The Best Ways to Treat Gender Dysphoria

In all cultures, the sexual organs are a basic identifier, defining us from the first time we’re viewed on a sonogram screen or the birthing room. ”It’s a boy!” or “It’s a girl!” are typically the trumpet cry heralding us into the world and the first words uttered about our existence. Except in instances when genitalia is ambiguous at birth, a penis or a vagina is visible, irrefutable proof of whom and what we are to those around us. But sometimes, what is visible on the outside does not match what we feel ourselves to be on the inside. If our biological sex and feelings about our gender identity do not match, gender dysphoria may result.

The story of gender dysphoria is as old as the story of our species. Once considered a psychiatric disorder, we now understand that gender dysphoria, sometimes called transgender, is a biological condition, related to the development of sexual identity and most likely established before birth. According to the National Institute of Health, gender dysphoria’s exact cause is not completely understood, but may involve a combination of hormonal, genetic and environmental factors. It is not homosexuality and does not determine the sex we are attracted to.

Symptoms of Gender Dysphoria

Individuals with gender dysphoria feel extreme discomfort and sometimes disgust with their sexual organs. They may look like a boy or girl on the outside, but feel like the opposite sex on the inside. This can result in behaviors concerning to parents and include:

  •         Belief that the sexual organs will change, for example, a girl thinks she will eventually grow a penis
  •         Refusal to dress according to their sex and asking or opting to wear clothing of the opposite sex instead
  •         Girls may want to urinate standing up and boys sitting down  
  •         A desire, expressed on a consistent and long-term basis, to be the opposite sex

These types of symptoms can also be associated with plain old growing pains and dissipate over time but for those with gender dysphoria, a deep emotional undercurrent of dissatisfaction with one’s self, coupled with depression, anxiety and social isolation may manifest, which will require treatment.

Dealing with Depression

As understanding and acceptance of gender dysphoria has grown, so has the range of treatments, and the ability of individuals to pursue treatment at an earlier age. Usually, the feeling of being the wrong sex, or stuck in the wrong body, needs to be felt for several years before a definitive diagnosis is made. However, the feelings of depression, anxiety and isolation which often accompany this diagnosis should not go unchecked or untreated even before a definitive determination has been made.

Family therapy for children and talk therapy for adults can be a very important and beneficial tool, not geared towards “curing” the individual but rather, supporting them to determine the best lifestyle for them and potential courses of treatment.

Many individuals will benefit from pharmaceutical medications prescribed for depression or anxiety to help with their feelings. People grappling with gender dysphoria who feel unsupported or who live with rejection may be more prone to suicidal thoughts and actions than the general population. For this reason as well as for quality of life issues, dealing with the emotional component of gender dysphoria is paramount.  

Treatments for Gender Dysphoria

Except for psychological support, treatment for gender dysphoria typically begins sometime after puberty although in some cases, parents and their children, along with professionals, will determine that an early beginning to treatment is appropriate. Treatments may also begin, or change, later in life. Bruce Jenner is a good example.

Treatment is geared towards life fulfillment, happiness and self-acceptance. The type of treatment pursued is completely up to the individual. Sometimes, working with a therapist or counsellor and choosing lifestyle options such as cross-dressing will be enough. Other times, more aggressive forms of treatment will be desired. The goal is to increase the enjoyment of life the individual has and to diminish anxiety, upset and depression. Additional treatments include:

Hormonal Therapy

For adolescents, hormonal therapy may be pursued in an effort to tamp down the body’s progression towards puberty so that the individual does not have to deal with the onslaught of hormonal changes that bring on, for example, menstruation in a female body or the increase of testosterone production in a male body which determine penis growth. This is accomplished with gonadotropin-releasing hormones (GnRH). GnRH buys time for the individual by stopping the onslaught of the body’s naturally-occurring hormones until further treatment, if any, is pursued.

Later in life, if the individual chooses, hormones can be used to help achieve the look and feel of the opposite sex and diminish the characteristics of their current biological sex. For biological men who identify as women, called transwomen, estrogen will be prescribed and for biological women who identify as men, called transmen, testosterone. These hormones can increase feelings of self-comfort and alter the appearance.  

Transwomen may see a shrinking of penis and testicle size, a diminishment of muscle mass and hair growth and a change in breast and hip shape.

Transmen may experience cessation of menses and enlargement of the clitoris, an increase in muscle mass, increased sex drive, a deepening voice and an increase in body and facial hair.

Hormonal treatment needs to be ongoing in order for full benefits to remain, even if the individual pursues gender reassignment surgery. As with any long-term medication use, there may be side effects and risks you should discuss with a doctor.

Hormonal treatments may be covered by your health insurance plan. Discuss your coverage options with your insurance provider so you can plan for the deductibles you will be responsible for each month. These can range from $25-$200 or more.

Before starting hormonal treatment of any kind, including those associated with gender reassignment surgery, discuss the impact your treatment will have on your fertility and your fertility preservation options if you wish to parent a child who is biologically-linked to you sometime in the future.

Gender Reassignment Surgery

Many transmen and transwomen opt for gender reassignment surgery. Typically, it is required you live as your preferred sex full time for at least a year and remain within a therapeutic situation during that time. This provides a transition period most people benefit from emotionally and also allows the individuals’ friends and family time to adjust. Gender reassignment surgery will feel drastic to some and a desperately-needed solution to others.

For transmen, the surgery will include surgical removal of both breasts and the uterus, fallopian tubes and ovaries. Construction of a functional penis and scrotum will be done.

For transwomen, breast implants, facial feminization, removal of the penis and testis and the construction of a vulva, vagina and clitoris capable of sensation will be done.      

Without insurance, gender reassignment surgery can cost between $25,000-$30,000 or more, not including medication and psychiatric support. The Human Rights Campaign provides a list of insurance carriers that cover transgender-related health care, here.

Hormonal therapy and regular physician examinations will be required for life. Mental health support can also be beneficial, based on the individual’s needs as can a strong support system or peer-to-peer counseling.