Gender dysphoria

What is gender dysphoria and transgender?

Gender dysphoria is a medical term that describes the discomfort felt by people whose innate sense of gender identity, i.e. the sense of being a boy/man or girl/woman conflicts with their visible sex characteristics. It is generally agreed that the condition has its origins before birth. Research studies indicate that a small part of the developing foetus brain progresses along a different pathway from the sex of the rest of the body.

The term transsexual applies to people whose gender dysphoria is of such severity that in order to alleviate the discomfort they transition, usually with medical assistance to a gender role different from that assigned to them at birth. Transgender or trans is a broader term that includes transsexualism and all those who experience some degree of gender variance which does not always require medical intervention. Other terms are non-binary, genderqueer, bi-gender which will come under the trans umbrella. In a 2009 UK report, it was estimated that 10,000 people had presented as transgender, with 6000 undergoing transition in the UK.

Trans people have legal rights under the Equality Act 2010, the Human Rights Act 1998 and the Gender Recognition Act 2004. This includes employment rights, protection against discrimination, legal status and of course the rights to health care.

Trans people can have a lesbian, bisexual, gay, pansexual or straight identity. Their chosen gender identity does not necessarily conform to being attracted to the opposite sex. Some people choose to cross dress (transvestite) and do not feel they need to belong to the opposite biological gender to themselves. Other people may choose to cross dress without a sexual or fetish component and therefore may identify as a trans person.

What kind of treatments are available?

Trans people are legally entitled to treatment on the NHS, but they may also choose to go privately. There are specialist clinics across the UK known as Gender Identity Clinics (GIC) that will manage a trans persons treatment. Mostly these clinics will have a multidisciplinary team of psychologists, psychiatrists, endocrinologists, specialist surgeons and other specialists necessary for treatment. GICs usually require a referral from the GP, and won’t take a self-referral. If the GP is unwilling, then a psychiatrist, psychologist, or sexual health centre via a GP can also write a referral. 

Usually interventions for physical reassignment known as gender reassignment are carried out about a year after the trans person has made a full transition. This involves legally changing name and other identification documents and ideally working or volunteering in their chosen gender role. The procedures at the GIC offer a combination of hormone medication and surgery to align the body with the chosen gender identity. Hormone therapy is life-long. Many trans people don’t have surgery as they feel sufficiently comfortable with hormone treatment alone. Evidence shows that treatment is generally very successful in giving trans people a sense of harmony and authenticity that they seek.

What about children with gender variance?

Gender variance in children can show itself in the way they behave, in their dress or play. For example, boys may say they want to be girls, or girls may say they want to be boys and behave and wish to dress in line with their gender variance feelings. Gender variance in children is uncommon, but not rare. It appears that very few children who present with gender variance go onto experience gender dysphoria. Usually it requires no medical intervention until the approach of puberty. If gender variance persists, medical help is available with a referral from a GP or CAMHS to a specialist service known as Gender Identity Development Units (GIDU). The GIDU will offer psychological support and at a later stage may offer medical interventions during the onset of puberty. Once the young person reaches 18, they are eligible to move into adult services for gender reassignment where surgical interventions become available. 

It is natural for parents to feel scared, worried and upset if their child presents with gender variance. It is important to understand that gender identity is naturally variable, it is nobodies fault, and nobody is to blame. It is also comforting to know that the earlier these difficulties are addressed, the more comfortable and happy your child may become as an adult.

How can counselling help trans people and those with gender dysphoria?

Counselling can be of real benefit to a trans person. They may wish to use the service to help them through their psychological process of transition or if they are experiencing problems with their trans identity. Counselling can provide emotional support as well as help facilitate the process of exploration of identity. Mostly it can support the validation, acceptance and recognition of a trans person's identity.

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Last updated 22 October 2015