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Gender dysphoria

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Gender dysphoria
Other namesGender identity disorder
SpecialtyPsychiatry, psychology Edit this on Wikidata
SymptomsDistress related to one's assigned gender, sex or sex characteristics[1][2][3]
ComplicationsEating disorders, suicide, depression, anxiety, social isolation[4]
Differential diagnosisVariance in gender identity or expression that is not distressing[1][3]
TreatmentTransitioning, psychotherapy[2][3]
MedicationHormones (e.g., androgens, antiandrogens, estrogens)
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Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth.[5][6] The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder.[7] The International Classification of Diseases uses the term gender incongruence instead of gender dysphoria, defined as a marked and persistent mismatch between gender identity and assigned gender, regardless of distress or impairment.

People with gender dysphoria commonly identify as transgender.[8] Gender nonconformity is not the same thing as gender dysphoria[9] and does not always lead to dysphoria or distress.[10]

The causes of gender incongruence are unknown but a gender identity likely reflects genetic, biological, environmental, and cultural factors.[11][12][13] Diagnosis can be given at any age, although gender dysphoria in children and adolescents may manifest differently than in adults.[14] Complications may include anxiety, depression, and eating disorders.[8] Treatment for gender dysphoria includes social transitioning and often includes hormone replacement therapy (HRT) or gender-affirming surgeries, and psychotherapy.[2][3]

Some researchers and transgender people argue for the declassification of the condition because they say the diagnosis pathologizes gender variance and reinforces the binary model of gender.[15] However, this declassification could carry implications for healthcare accessibility, as HRT and gender-affirming surgery could be deemed cosmetic by insurance providers, as opposed to medically necessary treatment, thereby affecting coverage.[16]

Signs and symptoms

Distress arising from an incongruence between a person's felt gender and assigned sex or gender (usually at birth) is the cardinal symptom of gender dysphoria.[17][18]

No particular sexual orientation indicates gender dysphoria.[19][20] A 2021 review in Dialogues in Clinical Neuroscience found no relation to sexual orientation, but acknowledged that historically the two were often erroneously conflated.[21] The British National Health Service also stated "gender dysphoria is not related to sexual orientation".[22]

Gender dysphoria in those assigned male at birth (AMAB) tends to follow one of two broad trajectories: early-onset or late-onset. Early-onset gender dysphoria is behaviorally visible in childhood but may temporarily subside, leading the person to identify as gay or homosexual for a period of time, followed by recurrence of gender dysphoria. A 2016 review in the Archives of Sexual Behavior states this group is usually sexually attracted to members of their natal sex in adulthood, commonly identifying as heterosexual. Late-onset gender dysphoria does not include visible signs in early childhood, but some report having had wishes to be the opposite sex in childhood that they did not report to others.[23] Likewise, according to the review, transgender people assigned male at birth who experience late-onset gender dysphoria will usually be attracted to women and may identify as lesbians or bisexual, while those with early-onset will usually be attracted to men.[23] The review states a similar pattern occurs in those assigned female at birth (AFAB), with those experiencing early-onset GD being most likely to be attracted to women and those with late-onset being most likely to be attracted to men and identify as gay.[23][24]

Symptoms of GD in children include preferences for opposite sex-typical toys, games, activities, or playmates as well as a great dislike of their own genitalia.[25] Some children may also experience social isolation from their peers, anxiety, loneliness, and depression.[4] In adolescents and adults, symptoms include the desire to be and to be treated as a different gender.[25] Adults with GD are at increased risk for stress, isolation, anxiety, depression, poor self-esteem, and suicide.[4] Transgender people are also at heightened risk for eating disorders[26] and substance abuse.[27] According to the American Psychiatric Association,[28] those who experience gender dysphoria later in life "often report having secretly hidden their gender dysphoric feelings from others when they were younger".[29]

Causes

See also: Causes of gender incongruence

The specific causes of gender dysphoria remain unknown, and treatments targeting the etiology or pathogenesis of gender dysphoria do not exist.[30] Evidence from studies of twins suggests that genetic factors play a role in the development of gender dysphoria.[11][12] Gender identity is thought to likely reflect a complex interplay of biological, environmental, and cultural factors.[13] Neurobiological basis of GD has been proven by the "distinct gray matter volume and brain activation and connectivity differences" in people with GD when compared to controls; and this "leads to the concept of brain gender".[31]

Diagnosis

DSM-5

The American Psychiatric Association permits a diagnosis of gender dysphoria in adolescents or adults if two or more of the following criteria are experienced for at least six months' duration:[25]

  • A significant incongruence between one's experienced or expressed gender and one's sexual characteristics
  • A strong desire to be rid of one's sexual characteristics due to incongruence with one's experienced or expressed gender
  • A strong desire for the sexual characteristics of a gender other than one's assigned gender
  • A strong desire to be of a gender other than one's assigned gender
  • A strong desire to be treated as a gender other than one's assigned gender
  • A strong conviction that one has the typical reactions and feelings of a gender other than one's assigned gender

In addition, the condition must be associated with clinically significant distress or impairment.[25]

The DSM-5 moved this diagnosis out of the sexual disorders category and into a category of its own.[25] The diagnosis was renamed from gender identity disorder to gender dysphoria, after criticisms that the former term was stigmatizing.[32] Subtyping by sexual orientation was deleted. The diagnosis for children was separated from that for adults, as "gender dysphoria in children". The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing, or ability to express it if they have insight.[33] Other specified gender dysphoria or unspecified gender dysphoria can be diagnosed if a person does not meet the criteria for gender dysphoria but still has clinically significant distress or impairment.[25] Intersex people are no longer excluded from the diagnosis of GD.[34]

ICD-11

The International Classification of Diseases (ICD-11) lists three conditions related to gender identity:[35]

  • Gender incongruence of adolescence or adulthood (HA60)
  • Gender incongruence of childhood (HA61)
  • Gender incongruence, unspecified (HA6Z)

ICD-11 defines gender incongruence as "a marked and persistent incongruence between an individual's experienced gender and the assigned sex", with no requirement for significant distress or impairment.[35]

Treatment

Treatment for a person diagnosed with GD may include psychological counseling, supporting the individual's gender expression, or may involve physical transition resulting from medical interventions such as hormonal treatment, genital surgery, electrolysis, laser hair removal, chest surgery, breast surgery or other reconstructive surgeries.[36] The goal of treatment may simply be to reduce problems resulting from the person's transgender status, for example, counseling the patient in order to reduce guilt associated with cross-dressing.[37]

Guidelines have been established to aid clinicians. The World Professional Association for Transgender Health (WPATH) Standards of Care are used by some clinicians as treatment guidelines. Others use guidelines outlined in Gianna Israel and Donald Tarver's Transgender Care.[38] Guidelines for treatment generally follow a "harm reduction" model.[39][40][41]

Children

Main article: Gender dysphoria in children

Medical, scientific, and governmental organizations have opposed conversion therapy, defined as treatment viewing gender nonconformity as pathological and something to be changed, instead supporting approaches that affirm children's diverse gender identities.[42][43][44] People are more likely to keep having gender dysphoria the more intense their gender dysphoria, cross-gendered behavior, and verbal identification with the desired/experienced gender are (i.e. stating that they are a different gender rather than wish to be a different gender).[45]

Professionals who treat gender dysphoria in children sometimes prescribe puberty blockers to delay the onset of puberty until a child is believed to be old enough to make an informed decision on whether hormonal or surgical gender reassignment is in their best interest.[46][47] Short-term side effects of puberty blockers include headaches, fatigue, insomnia, muscle aches and changes in breast tissue, mood, and weight.[48] Research on the long-term effects on brain development, cognitive function, fertility, and sexual function is limited.[49][50][51]

A review published in Child and Adolescent Mental Health found that puberty blockers are reversible, and that they are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.[52]

According to the American Psychiatric Association, "Due to the dynamic nature of puberty development, lack of gender-affirming interventions (i.e. social, psychological, and medical) is not a neutral decision; youth often experience worsening dysphoria and negative impact on mental health as the incongruent and unwanted puberty progresses. Trans-affirming treatment, such as the use of puberty suppression, is associated with the relief of emotional distress, and notable gains in psychosocial and emotional development, in trans and gender diverse youth".[14]

In its position statement published December 2020, the Endocrine Society stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care. They noted a decrease in suicidal ideation among youth who have access to gender-affirming care and comparable levels of depression to cisgender peers among socially transitioned pre-pubertal youth.[53] In its 2017 guideline on treating those with gender dysphoria, it recommends puberty blockers be started when the child has started puberty (Tanner Stage 2 for breast or genital development) and cross-sex hormones be started at 16, though they note "there may be compelling reasons to initiate sex hormone treatment prior to the age of 16 years in some adolescents with GD/gender incongruence". They recommend a multidisciplinary team of medical and mental health professionals manage the treatment for those under 18 and recommend "monitoring clinical pubertal development every 3 to 6 months and laboratory parameters every 6 to 12 months during sex hormone treatment".[54]

