The Case of Transgenderism

Since the very introduction of Gender Identity Disorder (GID) to the DSM (Diagnostic and Statistical Manual of Mental Disorders), many controversies have been made apparent. LGBTQA activists have years since said it was a poorly veiled, discriminatory attempt to restore the category of homosexuality, or promote “preventative treatment.” Because of this controversy, GID is now listed as gender dysphoria, and sexual development disorders have been introduced. Is this condition unjustly listed as a dysfunctional disorder, or is there legitimate science to justify the validation of this mindset? In order to answer this question, the defined “psychological disorder” must be properly examined in how it is portrayed, developed, and treated.

Definition and Development

According to the most recent edition of the DSM, gender dysphoria is “the distress that may accompany the mismatch between one’s assigned gender and how a person perceives their true gender” (Black 2014). Individuals suffering from gender dysphoria who most typically receive gender reassignment surgeries are transgendered. These people may be transitioning from male to female (a mtf), or from female to male (a ftm). In the Archives of Psychiatry & Psychotherapy, authors Puszyk and Czajeczny created the article “Gender dysphoria and gender variance in children - diagnostic and therapeutic controversies.” They examine the variance of gender dysphoria, and discuss the importance of transgender individuals’ developmental paths. This is to say, the way that gender dysphoria manifests itself in childhood and in adolescence is different, likely because the “plasticity of gender identity differentiation is greater in early childhood”(Puszyk 2017). According to Thomas E. Bevan, author of The psychobiology of transsexualism and transgenderism: A new view based on scientific evidence, the signs of gender dysphoria in children include: Insisting they are the other gender despite their physical traits; Preferring friends of the sex with which they identify; Rejecting gender typical clothes, toys, games, etc; Refusing to urinate in the way -- standing or sitting -- that other boys or girls typically do; Saying they want to get rid of their genitals, or have the genitals of their true sex; Believing they’ll grow up to be their desired gender despite physical traits; Having extreme distress about the body changes that happen during puberty (Bevan 2014). Adults with gender dysphoria are both more likely to be certain of their gender, and more likely to show extreme disgust with their genitals/bodies.

TRANSITION - No matter the age, the condition is associated with clinically significant distress or impairment in any area of functioning. Because this condition legitimately causes dysfunction, investigation of these individuals’ developmental paths is crucial for accurate medical and therapeutic help.

Biomedical Reasons of Transgenderism

For far too long, the cause of gender dysphoria was thought to be that of environmental influence, or the result of trauma. However, this stigma has since then been scientifically disproven. More often than not, gender dysphoria is the result of genetic conditions that require proper medical treatment. Two of the primary genetic causes (of both gender dysphoria and intersex conditions) that have been identified include congenital adrenal hyperplasia (CAH) and androgen insensitivity syndrome (AIS). Both of these conditions cause a person to be destined with gender dysphoria from birth, often causing mutations before a child is even born.

CAH

In an article titled “Female pseudohermaphroditism: Congenital adrenal hyperplasia presenting with diffuse hyperpigmentation” by Wajieha Saeed, CAH is discussed. It is said that CAH is a recessive genetic disorder that (in the case of gender dysphoria) affects the adrenal glands and prevents them from producing androgen, the male sex hormone (Saeed 2018). Females with this disease, surprisingly, are much more strongly affected by having this condition. In the instance of salt-losing CAH, a variation in which the body produces more androgens, symptoms such as abnormal genital development occurs in infant girls. Treatment of this disorder is only necessary in extreme cases, which only includes hormone therapy to both control androgen production, and hormones to replace the ones their adrenal glands cannot produce.

AIS

AIS is discussed thoroughly by The Journal of Genetics in the provided article, titled “Three novel and two known androgen receptor gene mutations associated with androgen insensitivity syndrome in sex-reversed XY female patients.” It is said that AIS is caused by a genetic mutation to a person’s X chromosome (Saranya 2016). This specific mutation (in order to lead to gender dysphoria) causes the afflicted persons to be resistant to male hormones (androgens). The result of a fetus with AIS developing in the womb is a person who appears almost completely genetically female, but has the organs of a male. In males, surgery is often needed later in life to prevent testicular cancer. Females often receive estrogen replacement after puberty.

