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Gender Identity Disorder - An Overview





Gender Dysphoria- An Overview



by Jennifer Burnett, MD



 March 18, 2008



Gender Dysphoria (GD)/Transsexualism (previously known as Gender Identity Disorder) is not a psychiatric problem, nor is it some immoral/sexual “lifestyle choice”. GD is a Congenital Anomaly (Birth Defect). But unlike most birth defects, it is entirely invisible at birth, for the “defect” is not on the outside but in the “inside”- in the brain, where a person’s self concept of being male or female lies. Whereas it seems inconceivable to almost everybody that a person’s gender identity could be opposite to their genital sex, to those with GD is the most evident thing they know about themselves, even if others cannot recognize this. Children with GD often know they are “different” at or before the age of 5. They can be observed routinely playing with toys of the “opposite” gender and dressing themselves up and playing “pretend” as the gender opposite to their birth sex.





 As I mentioned, there are essentially no visible “outward” differences in children (or adults) with GD, but research indicates that certain areas of the brain (“gender centers”) can develop opposite to the body’s sex. This anomalous condition occurs somewhere around 1 in 500 to 1 in 5000 births. That means that there really can be “a female brain” within a male body and vice versa. These gender centers (one is called the BSTc, located in the hypothalamus) may differentiate abnormally- opposite to the sexual development of the fetus’ genitals- due to imbalances of certain hormones. This can also be influenced by other chemicals called “endocrine disruptors” (such as phthalates, which are softening agents found in many different plastics). The differentiation of these gender centers begins around 8-14 weeks of gestation, so exposures to these types of chemicals during early pregnancy may have their most profound effects at this time.





Fortunately, in the USA and other developed nations, knowledge of GD has been increasing rapidly. Much of the credit goes to the Internet, TV Specials on GD and movies, such as Transamerica and Normal. Many children are being diagnosed early enough so that they can even be prevented from entering puberty “in the wrong gender”. Once the diagnosis is confirmed, cross-gender hormones can be started. But for those that grew up in prior generations and did not receive help early on, they usually learn to suppress their “atypical” behaviors and to construct elaborate façades in order to “fit in” and fulfill society’s expectations for them. They are just trying to get along as best as they can in a gender role that is opposite to who they really know themselves to be.





With a lot of practice, and as the years pass, they often become exceptionally good at this “deception” – so good they can repress their true nature for years, often deceiving themselves as well as everyone else. But this places an enormous mental and psychological burden on them. Finally, somewhere in their 30’s through their 60’s, they reach a crisis point where they can no longer “hold it together” and become unable to continue their self-deception. They then find themselves in a position where they either must admit who they really are and begin “transitioning” (moving toward living their life as their true gender) or face ever-worsening anxiety, severe depression and the risk of suicide. (Though many textbooks quote 20% as the number of those with GID who attempt suicide, my own poling indicates that over 90% make at least one serious attempt to take their own lives before, during and sometimes after transitioning.)





After reaching their “Transition or Die” crisis point, those who are fortunate and have the fortitude, resources and/or the support of family and friends will seek out medical and psychological care. Gender Therapists can help to confirm the diagnosis and recommend their patients to qualified doctors for initiation of the hormone therapy that will begin to change their “outside” to match their “inside”. Other adjuncts, such as electrolysis, voice lessons, breast implants and possibly Facial Feminization Surgery are often undertaken for M2F’s (Males transitioning to Females). It is a long a difficult path, fraught with many hazards. Most of those transitioning are subjected to terrible losses- divorce, estrangement from their children, loss of their jobs and abandonment by friends and other family members. Relationships within their churches, if they are attending one, almost always deteriorate and they are frequently forced to leave. 





However, since there is no other effective treatment for GD; transitioning is their only option other than death. For those who persevere, they gain the incredible satisfaction of finally getting to be their “true selves”. After living “full-time” for at least one year in their desired gender, they may then proceed to Sex Reassignment Surgery (SRS) and have all their legal documents (requirements can vary from state to state) and their passport reissued in their new gender. It is estimated, however, that only about 7% of those who start transitioning end up returning to jobs commensurate to their pre-transition levels. Only about 15% of marriages end up staying together. And most of those who have “made it” and are successful at “passing” (the ability to remain unrecognized as to their past gender) end up disappearing from the “T Community” over the subsequent years as they blend in and begin living normal lives, just like everyone else. 





Recommended Reading: 



True Selves, by Mildred Brown, and Chloe Ann Rounsley



Brain Sex, by Ann Moir and David Jessel










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