The World Professional Association for Transgender Health's Standards of Care 8, published in 2022, declare puberty blocking medication as "medically necessary", and recommends them for usage in transgender adolescents once the patient has reached Tanner stage 2 of development, and state that longitudinal data shows improved outcomes for transgender patients who receive them.[55] Some medical professionals disagree that adolescents are cognitively mature enough to make a decision with regard to hormone therapy or surgery, and advise that irreversible genital procedures should not be performed on individuals under the age of legal consent in their respective country.[56]

A review commissioned by the UK Department of Health found that there was very low certainty of quality of evidence about puberty blocker outcomes in terms of mental health, quality of life and impact on gender dysphoria.[57] The Finnish government commissioned a review of the research evidence for treatment of minors and the Finnish Ministry of Health concluded that there are no research-based health care methods for minors with gender dysphoria.[58] Nevertheless, they recommend the use of puberty blockers for minors on a case-by-case basis, and the American Academy of Pediatrics state that "pubertal suppression in children who identify as TGD [transgender and gender diverse] generally leads to improved psychological functioning in adolescence and young adulthood."[59]

In the United States, several states have introduced or are considering legislation that would prohibit the use of puberty blockers in the treatment of transgender children.[60] The American Medical Association,[61] the Endocrine Society,[62] the American Psychological Association,[63] the American Academy of Child and Adolescent Psychiatry[64] and the American Academy of Pediatrics[65] oppose bans on puberty blockers for transgender children. In the UK, in the case of Bell v Tavistock, an appeal court, overturning the original decision, ruled that children under 16 could give consent to receiving puberty blockers.[66] In 2022, the National Board of Health and Welfare in Sweden issued new guidelines recommending that puberty blockers only be given in "exceptional cases" and said that their use was grounded in "uncertain science." Instead, they recommended child psychiatric treatment, psychosocial interventions, and suicide prevention measures to be offered by clinicians.[67][68]

Psychological treatments

Main article: Psychotherapy

Until the 1970s, psychotherapy was the primary treatment for gender dysphoria and generally was directed to helping the person adjust to their assigned sex. Psychotherapy is any therapeutic interaction that aims to treat a psychological problem. Psychotherapy may be used in addition to biological interventions, although some clinicians use only psychotherapy to treat gender dysphoria.[30] Psychotherapeutic treatment of GD involves helping the patient to adapt to their gender incongruence or to explorative investigation of confounding co-occurring[69][70][71][72] mental health issues. Attempts to alleviate GD by changing the patient's gender identity to reflect assigned sex have been ineffective and are regarded as conversion therapy by most health organizations.[42][73]: 1741 

Biological treatments

Main article: Gender-affirming care

Biological treatments physically alter primary and secondary sex characteristics to reduce the discrepancy between an individual's physical body and gender identity.[74] Biological treatments for GD are typically undertaken in conjunction with psychotherapy; however, the WPATH Standards of Care state that psychotherapy should not be an absolute requirement for biological treatments.[75]

Hormonal treatments have been shown to reduce a number of symptoms of psychiatric distress associated with gender dysphoria.[31] A WPATH commissioned systematic review of the outcomes of hormone therapy "found evidence that gender-affirming hormone therapy may be associated with improvements in [quality of life] scores and decreases in depression and anxiety symptoms among transgender people." The strength of the evidence was low due to methodological limitations of the studies undertaken.[76] Some literature suggests that gender-affirming surgery is associated with improvements in quality of life and decreased incidence of depression.[77] Those who choose to undergo gender-affirming surgery report high satisfaction rates with the outcome, though these studies have limitations including risk of bias (lack of randomization, lack of controlled studies, self-reported outcomes) and high loss to follow up.[78][79][80]

For adolescents, much is unknown, including persistence. Disagreement among practitioners regarding treatment of adolescents is in part due to the lack of long-term data.[20] Young people qualifying for biomedical treatment according to the Dutch model[81][82] (including having GD from early childhood on which intensifies at puberty and absence of psychiatric comorbidities that could challenge diagnosis or treatment) found reduction in gender dysphoria, although limitations to these outcome studies have been noted, such as lack of controls or considering alternatives like psychotherapy.[83][unreliable medical source?]

In its position statement published December 2020, the Endocrine Society stated that there is durable evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically indicated surgery are effective and relatively safe when monitored appropriately and have been established as the standard of care. They noted a decrease in suicidal ideation among youth who have access to gender-affirming care and comparable levels of depression to cisgender peers among socially transitioned pre-pubertal youth.[53]

A review published in Child and Adolescent Mental Health found that puberty blockers are fully reversible, and that they are associated with such positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.[52]

More rigorous studies are needed to assess the effectiveness, safety, and long-term benefits and risks of hormonal and surgical treatments.[78] For instance, a 2020 Cochrane review found insufficient evidence to determine whether feminizing hormones were safe or effective, due to the lack of "completed studies that met [their] inclusion criteria."[84] Several studies have found significant long-term psychological and psychiatric pathology after surgical treatments.[78]

In 2021, a review published in Plastic and Reconstructive Surgery found that less than 1% of people who undergo gender-affirming surgery regret the decision. It concluded that "There is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population."[85]

Comorbidities

Among youth, around 20% to 30% of individuals attending gender clinics meet the DSM criteria for an anxiety disorder.[86] Gender dysphoria is also associated with an increased risk of eating disorders in transgender youth.[87]

A widely held view among clinicians is that there is an over-representation of neurodevelopmental conditions amongst individuals with GD, although this view has been questioned due to the low quality of evidence.[88] Studies on children and adolescents with gender dysphoria have found a high prevalence of autism spectrum disorder (ASD) traits or a confirmed diagnosis of ASD.[89][90] Adults with gender dysphoria attending specialist gender clinics have also been shown to have high rates of ASD traits or an autism diagnosis as well.[90] It has been estimated that children with ASD were over four times as likely to be diagnosed with GD,[88] with ASD being reported from 6% to over 20% of teens referring to gender identity services.[20]

Children and adolescents with gender dysphoria are also more likely to have ADHD, depression and histories of suicidality, self-harm and adverse childhood experiences.[89]

Epidemiology

See also: Transgender § Population figures and prevalence, and Transsexual § Prevalence

Different studies have arrived at different conclusions about the prevalence of gender dysphoria. The DSM-5 gives a gender dysphoria prevalence of 0.005% to 0.014% of people assigned male at birth (5-14 per 100k) and 0.002% to 0.003% of people assigned female at birth (2-3 per 100k).[91] The DSM-5 states that these numbers are likely underestimates, being based on the number of referrals to specialty clinics.[91] Not all adults seeking medical transition are referred to specialty clinics.[91]

According to Black's Medical Dictionary, gender dysphoria "occurs in one in 30,000 male births and one in 100,000 female births."[92] Studies in European countries in the early 2000s found that about 1 in 12,000 natal male adults (8 per 100k) and 1 in 30,000 (3 per 100k) natal female adults seek out gender-affirming surgery.[93] Studies of hormonal treatment or legal name change find higher prevalence than sex reassignment, with, for example a 2010 Swedish study finding that 1 in 7,750 (13 per 100k) adult natal males and 1 in 13,120 (8 per 100k) adult natal females requested a legal name change to a name of the opposite gender.[93]

Studies that measure transgender status by self-identification find even greater prevalence of gender identity different from sex assigned at birth (although some of those who identify as transgender or gender nonconforming may not experience clinically significant distress and so do not have gender dysphoria). A study in New Zealand found that 1 in 3,630 natal males (13 per 100k) and 1 in 22,714 (4 per 100k) natal females have changed their legal gender markers.[93] A survey of Massachusetts adults found that 0.5% (500 per 100k) identify as transgender.[93][94] A national survey in New Zealand of 8,500 randomly selected secondary school students from 91 randomly selected high schools found 1.2% (1,200 per 100k) of students responded "yes" to the question "Do you think you are transgender?".[95] Outside of a clinical setting, the stability of transgender or non-binary identities is unknown.[93]

Research indicates that among people who transition in adulthood, individuals are up to three times more likely to be male assigned at birth. However, among people transitioning in childhood, the sex ratio is closer to 1:1.[96] The prevalence of gender dysphoria in children remains uncertain due to the lack of formal prevalence studies.[45] A 2022 literature review reported that approximately 36% of adolescents assessed in specialized gender clinics were natal males, and 63% were natal females. One study highlighted in the review found no significant change in these proportions from 2014 to 2016.[97] However, when comparing more recent data with earlier studies, there has been a shift favoring natal females (ratio of 1:3) as opposed to nearly equal proportions in earlier studies (ratios of 0.8–0.9:1).[98]

History

Neither the DSM-I (1952) nor the DSM-II (1968) contained a diagnosis analogous to gender dysphoria. Gender identity disorder first appeared as a diagnosis in the DSM-III (1980), where it appeared under "psychosexual disorders" but was used only for the childhood diagnosis. Adolescents and adults received a diagnosis of transsexualism (homosexual, heterosexual, or asexual type). The DSM-III-R (1987) added "Gender Identity Disorder of Adolescence and Adulthood, Non-Transsexual Type" (GIDAANT).[99][100][101] DSM-V (2013) replaced gender identity disorder (GID) with gender dysphoria (GD) to avoid the stigma of the term disorder.[1]

Society and culture

A sign at a trans rights rally: "Gender is like that old jumper from my cousin: It was given to me and it doesn't fit."

