121. Gender Development

Question 1

Define Gender dysmorphia

Define Gender Role

Answer 1

Dysmorphia: discomfort when gender identity does not match natal sex

Gender role: societal/cultural expectation for how one should express themselves

Question 2

How has the DSM changed in regard to gender development?

Answer 2

Now knows identity is not pathological, but recognizes that inner conflict about identity could cause distress (gender dysmorphhia)

Depathologizing gender identity

Question 3

When do the following develop in a child:
Gender identity
Sexual orientation
Sexual Behavior

Answer 3

Gender identity: age 3-5
Sexual oreintation: during puberty (10-14)
Sexual behavior: occurs in utero

Question 4

Epidemiology and trends of gender dysmorphia

• course
• what is social transition
• comorbidities

Answer 4

0.6-2.7% of all people have gender dysmorphia
trend: younger age has higher prevalence due to shifting culture/social activism
Course: intensifies during puberty changes (incongruence grows)
Social transition: process of how one lives as affirmed gender/changing gender role (causes persistence of dysmorphia thru adulthood without tx)
CoM: Anxiety, Abuse/Harassment, Depression, ADHD, ASD, Self-Injury/SI, Low self-esteem, unemployment/homelessness, social isolation

Question 5

What are tx for gender dysmorphia?

Answer 5

1. Puberty Blockers (GnRH agonists): pause development of secondary sex characteristics - buy time for youth to explore gender (reversible)
2. Gender affirming hormones (testosterone, estradiol + androgen-blocker): partially irreversible, reduces undesired hormones and induce desired secondary sex characteristics (pt needs mental capacity to consent - usually age 16)
3. Gender affirming surgery
   transmasculine: chest reconstruction, oopher/hyster/vaginectomy, genital reconstruciton
   transfeminine: breast augmentation, facial feminization, orchie/penectomy, genital reconstruction