mental health disorders
Gender Incongruence and Gender Dysphoria
Treatment of Gender Dysphoria
For many adults or adolescents, gender-affirming hormone therapy and sometimes gender-confirming surgeries (breast, genital, or facial surgery) Sometimes other treatments (for example, voice therapy or electrolysis) Psychotherapy with adolescents and adults is often helpful to address any coexisting mental health concerns or transition-related issues, but is not mandatory The goal of treatment for transgender people with gender dysphoria, according to the World Professional Association for Transgender Health, is to achieve "lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfilment." Some transgender adults are satisfied with changing their gender expression by working, living, and dressing in society in a way consistent with their gender identity. This is called social transition. They may change their name and obtain identification (such as a driver's license) that helps them work and live in society as the opposite gender. Most transgender adults who seek medical treatment want hormone therapy and/or surgery that will make their physical appearance resemble that of their identified gender. They do not want psychological treatment. Using psychotherapy to try to "convert" a person's established transgender identity (so-called reparative therapy or conversion therapy) is ineffective and can be harmful. When medical or surgical treatment is given, it is aimed at relieving a person's distress and helping them adapt to rather than trying to dissuade them from their identity. Medical or surgical treatments include a combination of the following: Gender-affirming hormone therapy Electrolysis Voice therapy Gender-affirming surgery Before starting hormone therapy or having surgery, people should discuss options for fertility preservation with a doctor, if they want to have children in the future. Also, hormone therapy can decrease fertility but is not effective as contraception, and people on hormone therapy should use birth control as needed. Psychotherapy is no longer required before people can be given hormone therapy and/or have gender-affirming surgery. However, mental health care professionals can help by doing the following: Determining whether any mental health disorders (such as Depression or a Helping people deal with negative reactions from other people (such as disapproval or discrimination) Helping people find a way to express their gender identity in a way that is comfortable If applicable, supporting them when they come out (inform other people about their transgender identity) and transition to another gender People who were born with genitals that are not clearly male or female ( Symptoms ) or who have a genetic abnormality, such as Some people with gender dysphoria, in addition to adopting the behavior, dress, and mannerisms of the opposite sex, receive hormone treatments to change their secondary sex characteristics: For peopleassigned male at birth,treatment with the female hormone estrogen causes breast growth and other body changes, such as decreased facial and body hair and redistribution of fat to the hips. For peopleassigned female at birth,treatment with the male hormonetestosteronecauses such changes as growth of facial hair, deepening of the voice, and changes in distribution of body fat and muscle. In addition to physical effects, hormone therapy has significant beneficial psychological effects, including allowing the person to feel more at ease, less anxious, and better able to interact as their preferred gender. Gender-affirming surgery is irreversible, and doctors recommend it only for people who have received medical care by an appropriately trained and experienced health care professional and who have been treated according to current standards of care. Before having surgery, doctors typically advise that transgender people Use gender-affirming hormone therapy Live full-time in their preferred gender role for at least 1 year For transgender peopleassigned male at birth,surgery involves removal of part of the penis and the testes and creation of an artificial vagina. The remaining part of the penis is usually sexually sensitive and makes orgasm possible and is left to function like a clitoris. Male-to-female transformation may also include nongenital cosmetic surgeries to create or enhance feminine attributes (for example, breast augmentation, rhinoplasty, brow lift, tracheal shave [paring down the Adam's apple], and/or jaw reconfiguration). Some people undergo vocal cord surgeries to change the quality of the voice. For transgender peopleassigned female at birth,surgery involves removal of the breasts (mastectomy) and sometimes the internal reproductive organs (uterus and ovaries), closure of the vagina, and creation of an artificial penis and usually a scrotum. Results of female-to-male surgery are often less satisfactory than male-to-female surgery in terms of appearance and function, possibly explaining why fewer transgender men request gender-affirming surgery. Also, complications, mainly urinary problems, are common. But techniques for female-to-male surgery continue to improve, and more people are requesting surgery. Many people who have gender-affirming surgery are able to have satisfactory sexual relations. The ability to achieve orgasm is often retained after surgery, and some people report feeling comfortable sexually for the first time. However, few people endure gender-affirming surgery for the sole purpose of being able to function sexually as the opposite sex. Confirmation of their inner sense of gender identity is usually the motivation. 