Researchers disagree about the nature of distress and impairment in people with GD. Some authors have suggested that people with GD suffer because they are stigmatized and victimized;[15][102] and that, if society had less strict gender divisions, transgender people would suffer less.[103]

Some controversy surrounds the creation of the GD diagnosis, with Davy et al. stating that although the creators of the diagnosis state that it has rigorous scientific support, "it is impossible to scrutinize such claims, since the discussions, methodological processes, and promised field trials of the diagnosis have not been published."[34]

Some cultures have three or more defined genders. The existence of accepted social categories other than man or woman may alleviate the distress associated with cross-gender identity. For example, in Samoa, the fa'afafine, a group of feminine males, are mostly socially accepted. The fa'afafine appear similar to transgender women in terms of their lifelong identities and gendered behavior, but experience far less distress than do transgender women in Western cultures. This suggests that the distress of gender dysphoria is significantly increased by difficulties encountered from social disapproval by one's culture.[104] Overall, it is unclear whether or not gender dysphoria persists in cultures with third gender categories.[105]

Classification as a disorder

The psychiatric diagnosis of gender identity disorder (now gender dysphoria) was introduced in DSM-III in 1980. Arlene Istar Lev and Deborah Rudacille have characterized the addition as a political maneuver to re-stigmatize homosexuality.[106][107] (Homosexuality was declassified as a mental disorder in the DSM-II in 1974.) By contrast, Kenneth Zucker and Robert Spitzer argue that gender identity disorder was included in DSM-III because it "met the generally accepted criteria used by the framers of DSM-III for inclusion."[108] Some researchers, including Spitzer and Paul J. Fink, contend that the behaviors and experiences seen in transsexualism are abnormal and constitute a dysfunction.[109] The American Psychiatric Association stated that gender nonconformity is not the same thing as gender dysphoria,[9] and that "gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition."[1]

Individuals with gender dysphoria may or may not regard their own cross-gender feelings and behaviors as a disorder. Advantages and disadvantages exist to classifying gender dysphoria as a disorder.[3] Because gender dysphoria had been classified as a disorder in medical texts (such as the previous DSM manual, the DSM-IV-TR, under the name "gender identity disorder"), many insurance companies are willing to cover some of the expenses of sex reassignment therapy. Without the classification of gender dysphoria as a medical disorder, sex reassignment therapy may be viewed as a cosmetic treatment, rather than medically necessary treatment, and may not be covered.[16] In the United States, transgender people are less likely than others to have health insurance, and often face hostility and insensitivity from healthcare providers.[110] The Americans with Disabilities Act covers individuals with gender dysphoria,[111] provides some legal protections against discrimination which may aid transgender people in accessing legal protections they otherwise may be unable to.[original research?] Some researchers and transgender people support declassification of the condition because they say the diagnosis pathologizes gender variance and reinforces the binary model of gender.[15]

An analysis of the Samoan third gender fa'afafine suggests that the DSM-IV-TR diagnostic component of distress is not inherent in the cross-gender identity; rather, it is related to social rejection and discrimination suffered by the individual.[104] Psychology professor Darryl Hill insists that gender dysphoria is not a mental disorder, but rather that the diagnostic criteria reflect psychological distress in children that occurs when parents and others have trouble relating to their child's gender variance.[109] Transgender people have often been harassed, socially excluded, and subjected to discrimination, abuse and violence, including murder.[4][103]

In December 2002, the British Lord Chancellor's office published a Government Policy Concerning Transsexual People document that categorically states, "What transsexualism is not ... It is not a mental illness."[112] In May 2009, the government of France declared that a transsexual gender identity will no longer be classified as a psychiatric condition,[113] but according to French trans rights organizations, beyond the impact of the announcement itself, nothing changed.[114] Denmark made a similar statement in 2016.[115]

In the ICD-11, GID is reclassified as "gender incongruence", a condition related to sexual health.[35] The working group responsible for this recategorization recommended keeping such a diagnosis in ICD-11 to preserve access to health services.[116]

Gender euphoria

In 1990, Virginia Prince ended an article wishing her readers "gender euphoria."

Gender euphoria (GE) is a term for the satisfaction, enjoyment, or relief felt by trans and non-binary people when they feel their gender expression matches their personal gender identity.[117][93][118][119] Psych Central's definition is "deep joy when your internal gender identity matches your gender expression."[120] It is proposed that feelings of gender euphoria require societal acceptance of gender expression.[118] In academics and the medical field, a consensus has not yet been reached on a precise definition of the term, as it has been mainly used within a social context.[121][122] The first attempt to rigorously define gender euphoria through an online survey took place in 2021, conducted by Will Beischel, Stéphanie Gauvin, and Sari van Anders.[122][123] Transgender congruence is also used to ascribe transgender individuals feeling genuine, authentic, and comfortable with their gender identity and external appearance.[124][125]

The term gender euphoria has been used by the transgender community since at least the mid-1970s.[123] Originally, it referred to the feeling of joy arising from fulfilling a mix of gender roles, which was different from the concept of gender dysphoria, which is used to describe individuals who wished to medically transition to a different sex.[123] In the 1980s, the term was published in trans contexts, coming up in interviews with trans people.[126][127][128] For example, in a 1988 interview with a trans man, the subject states, "I think that day [Dr. Charles Ilhenfeld] administered my first shot of the 'wonder-drug' must have been one of the 'peak-experiences' of my life -- talk about 'gender euphoria'!"[129] The interview indicates he is referring to testosterone.[129]

Other figures, including Mariette Pathy Allen and Virginia Prince, have used the term in their work. In 1990, Virginia Prince used the phrase in the trans magazine Femme Mirror, ending an article with, "...from here on you can enjoy GENDER EUPHORIA - HAVE A GOOD LIFE!"[130] Starting in 1991, a monthly newsletter named Gender Euphoria was released,[131] featuring articles about transgender topics; Leslie Feinberg read the newsletter to better understand the transgender community.[132] However, there are instances in which gender euphoria has been used with a different meaning, such as in 1979, when the Black feminist Michele Wallace used it to describe the male privilege present in Black men.[133][134]

The term has been embraced as part of a movement to stop pathologizing being transgender.[135] In 1989, Mariette Pathy Allen published an unnamed transgender person's quote in her photography book Transformations: "The shrinks may call it 'gender dysphoria,' but for some of us, it's gender 'euphoria,' and we're not going to apologize anymore!"[136] The movement to focus on the positive side of gender expression was also advocated for in 1994, when the Scottish "TV/TS" periodical The Tartan Skirt wrote, "Let's accentuate the positive, discard the negative, and promote the new condition of 'Gender Euphoria.'"[137] In 1997, Patrick Califia described transgender activists picketing using signs that read "Gender Euphoria NOT Gender Dysphoria" and handing out "thousands of leaflets" at protests.[135] The following year, in 1998, Second Skins: The Body Narratives of Transsexuality reported:

The transactivist group Transexual Menace is campaigning to have the diagnosis "Gender Identity Disorder" removed entirely from the Diagnostic and Statistical Manual of Mental Disorders. "Gender Euphoria NOT Gender Dysphoria"; its slogans invert the pathologizing of transgender, offering pride in queer difference as an alternative to the psychiatric story.[138]

Similarly, Florence Ashley has advocated for the medical field to focus on helping patients achieve gender euphoria instead of treating patients on the basis of gender dysphoria.[139][140] They argue that currently, in order for individuals to receive gender-affirming care, they must be diagnosed with gender dysphoria, which is not always accessible and entails people must be experiencing significant distress before they can fully express their own gender identity.[141] Ashley's stance that gender euphoria does not need to be preceded by a clinical diagnosis of gender dysphoria, and that gender euphoria is complex, is echoed by Elliot Tebbe and Stephanie Budge in their 2022 Nature Reviews Psychology[142] article, in which they write, "Gender euphoria is not merely the absence of gender dysphoria, but rather a conglomeration of positive emotions and subjective well-being in response to being affirmed in one’s gender."[143]

Gender euphoria has also been expressed through art. In 2019, the Midsumma festival in Australia hosted "Gender Euphoria," a cabaret focusing on "bliss" in transgender experiences, including musical, ballet, and burlesque performances.[144][145][146][147] A reviewer described it as "triumphant – honest, unpretentious, touching, and a vital celebration."[145] Moreover, photography in the East Village in Manhattan has served as means to express gender euphoria, contrasting fashion photography, which is said to reinforce the gender binary.[148]

