potential "transsexual genic influences."

18. TREATMENTS

19. PSYCHOTHERAPY
 Individuals can be taught about self
awareness and confidence needed to handle
any issues arising in their daily lives.
 The support of family members can be
engaged through the use of group, marital,
and family therapy, which can help in
creating an accommodating and encouraging
environment
 Through the use of speech therapy, male-to-
female individuals with gender dysphoria can
learn how to engage their voice and sound a
lot female while talking.

20. PHARMACOLOGIC THERAPY
 Many individuals, especially those desiring a
complete transformation will need hormonal therapy
to enable that process.
 For females seeking a male transformation, the
hormone testosterone will be helpful in promoting
body hair.
 Some individuals may also have comorbid
psychiatric diagnoses, such as depression, anxiety,
or psychosis. These are best treated with
medications like antidepressants, anxiolytics, and
antipsychotics.

21. SEXUAL REASSIGNMENT SURGERY
 SRS among teenagers remains a controversial
topic, and much debate continues on this issue. In
many countries, SRS is not available to teenagers,
on the other hand, having this treatment done in the
early stages when secondary sex characteristics
are not fully formed, may be helpful.
 In adults, there is a reported satisfactory result in 87
percent of male-to-female and 97 percent of female-to-
male SRS patients
 Opposite sex genitals reassignment.

22. HORMONE THERAPY
 If child has gender dysphoria and they've reached
puberty, they could be treated with gonadotropin-
releasing hormone (GnRH) analogues. These are
synthetic (man-made) hormones that suppress the
hormones naturally produced by the body.
 GnRH analogues suppress the hormones produced by
child’s body which in turn suppress puberty.
 The effects of treatment with GnRH analogues are
considered to be fully reversible, so treatment can
usually be stopped at any time after a discussion
between parent, effected child and doctor.