Expert Tips for Managing Patients with Gender Dysphoria

A patient’s gender typically aligns with his or her phenotypic presentation, meaning those who have male genitalia usually identify as boys, and those with female genitalia generally identify as girls. However, a small minority of individuals find that their basic sense of being male or female — or, rarely, some other category like “neither-nor,” “third gender,” or “intersex” — is at odds with their apparent gender.

Those patients may be diagnosed with gender dysphoria, and in the last few years, healthcare professionals have seen an increase in the number of patients asking for help with those issues, sometimes in the form of gender change interventions. To help primary care providers manage patients with gender concerns, Heino F.L. Meyer-Bahlburg, a researcher from Columbia University in New York City, assembled a comprehensive review of important information on the topic, including possible causes, age of typical awareness, and societal issues. He cited a need for interdisciplinary team management to ensure that all genetic, endocrine, surgical, psychiatric, cultural, legal, and ethical questions are adequately addressed.

In his review, Meyer-Bahlburg explained that sexual differentiation is a complex process that influences each individual’s body, brain, behavior, and identity. Referring to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnosis criteria for associated disorders, he introduced and defined many terms that are used to describe gender-questioning patients.

Meyer-Bahlburg pointed out that somatic disorders of sex development (DSD), gender identity disorder (GID), and patient-initiated gender change are very different, as each syndrome varies in severity and the timing of the patient’s awareness and decision to seek help.

Fortunately, researchers now have better data on the outcomes of long-term gender and sexuality in DSD, and that data has been instrumental in changing policies related to gender assignment and gender-confirming surgery. Meyer-Bahlburg said it’s important to discuss gender reassignment with patients who wish to pursue the procedure, as it has become an increasingly frequent surgery. Society also seems to be more accepting of it, which may have propelled the increase.

Still, Meyer-Bahlburg concluded that more research is needed to clarify the short- and long-term effects of treatment with puberty-suppressing medications and cross-sex hormones on behavior and the brain.