See also

References

  1. ^ a b c d "Gender Dysphoria" (PDF). American Psychiatric Publishing. 2013. Archived (PDF) from the original on December 29, 2016. Retrieved December 24, 2016.
  2. ^ a b c Maddux JE, Winstead BA (2015). Psychopathology: Foundations for a Contemporary Understanding. Routledge. pp. 464–465. ISBN 978-1317697992. Archived from the original on June 5, 2020. Retrieved December 26, 2019.
  3. ^ a b c d e Coleman E (2011). "Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7" (PDF). International Journal of Transgenderism. 13 (4). Routledge Taylor & Francis Group: 165–232. doi:10.1080/15532739.2011.700873. S2CID 39664779. Archived from the original (PDF) on August 2, 2014. Retrieved August 30, 2014.
  4. ^ a b c d Davidson MR (2012). A Nurse's Guide to Women's Mental Health. Springer Publishing Company. p. 114. ISBN 978-0-8261-7113-9.
  5. ^ Human Rights Campaign. "Sexual Orientation and Gender Identity Definitions". Archived from the original on November 25, 2015. Retrieved June 13, 2021.
  6. ^ Morrow DF, Messinger L, eds. (2006). Sexual Orientation and Gender Expression in Social Work Practice: working with gay, lesbian, bisexual, and transgender people. New York: Columbia University Press. p. 8. ISBN 978-0-231-50186-6. Gender identity refers to an individual's personal sense of identity as masculine or feminine, or some combination thereof.
  7. ^ DSM-5 fact sheet 2013: "DSM-5 aims to avoid stigma and ensure clinical care for individuals who see and feel themselves to be a different gender than their assigned gender. It replaces the diagnostic name 'gender identity disorder' with 'gender dysphoria', as well as makes other important clarifications in the criteria."
  8. ^ a b Russo J, Coker JK, King JH (2017). DSM-5® and Family Systems. Springer Publishing Company. p. 352. ISBN 978-0826183996. Archived from the original on April 19, 2021. Retrieved December 3, 2020. People meeting criteria for Gender Dysphoria most often identify themselves as trans or transgender. Trans or transgender can be used as umbrella terms to include the broad spectrum of persons whose gender identity differs from the assigned gender (APA, 2013).
  9. ^ a b Parekh, Ranna. "What Is Gender Dysphoria?". American Psychiatric Publishing. Archived from the original on January 14, 2020. Retrieved November 20, 2018.
  10. ^ "Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People" (PDF) (ver. 7 ed.). World Professional Association for Transgender Health (WPATH). 2011. Archived from the original on August 14, 2015. 5 ("only some gender nonconforming people experience gender dysphoria at some point in their lives.")
  11. ^ a b Heylens G, De Cuypere G, Zucker KJ, Schelfaut C, Elaut E, Vanden Bossche H, et al. (March 2012). "Gender identity disorder in twins: a review of the case report literature". Journal of Sexual Medicine. 9 (3): 751–757. doi:10.1111/j.1743-6109.2011.02567.x. PMID 22146048. Of 23 monozygotic female and male twins, nine (39.1%) were concordant for GID; in contrast, none of the 21 same‐sex dizygotic female and male twins were concordant for GID, a statistically significant difference (P = 0.005)... These findings suggest a role for genetic factors in the development of GID.
  12. ^ a b Diamond, Milton (2013). "Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation". International Journal of Transgenderism. 14 (1): 24–38. doi:10.1080/15532739.2013.750222. S2CID 144330783. Combining data from the present survey with those from past-published reports, 20% of all male and female monozygotic twin pairs were found concordant for transsexual identity... The responses of our twins relative to their rearing, along with our findings regarding some of their experiences during childhood and adolescence show their identity was much more influenced by their genetics than their rearing.
  13. ^ a b Rosenthal SM (December 2014). "Approach to the patient: transgender youth: endocrine considerations". Journal of Clinical Endocrinology and Metabolism. 99 (12): 4379–4389. doi:10.1210/jc.2014-1919. PMID 25140398.
  14. ^ a b "Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth" (PDF). Archived (PDF) from the original on December 7, 2020.
  15. ^ a b c Bryant K (2018). "Gender Dysphoria". Encyclopædia Britannica Online. Archived from the original on April 18, 2020. Retrieved August 16, 2018.
  16. ^ a b Ford Z. "APA Revises Manual: Being Transgender is No Longer a Mental Disorder". ThinkProgress. Archived from the original on February 2, 2013. Retrieved April 7, 2013.
  17. ^ Zucker KJ, Lawrence AA, Kreukels BP (2016). "Gender Dysphoria in Adults". Annual Review of Clinical Psychology. 12: 217–247. doi:10.1146/annurev-clinpsy-021815-093034. PMID 26788901. [For DSM-5] a reconceptualization was articulated in which 'identity' per se was not considered a sign of a mental disorder. Rather, it was the incongruence between one's felt gender and assigned sex/gender (usually at birth) leading to distress and/or impairment that was the core feature of the diagnosis.
  18. ^ Lev, Arlene Istar (2013). "Gender Dysphoria: Two Steps Forward, One Step Back". Clinical Social Work Journal. 41 (3): 288–296. doi:10.1007/s10615-013-0447-0. S2CID 144556484. [Despite some misgivings], I think that the change in nomenclature from the DSM-IV to the DSM-5 is a step forward, that is, removing the concept of gender as the site of the disorder and placing the focus on issues of distress and dysphoria.
  19. ^ Thompson, Lucy; Sarovic, Darko (2022). "A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology". PLOS Global Public Health. 2 (3): e0000245. doi:10.1371/journal.pgph.0000245. PMC 10021877. PMID 36962334. S2CID 247379163.
  20. ^ a b c Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L (March 2, 2018). "Gender dysphoria in adolescence: current perspectives". Adolescent Health, Medicine and Therapeutics. 9: 31–41. doi:10.2147/AHMT.S135432. PMC 5841333. PMID 29535563. for the majority of adolescent-onset cases, GD presented in the context of severe mental disorders and general identity confusion. In such situations, appropriate treatment for psychiatric comorbidities may be warranted before conclusions regarding gender identity can be drawn."; "There is still no clear consensus regarding hormonal treatment for adolescents because long-term data are unavailable"; "In a nationwide long-term follow-up study of adult cases, psychiatric morbidity, suicide attempts and suicide mortality persisted as elevated after juridical and medical SR.
  21. ^ Crocq MA (2021). "How gender dysphoria and incongruence became medical diagnoses - a historical review". Dialogues in Clinical Neuroscience. 23 (1): 44–51. doi:10.1080/19585969.2022.2042166. PMC 9286744. PMID 35860172.
  22. ^ "Gender Dysphoria". 23 October 2017. Archived from the original on October 22, 2022. Retrieved October 23, 2022.
  23. ^ a b c Guillamon A, Junque C, Gómez-Gil E (October 2016). "A Review of the Status of Brain Structure Research in Transsexualism". Archives of Sexual Behavior. 45 (7): 1615–1648. doi:10.1007/s10508-016-0768-5. PMC 4987404. PMID 27255307.
  24. ^ Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. 2013. pp. 451–460. ISBN 978-0-89042-554-1.
  25. ^ a b c d e f American Psychiatry Association (2022). Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision (DSM-5-TR) (5th TR ed.). Washington, DC: American Psychiatric Publishing. pp. 511–520. ISBN 978-0-89042-576-3.
  26. ^ Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE (August 2015). "Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students". Journal of Adolescent Health. 57 (2): 144–149. doi:10.1016/j.jadohealth.2015.03.003. PMC 4545276. PMID 25937471.
  27. ^ Harmon A, Oberleitner MG (2016). "Gender dysphoria". Gale encyclopedia of children's health: Infancy through adolescence (3rd ed.). Farmington, MI: Gale.
  28. ^ Turban, Jack (August 2022). "What is Gender Dysphoria?". American Psychiatric Association. Retrieved October 23, 2023.
  29. ^ "Expert Q&A: Gender Dysphoria".
  30. ^ a b Gijs L, Brawaeys A (2007). "Surgical Treatment of Gender Dysphoria in Adults and Adolescents: Recent Developments, Effectiveness, and Challenges". Annual Review of Sex Research. 18 (178–224): 178–224. doi:10.1080/10532528.2007.10559851.
