gender identity disorder

• Gender Dysphoria (GD)


  A condition where an individual's gender identity does not match their biological sex
• Gender Dysphoria affects males more than females
• It is estimated that up to 1 in 5000 people may have the condition
• Indications of gender dysphoria in children

  • Unhappy wearing clothes of their gender assigned at birth
  • Unhappy playing gender-stereotypical games
  • During adolescence, they may find the development of their body distressing as it is a physical sign of their 'wrong sex'
• Treatment for Gender Dysphoria

  • Psychological interventions
  • Medical interventions: masculinising or feminising hormones can be taken to alter physical features, with the ultimate remedy being gender reassignment surgery
• Since 2000, 865 gender reassignment surgeries have been performed by the NHS
• Gender Identity Disorder (GID)


  The clinical label used in the DSM-IV for this condition, with gender dysphoria referring specifically to the personal experience of this discomfort
• Gender Dysphoria


  The clinical label used in the more recent DSM-5 classification system, in order to remove the damaging label of people with the condition as 'disordered'
• The APA have said that no gender identity can be 'disordered' so it would be wrong to label them as such
• Symptoms that must be present for a Gender Dysphoria diagnosis (DSM-V)


  • A marked incongruence between one's experienced/expressed gender and primary and/or secondary sex characteristics
  • A strong desire to be rid of one's primary and/or secondary sex characteristics
  • A strong desire for the primary and/or secondary sex characteristics of the other gender
  • A strong desire to be of the other gender
  • A strong desire to be treated as the other gender
  • A strong conviction that one has the typical feelings and reactions of the other gender
• Genetic explanation


  The condition is seen as an inherited abnormality - Attention has centred on gene variants of the androgen receptor, which influences the action of testosterone and is involved in the masculinisation of the brain
• Hare et al. (2009) – looked at the DNA of 112 MtF transgender participants and found they were more likely to have a longer version of the androgen receptor gene compared to non-transgender individuals
• Effect of the androgen receptor gene abnormality

  Reduced action of testosterone, and this may under-masculinise the brain in the womb
• The genetic explanation lacks explanatory power as it cannot explain why some people who are genetically female identify as male (FtM)
• Biochemical explanation


  Sees a role for hormonal imbalances during foetal growth in the womb and in later child development. Significant amounts of male hormones are secreted from the testes during the third month of pregnancy and again between 2-12 weeks after birth, which is crucial for masculinisation of the infant. Hormone levels in the womb may be affected by genetic conditions, such as androgen insensitivity syndrome or maternal stress
• Effect of lack of testosterone in a genetically male individual


  Less masculinised brain (i.e. smaller SDN) and a female identity
• Gladue (1985) – reported that there were few, if any, hormonal differences between gender-dysphoric men, heterosexual men and homosexual men, as evidence against the influence of hormones on gender dysphoria. A social explanation may therefore be more fitting
• There is research to suggest that most gender dysphoria occurs in childhood and for the majority of such children it does not persist after puberty
• However, those for whom it does persist tend to have stronger gender dysphoric symptoms in childhood
• Zucker et al. (2008) – performed a longitudinal study on 25 gender-dysphoric females between 2-3 years of age. Only 12% (3) were still gender dysphoric at age 18
• Furthermore, a study on equivalent males found that only 20% were still gender dysphoric as adults, thus supporting the idea that the majority of people exhibiting gender dysphoria do so only in the short term
• Brain-sex theory


  The theory is based on the fact that male and female brains are different and transgender brains do not match their genetic sex
• The BSTc (bed nucleus of the stria terminalis) in the thalamus (located in the brain) has been implicated
• Generally speaking, the BSTc is twice as large in a heterosexual male brain compared to a heterosexual female brain, containing twice the number of neurons
• Brain-sex theory


  It may be the case that an individual with gender dysphoria has the BSTc that corresponds to their gender rather than their sex
• Zhou et al. (1995) and Kruijver et al. (2000) – both found that the number of neurons in the BSTc/volume of the BSTc of MtF transgender participants was similar to that found in a female brain, and the BSTc of FtM transgender individuals was more similar to that of a male brain
• Rametti et al. (2011) – studied the brains of FtM transgender participants before they started transgender hormone therapy. They found that the white matter was more similar to that found in males i.e. those who shared their gender identity rather than their biological sex
• Hulshoff Pol et al. (2006) found that transgender hormone therapy does influence the size of the BSTc
• This suggests that hormones can have an effect on the BSTc – even after it is supposedly fully developed at five years old
• This suggests that BSTc volumes/ neuron numbers found in post-mortem research were affected by hormonal therapy and not prenatal development as suggested
• Chung et al. (2002) challenged the time at which the BSTc appears, claiming that the differences in volume and number of neurons does not develop until adulthood
• Chung argues that pre-natal hormones might remain dormant until adulthood and then trigger the change in the BSTc
• This therefore cannot explain why there are cases of children who are aware of their gender dysphoria at an early age e.g. Zach Avery
• Learning Theory


  Operant Conditioning could explain gender dysphoria - individuals may be reinforced (rewarded) for exhibiting cross-gender behaviour - parents
• Social Learning Theory


  Suggests that gender dysphoria may be learned by observation and imitation of individuals modelling cross-gender behaviour
• Rekers (1995): reported that in 70 gender-dysphoric boys, there was more evidence of social than biological factors. In particular, there was a common factor of a lack of stereotypically male models, suggesting that social learning factors play a role in the condition
• Bennet (2006) Points out that while SLT explains the development of cross-gender behaviours, it cannot explain the strength of beliefs that individuals possess concerning being the wrong gender, or the resistance of such beliefs to therapy
• This indicates that the biological explanation is more likely because the social explanations are limited to explaining only superficial behaviours
• childhood truma/ upbringing - researchers suggest that gender dysphoria is linked to mental illness, which may be linked to someones duficulty growing up.
• Coates et al. (1991) - conducted a case study of a boy with gender dysphoria and concluded that this occurred as a result of his mother's depression following an abortion. They argued that this caused the boy significant trauma when he was aged 3 and that this led to a cross-gender fantasy as a way of resolving the anxiety he experienced