Dimorphism

An article provided by Harvard University’s Katherine J. Wu, titled “Between the (Gender) Lines: the Science of Transgender Identity,” discussed another recent and prominent scientific discovery supporting the science behind transgenderism and gender dysphoria. In order to understand the following concept, the terms “sexual dimorphism” and “cisgender” must be explained. Sexual dimorphism describes the traits of the body’s anatomical structures that differ between men and women, and a cisgender person is someone whose gender is in alignment with their sex, eg cisgender women, cisgender men. When viewing images of the dimorphic areas of the brain - specifically the bed nucleus of the stria terminalus (BSTc) and sexually dimorphic nucleus - in mtf transgender women, it has been proven that these dimorphic qualities are more similar to a cisgender woman than that of a cisgender man. This suggests “that the general brain structure of these women is in keeping with their gender identity”(Wu). The cause of this divergence in a transgender person from their anatomical sex is generally unknown, but it can be linked in several case studies to the effect of hormones on a fetus. In the end, this evidence further proves the legitimacy of both gender dysphoria and transgenderism.

Persons affected by gender dysphoria receive very specific treatments. Instead of receiving counseling to “correct” a person’s gender identity to conform to their biological sex, a properly diagnosed person may choose to transition. This transition may include at least one cross-sex medical procedure, chronic hormone treatment, intermittent psychotherapy or counseling (to aid with transition), and further gender-conforming surgery (Black 286). The gender reassignment surgeries that are used include: penectomy, vaginoplasty, mastectomy, phalloplasty. Penectomies and vaginoplasties are known as “transfeminine bottom surgery,” and are variants of a surgery a male to female (mtf) transgender person would have to correct her genitals; the male genitalia is reconstructed into that of a female. Mastectomies are known as “transmasculine top surgery,” and is the surgery a female to male (ftm) transgender person would have to remove his breast tissue and create a masculine appearance to the chest. Phalloplasties are known as “transmasculine bottom surgery,” and is the surgery a female to male (ftm) person would have to correct his genitals; the female genitalia is reconstructed into that of a male. All that being said, when it comes to the case of transgender children, many parents find the extent of this surgical treatment controversial. Parents may worry their child is “going through a phase” or “going to change their mind,” so such permanent treatment is generally not used. When a child receives a diagnosis of genuine gender dysphoria, their treatment will start with hormone blockers. An article on the LiveScience site by Christopher Wanjek states: “Drugs that block hormones, called GnRH agonists, are endorsed as standard care for transgender youth by the Endocrine Society, the nation's largest professional medical organization devoted to endocrinology and metabolism”(Wanjek). In a ftm transgender child, the female hormone estrogen is blocked, and the onset of puberty and feminine development is paused. In a mtf transgender child, the male hormone testosterone is blocked, pausing the onset of puberty and masculine development. In either case, a child receiving hormone blockers waits several years to start hormone therapy: a hormonal supplement of either testosterone or estrogen, respectively. This is so a transgender child can begin pubescent development at the same time as their peers; however, hormone therapy is also given to transitioning adults in later stages without having hormone blockers. Later in life, these adolescents may seek gender-conforming surgery.

In a society that ostracizes even the idea of transgender validation, the stress of this disorder can be overwhelming. The stress of gender dysphoria and treatment has been said to result in further psychological disorders and mental diagnosis in approximately 71% of people with the condition (WebMD 2). This means that proper diagnosis is highly important. In order to prevent the development of anxiety, depression, other mood disorders, or suicidal tendencies in these peoples, treatment is required.

Gender in itself is a complicated concept… It lies on a spectrum with an X, Y, and Z axis. This is why the terms gender dysphoria and gender identity disorder (DID) are seen as pathologizing, and “the term used... by advocates of excluding gender dysphoria from diagnostic classification is a somewhat broader gender variance (GV)”(Puszyk 35). Anyone affected by this requires specialized treatment, and may be different for every case. The idea of hormone or surgical treatment is to make the individual comfortable with themselves, to alleviate the stress that comes with dysphoria. While one ftm may seek a complete transition, both top and bottom transmasculine surgery with testosterone supplements, another ftm may be comfortable after only having transmasculine top surgery. Gender variant individuals go through diligent therapy and psychologist visits to determine what treatment best suits their needs, which is why any and all treatment courses are valid.

The truth of the matter is this: the misdiagnosis of gender dysphoria simply does not occur. The diagnostic criteria set in place is clear-cut, and a definitive way of distinguishing transgendered individuals and determining the treatment they need. In order for stigmatization of transgenderism to stop, unaffected people need to be educated in the legitimacy of this condition. The true prevalence of this may be unknown, but these individuals still exist and the decisions that they make should be respected and supported.

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