  31. ^ a b Altinay M, Anand A (August 2020). "Neuroimaging gender dysphoria: a novel psychobiological model". Brain Imaging and Behavior. 14 (4): 1281–1297. doi:10.1007/s11682-019-00121-8. PMID 31134582. S2CID 167207854. Archived from the original on 2021-10-21. A recently published study (Colizzi et al. 2014), where 118 patients were followed before and 12 months after HRT revealed that 14% of the patients had comorbid Axis-I psychiatric diagnosis. Psychiatric distress and impairment were found to be higher in the beginning phase of the study but after HRT, there was a significant improvement in major depressive disorder, anxiety and functional impairment. Similarly, Fisher and colleagues' (Fisher et al. 2013) 2013 paper suggests that the dysfunction and impairment in the transgender population is highly associated with lack of HRT, which may suggest that at least a fraction of the impairment that was documented as comorbid Axis-I psychiatric disorders could in fact be impairment from GD. Finally, a metanalysis done by Dhejne and colleagues (Dhejne et al. 2016) reviewed 38 longitudinal studies that investigated psychiatric comorbidities pre and post gender affirmation treatments in transgender people with GD. The results of this analysis indicate that depression and GAD do have higher prevalence in transgender population but this finding was isolated to baseline (pre-gender affirmation treatments) where after gender affirmation therapies, rate of psychiatric comorbidities decreased to cisgender population levels
  32. ^ "Gender Dysphoria in Children". American Psychiatric Association. May 4, 2011. Archived from the original on March 14, 2012. Retrieved July 3, 2011.
  33. ^ "P 00 Gender Dysphoria in Children". American Psychiatric Association. Archived from the original on March 14, 2012. Retrieved April 2, 2012.
  34. ^ a b Davy Z, Toze M (2018). "What Is Gender Dysphoria? A Critical Systematic Narrative Review". Transgender Health. 3 (1). Mary Ann Liebert, Inc. Publishers: 159–169. doi:10.1089/trgh.2018.0014. PMC 6225591. PMID 30426079.
  35. ^ a b c "Gender incongruence (ICD-11)". icd.who.int. World Health Organization. Archived from the original on August 1, 2018. Retrieved August 28, 2018.
  36. ^ "NHS - Treatment - Gender dysphoria". NHS. 2016. Archived from the original on November 2, 2013. Retrieved January 10, 2019.
  37. ^ Leiblum S (2006). Principles and Practice of Sex Therapy, Fourth Edition. Guilford Press. pp. 488–9. ISBN 978-1-59385-349-5.
  38. ^ Heyes CJ, Latham JR (2018). "Trans surgeries and cosmetic surgeries: The politics of analogy". Transgender Studies Quarterly. 5 (2): 174–189. doi:10.1215/23289252-4348617.
  39. ^ Committee On Adolescence (July 2013). "Office-based care for lesbian, gay, bisexual, transgender, and questioning youth". Pediatrics. 132 (1): 198–203. doi:10.1542/peds.2013-1282. PMID 23796746. However, adolescents with multiple or anonymous partners, having unprotected intercourse, or having substance abuse issues should be tested at shorter intervals.
  40. ^ "www.glma.org Compendium of Health Profession Association LGBT Policy & Position Statements" (PDF). GLMA. 2013. Archived (PDF) from the original on November 9, 2020. Retrieved August 27, 2013.
  41. ^ "APA Policy Statements on Lesbian, Gay, Bisexual, & Transgender Concerns" (PDF). American Psychological Association. 2011. Archived (PDF) from the original on January 21, 2022. Retrieved August 27, 2013. Be it further resolved that APA recognizes the efficacy, benefit, and necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments
  42. ^ a b "Health and Medical Organization Statements on Sexual Orientation, Gender Identity/Expression and 'Reparative Therapy'". lambdalegal.org. Lambda Legal. Archived from the original on June 15, 2017. Retrieved January 14, 2022.
  43. ^ "Policy and Position Statements on Conversion Therapy". Human Rights Campaign. Archived from the original on April 27, 2017. Retrieved April 12, 2017.
  44. ^ American Psychiatric Association (December 2018). "Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies)" (PDF). American Psychiatric Association. Archived from the original (PDF) on 10 December 2021. While many might identify as questioning, queer, or a variety of other identities, 'reparative' or conversion therapy is based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill and should change ... APA encourages legislation which would prohibit the practice of 'reparative' or conversion therapies that are based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill(references omitted)
  45. ^ a b Ristori J, Steensma TD (January 2, 2016). "Gender dysphoria in childhood". International Review of Psychiatry. 28 (1): 13–20. doi:10.3109/09540261.2015.1115754. PMID 26754056. S2CID 5461482.
  46. ^ The Transgendered Child: A Handbook for Families and Professionals (Brill and Pepper, 2008)[full citation needed][page needed]
  47. ^ Alleyne R (April 15, 2011). "Puberty blocker for children considering sex change". The Daily Telegraph. Archived from the original on January 11, 2022. Retrieved December 1, 2020.
  48. ^ "Puberty Blockers". www.stlouischildrens.org. Archived from the original on July 1, 2022. Retrieved August 18, 2022.
  49. ^ "As children line up at gender clinics, families confront many unknowns". Reuters. October 6, 2022. Archived from the original on October 6, 2022. Retrieved October 10, 2022.
  50. ^ Rosenthal SM (December 2016). "Transgender youth: current concepts". Annals of Pediatric Endocrinology & Metabolism. 21 (4): 185–192. doi:10.6065/apem.2016.21.4.185. PMC 5290172. PMID 28164070. The primary risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists include adverse effects on bone mineralization, compromised fertility, and unknown effects on brain development.
  51. ^ de Vries AL, Cohen-Kettenis PT (2012). "Clinical management of gender dysphoria in children and adolescents: the Dutch approach". Journal of Homosexuality. 59 (3): 301–320. doi:10.1080/00918369.2012.653300. PMID 22455322. S2CID 11731779.
  52. ^ a b Rew L, Young CC, Monge M, Bogucka R (February 2021). "Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature". Child and Adolescent Mental Health. 26 (1): 3–14. doi:10.1111/camh.12437. PMID 33320999. S2CID 229282305. Archived from the original on May 20, 2022. Retrieved June 5, 2022. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.
  53. ^ a b "Transgender Health: An Endocrine Society Position Statement". www.endocrine.org. The Endocrine Society. December 15, 2020. Archived from the original on December 25, 2020. Retrieved June 15, 2022.
  54. ^ Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. (November 2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology and Metabolism. 102 (11): 3869–3903. doi:10.1210/jc.2017-01658. PMID 28945902.
  55. ^ Coleman E, Radix AE, Bouman WP, Brown GR, de Vries AL, Deutsch MB, et al. (2022). "Standards of Care for the Health of Transgender and Gender Diverse People, Version 8". International Journal of Transgender Health. 23 (Suppl 1): S1–S259. doi:10.1080/26895269.2022.2100644. PMC 9553112. PMID 36238954.
  56. ^ Maddux JE, Winstead BA (2015). Psychopathology: Foundations for a Contemporary Understanding. Routledge. pp. 464–465. ISBN 978-1317697992.
  57. ^ "Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria". Archived from the original on 2 April 2021. Retrieved 2 April 2021. The critical outcomes for decision making are the impact on gender dysphoria, mental health and quality of life. The quality of evidence for these outcomes was assessed as very low certainty using modified GRADE.
  58. ^ "Finnish guidelines for treatment of child and adolescent gender dysphoria" (PDF). Council for Choices in Health Care (COHERE). March 2021. Archived (PDF) from the original on 3 December 2020. Retrieved 22 April 2021. p. 6: Terveydenhuoltolain mukaan (8§) terveydenhuollon toiminnan on perustuttava näyttöön ja hyviin hoito- ja toimintakäytäntöihin. Alaikäisten osalta tutkimusnäyttöön perustuvia terveydenhuollon menetelmiä ei ole. [According to the Health Care Act (Section 8), health care activities must be based on evidence and good care and operating practices. There are no research-based health care methods for minors. [translation provided by Wikipedia]]
  59. ^ Rafferty J (October 2018). "Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents". Pediatrics. 142 (4): e20182162. doi:10.1542/peds.2018-2162. PMID 30224363. Archived from the original on 2019-07-19. Retrieved 2021-06-11.
  60. ^ Safer JD (February 17, 2020). "Controversial pubertal blocker legislation may bring unintended consequences for children". Healio. Archived from the original on December 30, 2020. Retrieved 15 December 2020.
  61. ^ "AMA fights to protect health care for transgender patients". State Advocacy Update. American Medical Association. March 26, 2021. Archived from the original on June 29, 2021. Retrieved June 29, 2021.
  62. ^ "Endocrine Society urges policymakers to follow science on transgender health: Texas custody case prompts unfounded claims". Endocrine Society (Press release). Washington, DC. October 28, 2019. Archived from the original on June 11, 2021. Retrieved June 11, 2021.
  63. ^ "Criminalizing Gender Affirmative Care with Minors: Suggested Discussion Points With Resources to Oppose Transgender Exclusion Bills". American Psychological Association. Archived from the original on 2021-06-29. Retrieved 2021-06-29.
  64. ^ "AACAP Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse Youth". American Academy of Child and Adolescent Psychiatry. November 8, 2019. Archived from the original on June 7, 2021. Retrieved June 29, 2021.
