Gender Dysphoria (GD)

As described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an authoritative volume that defines and classifies mental disorders, Gender Dysphoria (GD) is described as the “incongruence between assigned gender and experienced gender.” Those diagnosed with GD must also have recently experienced the “desire to be treated as one’s experienced gender within society, or a conviction that one’s feelings or reactions are typical of people with the same gender identity.” (Davy and Toze, 2018).

These feelings are common among transgender individuals; and many insurances require a diagnosis before treatment becomes available. Aetna, being a large insurance company has policies around gender affirming surgeries. Most surgeries need at least one singed letter of referral and well-documented diagnosis of gender dysphoria before Aetna will deem the surgeries medically necessary. Although a GD diagnosis may be necessary for treatment, GD is NOT considered a mental disorder. Recent individuals diagnosed with GD may look for a variety of treatment options they need to decide what treatment, if any, would be most appropriate. No matter if an individual seeks further medical attention or not, it does not mitigate the GD diagnosis. As for treatment, John Hopkins has listed surgical and non-surgical options.


non-surgical options :

  1. Laser hair removal, “where a dermatologist moves a low-energy beam over your skin. The pigments in your hair follicles absorb the energy, which results in long-term or permanent hair reduction.” (John Hopkins, 2020)
  2. Hormone Replacement Therapy (HRT) can be used in Male to Female or Female to male transitions depending on the hormone used.
    • The masculinizing hormone testosterone minimizes feminine characteristics and promotes masculinity. Some may see an increase in muscle mass, a redistribution of fat, an increased libido, clitoral growth, vaginal dryness, and cessation of menses.
    • The Feminizing hormone estrogen minimizes masculinity and promotes femininity. Those starting estrogen may notice breast development, redistribution of fat, reduced muscle mass, reduced body hair, and change in sweat and odor. Other sexual effects such as reduced erectile function, change in libido, low sperm count, and a change in testicular size may occur with estrogen.
  3. Speech Therapy is created with the individual in mind, though the care plan may include: Habitual speaking pitch, resonance, inflections, speech rate, volume, articulation, pragmatics, and nonverbal communication. There are also vocal cord reconstructive surgery options available.
  4. Specific mental health needs targeted toward transitioning individuals are also available. A mental health issue may go beyond GD, though GD competent mental health professionals exist.

surgical options:

  1. Phalloplasty (Penile construction): This is where surgeons remove the vagina and use the vaginal tissue, or tissue from another body part, to reconstruct the urethra and penis.
  2. Vaginoplasty (Vaginal construction): This multistage surgical process includes removing the penis and testicles, using the tissue from the penis to construct the vagina, clitoris, and labia.
  3. Top surgery can either be a mastectomy or augmentation. A bilateral mastectomy is the removal of breast tissue and the reshaping to a male chest, with the refinement of nipples and areola. Breast augmentation is the enlargement of breasts through the use of implants.
  4. Facial feminization or masculinization surgery is used when hormone replacement therapy doesn’t feminize or masculinize the facial structure enough to relieve symptoms of gender dysphoria.
    • Feminizing facial surgery includes a reshaping of the nose; lifting the brow; chin, cheek, and jaw reshaping, Adam’s apple reduction, lip augmentation, hairline restoration, and earlobe reduction.
    • Masculinizing facial surgery includes forehead lengthening and augmentation; cheek, nose, and chin reshaping, jaw augmentation, and construction of an Adam’s apple.

After any surgery, it is crucial to talk to the surgeon. They will give recovery time and any next steps that may be needed. All bodies react differently to surgery, and recovery times may vary.


Reproductive health

Those looking to transition may still want the chance to procreate. Options to save eggs and sperm are available at most sperm and egg banks. Before these decisions, check with healthcare providers. It is important to find a provider that understands your specific needs and offers services with those needs in mind.


Sources

Neira, P. M., J.D., M.S.N., & M.D., M.S.E., D. O. (2020). Gender affirmation: Do i need surgery? Retrieved February 12, 2021, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/gender-affirmation-do-i-need-surgery

J. (2021). Gender affirmation Nonsurgical services. Retrieved February 12, 2021, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/gender-affirmation-nonsurgical-services

J. (2020). Gender affirmation surgeries. Retrieved February 12, 2021, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/gender-affirmation-surgeries

A778388, A. (2021, January 12). Gender affirming surgery. Retrieved February 12, 2021, from http://www.aetna.com/cpb/medical/data/600_699/0615.html

A. (2013). Diagnostic and statistical manual of mental disorders (dsm–5). Retrieved February 12, 2021, from https://www.psychiatry.org/psychiatrists/practice/dsm

Davy, Z., & Toze, M. (2018). What is gender dysphoria? A critical systematic narrative review. Transgender Health, 3(1), 159-169. doi:10.1089/trgh.2018.0014

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