  65. ^ Schmidt S (April 22, 2021). "FAQ: What you need to know about transgender children". The Washington Post. Archived from the original on 16 June 2021. Retrieved June 29, 2021.
  66. ^ Siddique H (17 September 2021). "Appeal court overturns UK puberty blockers ruling for under-16s". The Guardian. Archived from the original on September 17, 2021. Retrieved September 17, 2021.
  67. ^ Milton J (February 23, 2022). "Swedish health board wants doctors to stop prescribing life-saving puberty blockers". PinkNews. Retrieved October 12, 2022.
  68. ^ Ghorayshi A (July 28, 2022). "England Overhauls Medical Care for Transgender Youth". The New York Times. Retrieved October 12, 2022.
  69. ^ Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N (2015). "Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development". Child and Adolescent Psychiatry and Mental Health. 9: 9. doi:10.1186/s13034-015-0042-y. PMC 4396787. PMID 25873995.
  70. ^ "Development of the diagnosis gender dysphoria" (PDF). Swedish National Board of Health and Welfare (in Swedish). Feb 2020. Archived (PDF) from the original on March 8, 2021. Retrieved March 13, 2021.
  71. ^ Kozlowska K, Chudleigh C, McClure G, Maguire AM, Ambler GR (2021-01-12). "Attachment Patterns in Children and Adolescents With Gender Dysphoria". Frontiers in Psychology. 11: 582688. doi:10.3389/fpsyg.2020.582688. PMC 7835132. PMID 33510668.
  72. ^ D'Angelo R, Syrulnik E, Ayad S, Marchiano L, Kenny DT, Clarke P (January 2021). "One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria". Archives of Sexual Behavior. 50 (1): 7–16. doi:10.1007/s10508-020-01844-2. PMC 7878242. PMID 33089441.
  73. ^ George R. Brown, MD (July 20, 2011). "Chapter 165 Sexuality and Sexual Disorders". In Robert S. Porter, MD; et al. (eds.). The Merck Manual of Diagnosis and Therapy (19th ed.). Whitehouse Station, NJ, USA: Merck & Co., Inc. pp. 1740–1747. ISBN 978-0-911910-19-3.
  74. ^ Bockting W, Knudson G, Goldberg J (January 2006). "Counselling and Mental Health Care of Transgender Adults and Loved Ones". International Journal of Transgenderism. 9 (3–4): 35–82. doi:10.1300/J485v09n03_03. S2CID 71503744. As per Figure 1, delusions about sex or gender, dissociative disorders, thought disorders, or obsessive or compulsive features should be evaluated and treated prior to proceeding with hormone therapy or surgery. Thought disorders, dissociative disorders, and obsessive-compulsive disorders can, rarely, cause a transient wish for sex reassignment which disappears or significantly lessens when the underlying mental health condition is treated. It is important to treat these disorders before proceeding with hormones or surgery to ensure that the desire for alteration of primary or secondary sex characteristics is not a temporary desire. See also WPATH Standards of Care, version 7 Archived 2015-08-14 at the Wayback Machine, page 23: "The role of mental health professionals includes making reasonably sure that the gender dysphoria is not secondary to or better accounted for by other diagnoses." And the paradigmatic Dutch model Archived 2022-06-09 at the Wayback Machine for consideration of comorbid conditions before proceeding with treatment for childhood onset.
  75. ^ "Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People" (PDF). World Professional Association for Transgender Health. pp. 28–29. Archived (PDF) from the original on 18 March 2021. Retrieved 15 March 2021.
  76. ^ Baker KE, Wilson LM, Sharma R, Dukhanin V, McArthur K, Robinson KA (April 2021). "Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review". Journal of the Endocrine Society. 5 (4): bvab011. doi:10.1210/jendso/bvab011. PMC 7894249. PMID 33644622. This systematic review of 20 studies found evidence that gender-affirming hormone therapy may be associated with improvements in QOL scores and decreases in depression and anxiety symptoms among transgender people. Associations were similar across gender identity and age. The strength of evidence for these conclusions is low due to methodological limitations.
  77. ^ Wernick JA, Busa S, Matouk K, Nicholson J, Janssen A (November 2019). "A Systematic Review of the Psychological Benefits of Gender-Affirming Surgery". The Urologic Clinics of North America. Gender Affirming Surgery. 46 (4): 475–486. doi:10.1016/j.ucl.2019.07.002. PMID 31582022. S2CID 201997501. Retrieved 2021-12-27.
  78. ^ a b c Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. (November 2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". Journal of Clinical Endocrinology and Metabolism. 102 (11): 3869–3903. doi:10.1210/jc.2017-01658. PMID 28945902. In the future, we need more rigorous evaluations of the effectiveness and safety of endocrine and surgical protocols.Specifically, endocrine treatment protocols for GD/gender incongruence should include the careful assessment of the following: (1) the effects of prolonged delay of puberty in adolescents on bone health, gonadal function, and the brain (including effects on cognitive, emotional, social, and sexual development); [...] and (4) the risks and benefits of gender-affirming hormone treatment in older transgender people." "Future research is needed to ascertain the potential harm of hormonal therapies (176)." "The satisfaction rate with surgical reassignment of sex is now very high (187)." "Owing to the lack of controlled studies, incomplete follow-up, and lack of valid assessment measures, evaluating various surgical approaches and techniques is difficult." "Several postoperative studies report significant long-term psychological and psychiatric pathology (259–261)." "We need more studies with appropriate controls that examine long-term quality of life, psychosocial outcomes, and psychiatric outcomes to determine the long-term benefits of surgical treatment.
  79. ^ Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, Erwin PJ, Montori VM (February 2010). "Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes". Clinical Endocrinology. 72 (2): 214–231. doi:10.1111/j.1365-2265.2009.03625.x. PMID 19473181. S2CID 19590739. Archived from the original on 2021-07-17. Retrieved 2021-07-17. The evidence in this review is of very low quality9, 10 due to the serious methodological limitations of included studies. Studies lacked bias protection measures such as randomization and control groups, and generally depended on self-report to ascertain the exposure (i.e. hormonal therapy was self-reported as opposed to being extracted from medical records). Our reliance on reported outcome measures may also indicate a higher risk of reporting bias within the studies. Statistical heterogeneity of the results was also significant.
  80. ^ Sutcliffe PA, Dixon S, Akehurst RL, Wilkinson A, Shippam A, White S, et al. (March 2009). "Evaluation of surgical procedures for sex reassignment: a systematic review". Journal of Plastic, Reconstructive & Aesthetic Surgery. 62 (3): 294–306, discussion 306–308. doi:10.1016/j.bjps.2007.12.009. PMID 18222742. Archived from the original on 2021-07-17. Retrieved 2021-07-17. The evidence concerning gender reassignment surgery in both MTF and FTM transsexism has several limitations in terms of: (a) lack of controlled studies, (b) evidence has not collected data prospectively, (c) high loss to follow up and (d) lack of validated assessment measures. Some satisfactory outcomes were reported, but the magnitude of benefit and harm for individual surgical procedures cannot be estimated accurately using the current available evidence.
  81. ^ Cohen-Kettenis PT, Delemarre-van de Waal HA, Gooren LJ (August 2008). "The treatment of adolescent transsexuals: changing insights". The Journal of Sexual Medicine. 5 (8): 1892–1897. doi:10.1111/j.1743-6109.2008.00870.x. PMID 18564158. Archived from the original on April 13, 2021. Retrieved April 14, 2021.
  82. ^ de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT (October 2014). "Young adult psychological outcome after puberty suppression and gender reassignment". Pediatrics. 134 (4): 696–704. doi:10.1542/peds.2013-2958. PMID 25201798. S2CID 18155489. Archived from the original on April 13, 2021. Retrieved April 14, 2021.
  83. ^ Zucker KJ (October 2019). "Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues". Archives of Sexual Behavior. 48 (7): 1983–1992. doi:10.1007/s10508-019-01518-8. PMID 31321594. S2CID 197663705. Archived from the original on June 9, 2022. Retrieved April 14, 2021. In the Dutch model, several factors were identified in deeming adolescent eligibility for early biomedical treatment. According to Cohen-Kettenis, Delemarre-van de Waal, and Gooren (2008), these included the following: (1) the presence of gender dysphoria from early childhood on; (2) an exacerbation of the gender dysphoria after the first signs of puberty; (3) the absence of psychiatric comorbidity that would interfere with a diagnostic evaluation or treatment; (4) adequate psychological and social support during treatment; and (5) a demonstration of knowledge of the sex/gender reassignment process. Several studies have reported on the benefits of this therapeutic protocol in reducing gender dysphoria (e.g., de Vries et al., 2014, which is the best study to date). Of course, one should bear in mind some of the limitation to these outcome studies, including the fact that not all assessed adolescents were deemed eligible for the treatment protocol (and thus we know relatively little about the longer-term outcomes of these youth) and that study designs have not included alternative treatment options (such as psychosocial therapy) or even being assigned to a wait-list control condition
  84. ^ Haupt C, Henke M, Kutschmar A, Hauser B, Baldinger S, Saenz SR, Schreiber G (November 2020). "Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women". The Cochrane Database of Systematic Reviews. 2020 (11): CD013138. doi:10.1002/14651858.cd013138.pub2. PMC 8078580. PMID 33251587. We found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition.
  85. ^ Bustos VP, Bustos SS, Mascaro A, Del Corral G, Forte AJ, Ciudad P, et al. (March 2021). "Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence". Plastic and Reconstructive Surgery. Global Open. 9 (3): e3477. doi:10.1097/GOX.0000000000003477. PMC 8099405. PMID 33968550. Archived from the original on April 6, 2022. Retrieved April 15, 2022.
  86. ^ Janssen A, Leibowitz S (May 22, 2018). Affirmative Mental Health Care for Transgender and Gender Diverse Youth: A Clinical Guide. Springer. p. 8. ISBN 978-3-319-78307-9. Archived from the original on October 15, 2021. Retrieved August 6, 2021.
  87. ^ Coelho JS, Suen J, Clark BA, Marshall SK, Geller J, Lam PY (October 2019). "Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review". Current Psychiatry Reports. 21 (11): 107. doi:10.1007/s11920-019-1097-x. PMID 31617014. S2CID 204542613. Significantly higher rates of eating disorder symptoms were documented in transgender youth compared to cisgender youth.
  88. ^ a b Thrower E, Bretherton I, Pang KC, Zajac JD, Cheung AS (March 2020). "Prevalence of Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder Amongst Individuals with Gender Dysphoria: A Systematic Review". Journal of Autism and Developmental Disorders. 50 (3): 695–706. doi:10.1007/s10803-019-04298-1. PMID 31732891. S2CID 208061795. Archived from the original on June 9, 2022. Retrieved August 6, 2021.
  89. ^ a b Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth; et al. (2024). "Characteristics of children and adolescents referred to specialist gender services: a systematic review". Archives of Disease in Childhood. doi:10.1136/archdischild-2023-326681. PMID 38594046.
  90. ^ a b Kyriakou A, Nicolaides NC, Skordis N (March 2020). "Current approach to the clinical care of adolescents with gender dysphoria". Acta Bio-Medica. 91 (1): 165–175. doi:10.23750/abm.v91i1.9244. PMC 7569586. PMID 32191677.
  91. ^ a b c Diagnostic and Statistical Manual of Mental Disorders 5. American Psychiatric Association. 2013. p. 454. ISBN 978-0-89042-555-8.
  92. ^ Harvey Marcovitch, ed. (2018). "Gender Identity Disorders". Black's Medical Dictionary (43rd ed.). New York: Bloomsbury. ISBN 9781472943064. Archived from the original on 2022-06-09. Retrieved 2021-01-14.
  93. ^ a b c d e f Zucker KJ (October 2017). "Epidemiology of gender dysphoria and transgender identity". Sexual Health. 14 (5): 404–411. doi:10.1071/SH17067. PMID 28838353. S2CID 205237976. Archived from the original on 2022-06-09. Retrieved 2020-12-22.
  94. ^ Conron KJ, Scott G, Stowell GS, Landers SJ (January 2012). "Transgender health in Massachusetts: results from a household probability sample of adults". American Journal of Public Health. 102 (1). American Public Health Association: 118–122. doi:10.2105/AJPH.2011.300315. OCLC 01642844. PMC 3490554. PMID 22095354. Between 2007 and 2009, survey participants aged 18 to 64 years in the Massachusetts Behavioral Risk Factor Surveillance System (MA-BRFSS; N = 28 662) were asked: "Some people describe themselves as transgender when they experience a different gender identity from their sex at birth. For example, a person born into a male body, but who feels female or lives as a woman. Do you consider yourself to be transgender?" ... We restricted the analytic sample to 28176 participants who answered yes or no to the transgender question (excluding n=364, 1.0% weighted who declined to respond. ... Transgender respondents (n=131; 0.5%; 95% confidence interval [CI]=0.3%, 0.6%) were somewhat younger and more likely to be Hispanic than were nontransgender respondents.
  95. ^ Clark TC, Lucassen MF, Bullen P, Denny SJ, Fleming TM, Robinson EM, Rossen FV (July 2014). "The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth'12)". Journal of Adolescent Health. 55 (1): 93–99. doi:10.1016/j.jadohealth.2013.11.008. hdl:2292/22335. PMID 24438852. Whether a student was transgender was measured by the question, "Do you think you are transgender? This is a girl who feels like she should have been a boy, or a boy who feels like he should have been a girl (e.g., Trans, Queen, Fa'faffine, Whakawahine, Tangata ira Tane, Genderqueer)?" ... Over 8,000 students (n = 8,166) answered the question about whether they were transgender. Approximately 95% of students did not report being transgender (n=7,731; 94.7%), 96 students reported being transgender (1.2%), 202 reported not being sure (2.5%), and 137 did not understand the question (1.7%).
  96. ^ Landén M, Wålinder J, Lundström B (April 1996). "Prevalence, incidence and sex ratio of transsexualism". Acta Psychiatrica Scandinavica. 93 (4): 221–223. doi:10.1111/j.1600-0447.1996.tb10638.x. PMID 8712018. S2CID 26661088. On average, the male [to female]:female [to male] ratio in prevalence studies is estimated to be 3:1. However ... the incidence studies have shown a considerably lower male [to female] predominance. In Sweden and England and Wales, a sex ratio of 1:1 has been reported. In the most recent incidence data from Sweden, there is a slight male [to female] predominance among the group consisting of all applicants for sex reassignment, while in the group of primary [early onset] transsexuals there is no difference in incidence between men and women.
  97. ^ Chiniara, Lyne N.; Bonifacio, Herbert J.; Palmert, Mark R. (June 19, 2018). "Characteristics of Adolescents Referred to a Gender Clinic: Are Youth Seen Now Different from Those in Initial Reports?". Hormone Research in Paediatrics. 89 (6): 434–441. doi:10.1159/000489608. ISSN 1663-2818. PMID 29920505. S2CID 49314194.
  98. ^ Thompson, Lucy; Sarovic, Darko; Wilson, Philip; Sämfjord, Angela; Gillberg, Christopher (March 9, 2022). "A PRISMA systematic review of adolescent gender dysphoria literature: 1) Epidemiology". PLOS Global Public Health. 2 (3): e0000245. doi:10.1371/journal.pgph.0000245. ISSN 2767-3375. PMC 10021877. PMID 36962334.
  99. ^ Koh J (2012). "[The history of the concept of gender identity disorder]". Seishin Shinkeigaku Zasshi = Psychiatria et Neurologia Japonica. 114 (6): 673–680. PMID 22844818.
  100. ^ Pauly IB (1993). "Terminology and Classification of Gender Identity Disorders". Journal of Psychology & Human Sexuality. 5 (4): 1–14. doi:10.1300/J056v05n04_01. S2CID 142954603.
  101. ^ Drescher, Jack, Transsexualism, Gender Identity Disorder and the DSM, Journal of Gay & Lesbian Mental Health 14, no. 2 (2010): 112.
  102. ^ Bryant KE (2007). The Politics of Pathology and the Making of Gender Identity Disorder. Ann Arbor, Michigan. p. 222. ISBN 978-0-549-26816-1.{{cite book}}: CS1 maint: location missing publisher (link)
  103. ^ a b Giordano S (2012). Children with Gender Identity Disorder: A Clinical, Ethical, and Legal Analysis. New Jersey: Routledge. p. 147. ISBN 978-0-415-50271-9.
  104. ^ a b Vasey PL, Bartlett NH (2007). "What can the Samoan "Fa'afafine" teach us about the Western concept of gender identity disorder in childhood?". Perspectives in Biology and Medicine. 50 (4): 481–490. doi:10.1353/pbm.2007.0056. PMID 17951883. S2CID 37437172.
  105. ^ Diagnostic and Statistical Manual of Mental Disorders 5. American Psychiatric Association. 2013. p. 457. ISBN 978-0-89042-555-8.
  106. ^ Lev AI (2004). Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families. Haworth Press. p. 172. ISBN 978-0-7890-2117-5. Archived from the original on January 23, 2021. Retrieved November 11, 2020.
  107. ^ Rudacille D (February 2005). The Riddle of Gender: Science, Activism, and Transgender Rights. Pantheon. ISBN 978-0-375-42162-4.[page needed]
  108. ^ Zucker KJ, Spitzer RL (Jan–Feb 2005). "Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note". Journal of Sex & Marital Therapy. 31 (1): 31–42. doi:10.1080/00926230590475251. PMID 15841704. S2CID 22589255.
  109. ^ a b Hausman K (18 July 2003). "Controversy Continues to Grow Over DSM's GID Diagnosis". Psychiatric News. Archived from the original on 2014-05-22. Retrieved 2014-05-22.
  110. ^ Mallon GP (2009). Social Work Practice with Transgender and Gender Variant Youth. New Jersey: Routledge. ISBN 978-0-415-99482-8.
  111. ^ Devan Cole. "Federal appeals court says Americans with Disabilities Act protections cover 'gender dysphoria,' handing a win to trans people". CNN. CNN. Retrieved 5 September 2022.
  112. ^ "Government Policy concerning Transsexual People". People's rights/Transsexual people. U.K. Department for Constitutional Affairs. 2003. Archived from the original on May 11, 2008.
  113. ^ "La transsexualité ne sera plus classée comme affectation psychiatrique". Le Monde. May 16, 2009. Archived from the original on February 26, 2018. Retrieved May 31, 2009.
  114. ^ "La France est très en retard dans la prise en charge des transsexuels" [France is far behind in caring for transsexuals]. Libération (in French). May 17, 2011. Archived from the original on November 30, 2014. Retrieved March 11, 2018. En réalité, ce décret n'a été rien d'autre qu'un coup médiatique, un très bel effet d'annonce. Sur le terrain, rien n'a changé. [In reality, this decree was nothing other than a media stunt, a very good publicity effect. On the ground, nothing has changed.]
  115. ^ Worley W (May 14, 2016). "Denmark will become first country to no longer define being transgender as a mental illness". The Independent. Archived from the original on March 11, 2018. Retrieved March 22, 2018.
  116. ^ Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, et al. (October 2016). "Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations". World Psychiatry. 15 (3): 205–221. doi:10.1002/wps.20354. PMC 5032510. PMID 27717275.
  117. ^ Tebbe, Elliot A.; Budge, Stephanie L. (2022-09-26). "Factors that drive mental health disparities and promote well-being in transgender and nonbinary people". Nature Reviews Psychology. 1 (12): 694–707. doi:10.1038/s44159-022-00109-0. ISSN 2731-0574. PMC 9513020. PMID 36187743.
  118. ^ a b Benestad, E. E. P. (October 2010). "From gender dysphoria to gender euphoria: An assisted journey". Sexologies. 19 (4): 225–231. doi:10.1016/j.sexol.2010.09.003. ISSN 1158-1360. Retrieved May 15, 2021.
  119. ^ Austin, Ashley; Papciak, Ryan; Lovins, Lindsay (December 5, 2022). "Gender euphoria: a grounded theory exploration of experiencing gender affirmation". Psychology & Sexuality. 13 (5): 1406–1426. doi:10.1080/19419899.2022.2049632. ISSN 1941-9899. S2CID 247281003.
  120. ^ Collins D (2022-05-12). "Sex vs. Gender: What's the Difference and Why Does it Matter?". PsychCentral. Archived from the original on 2022-06-02. Retrieved 2022-06-01.
  121. ^ Bradford NJ, Rider GN, Spencer KG (September 2021). "Hair removal and psychological well-being in transfeminine adults: associations with gender dysphoria and gender euphoria". The Journal of Dermatological Treatment. 32 (6): 635–642. doi:10.1080/09546634.2019.1687823. PMID 31668100. S2CID 204975343.
  122. ^ a b Beischel WJ, Gauvin SE, van Anders SM (2021-05-03). ""A little shiny gender breakthrough": Community understandings of gender euphoria". International Journal of Transgender Health. 23 (3): 274–294. doi:10.1080/26895269.2021.1915223. PMC 9255216. PMID 35799953.
  123. ^ a b c Kai, Jacobsen; Devor, Aaron (2022). "Moving From Gender Dysphoria to Gender Euphoria: Trans Experiences of Positive Gender-Related Emotions". Bulletin of Applied Transgender Studies. 1 (1–2): 119–143. doi:10.57814/GGFG-4J14. ISSN 2769-2124.
  124. ^ Huit, T. Zachary; Ralston, Allura L.; Haws, J. Kyle; Holt, Natalie R.; Hope, Debra A.; Puckett, Jae A.; Mocarski, Richard A.; Woodruff, Nathan (2021-11-04). "Psychometric Evaluation of the Transgender Congruence Scale". Sexuality Research and Social Policy. 20 (2): 491–504. doi:10.1007/s13178-021-00659-7. ISSN 1553-6610. S2CID 243792173. Archived from the original on 2022-06-09. Retrieved 2022-05-06.
  125. ^ Kozee, Holly B.; Tylka, Tracy L.; Bauerband, L. Andrew (June 2012). "Measuring Transgender Individuals' Comfort With Gender Identity and Appearance: Development and Validation of the Transgender Congruence Scale". Psychology of Women Quarterly. 36 (2): 179–196. doi:10.1177/0361684312442161. ISSN 0361-6843. S2CID 10564167. Archived from the original on 2021-12-23. Retrieved 2022-05-06.
  126. ^ Aman R (1986). Maledicta. Maledicta Press. ISBN 978-0-916500-29-0. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  127. ^ Aman R (1988). Lillian Mermin Feinsilver Festschrift. Maledicta Press. ISBN 978-0-916500-29-0. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  128. ^ Transsexualism: A Collection of Articles, Editorials, and Letters on the Subject of Male-to-female and Female-to-male Transsexualism Edited from the TV-TS Tapestry Journal, Issues 39-52. International Foundation for Gender Education. 1988. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  129. ^ a b Transsexualism: A Collection of Articles, Editorials, and Letters on the Subject of Male-to-female and Female-to-male Transsexualism Edited from the TV-TS Tapestry Journal, Issues 39-52. University of Michigan: International Foundation for Gender Education. 1988. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  130. ^ Prince, Virginia (1990). Femme Mirror. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  131. ^ MacKenzie GO (1994). Transgender Nation. Popular Press. ISBN 978-0-87972-596-9. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  132. ^ Feinberg L (October 10, 1999). Trans Liberation: Beyond Pink or Blue. Beacon Press. ISBN 978-0-8070-7951-5. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  133. ^ Gittelson N (1979). Dominus: A Woman Looks at Men's Lives. Harcourt Brace Jovanovich. ISBN 978-0-15-626118-0. Archived from the original on June 2, 2022. Retrieved June 2, 2022.
  134. ^ Kriegel L (1979). On Men and Manhood. Hawthorn Books. ISBN 978-0-8015-0248-4. Archived from the original on June 2, 2022. Retrieved June 2, 2022.
  135. ^ a b Califia P (1997). Sex Changes: The Politics of Transgenderism. Cleis Press. ISBN 978-1-57344-072-1. Archived from the original on June 2, 2022. Retrieved June 2, 2022.
  136. ^ Allen MP (1989). Transformations: Crossdressers and Those who Love Them. Dutton. ISBN 978-0-525-24820-0. Archived from the original on June 2, 2022. Retrieved June 2, 2022.
  137. ^ The Tartan Skirt: Magazine of the Scottish TV/TS Group. ADF Editorial Services. 1994. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  138. ^ Prosser J (1998). Second Skins: The Body Narratives of Transsexuality. Columbia University Press. ISBN 978-0-231-10934-5. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  139. ^ Ashley F (November 2021). "The Misuse of Gender Dysphoria: Toward Greater Conceptual Clarity in Transgender Health". Perspectives on Psychological Science. 16 (6): 1159–1164. doi:10.1177/1745691619872987. PMID 31747342. S2CID 208214158.
  140. ^ Ashley F, Ells C (December 2018). "In Favor of Covering Ethically Important Cosmetic Surgeries: Facial Feminization Surgery for Transgender People". The American Journal of Bioethics. 18 (12): 23–25. doi:10.1080/15265161.2018.1531162. PMID 31159694. S2CID 81006262.
  141. ^ Ashley F (July 2019). "Gatekeeping hormone replacement therapy for transgender patients is dehumanising". Journal of Medical Ethics. 45 (7): 480–482. doi:10.1136/medethics-2018-105293. PMID 30988174. S2CID 117715087.
  142. ^ Tebbe, Elliot A; Budge, Stephanie L (September 26, 2022). "Factors that drive mental health disparities and promote well-being in transgender and nonbinary people". National Library of Medicine.
  143. ^ Tebbe EA, Budge SL (September 2022). "Factors that drive mental health disparities and promote well-being in transgender and nonbinary people". Nature Reviews Psychology. 1 (12): 694–707. doi:10.1038/s44159-022-00109-0. PMC 9513020. PMID 36187743.
  144. ^ Connor A (2019-01-25). "The joy that comes from embracing trans identity shouldn't be so rare". The Guardian. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  145. ^ a b Dezfouli L (19 January 2019). "Review: Gender Euphoria, Midsumma Festival". ArtsHub Australia. Archived from the original on 2022-06-02. Retrieved 2022-06-02.
  146. ^ "Gender Euphoria review (Melbourne International Arts Festival)". Daily Review: Film, stage and music reviews, interviews and more. 2019-10-17. Archived from the original on 2022-03-28. Retrieved 2022-06-02.
  147. ^ Woodhead C (October 16, 2019). "A joyful and poignant celebration of difference". The Age. Archived from the original on June 2, 2022. Retrieved June 2, 2022.
  148. ^ Ridout A (October 28, 2015). Gender Euphoria: Photography, Fashion, and Gender Nonconformity in The East Village (Master of Arts thesis). Louisiana State University and Agricultural and Mechanical College. doi:10.31390/gradschool_theses.3825.

Further reading

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