Transsexualism

Alternative names
Gender identity disorder

Definition

Gender identity disorder describes a conflict between a person’s physical or apparent gender and that person’s self-identification. For instance, a person identified as a boy may actually feel and act like a girl. This is distinct from homosexuality in that homosexuals nearly always identify with their apparent sex or gender.

Identity issues may occur in a variety of scenarios and manifest in different ways. For example, some people with normal genitals and secondary sex characteristics of one gender privately identify more with the other gender. Some may cross-dress, and some may actually seek sex-change surgery. Others are born with ambiguous genitalia, which can raise identity issues.

Causes, incidence, and risk factors

People with gender identity disorder may act and present themselves as members of the opposite sex. The disorder may affect self-concept, choice of sexual partners, and the display of femininity or masculinity through mannerisms, behavior, and dress.

The feeling of being in the body of the “wrong” gender must persist for at least 2 years for this diagnosis to be made. The cause is unknown, but hormonal influences in the womb, genetics, and environmental factors (such as parenting) are suspected to be involved. The disorder may occur in children or adults, and is rare.

Symptoms

Children:

     
  • Express the desire to be the opposite sex  
  • Have disgust with their own genitals  
  • Believe that they will grow up to become the opposite sex  
  • Are rejected by their peer group, feel isolated  
  • Have depression or anxiety

Adults:

     
  • Desire to live as a person of the opposite sex  
  • Wish to be rid of their own genitals  
  • Dress in a way that is typical of the opposite sex  
  • Have depression or anxiety  
  • Feel isolated

Either adults or children:

     
  • Withdraw from social interaction  
  • Cross-dress, show habits typical of the opposite sex

Signs and tests

A history and psychiatric evaluation confirms the persistent desire to be the opposite sex. The person’s partner choices may be same-sex or opposite sex.

Treatment

Individual and family counseling is recommended for children, and individual or couples therapy is recommended for adults. Sex reassignment through surgery and hormonal therapy is an option, but identity problems may persist after this form of treatment.

Expectations (prognosis)

A better outcome is associated with the early diagnosis and treatment of this disorder.

Complications

     
  • Poor self-concept  
  • Social isolation  
  • Emotional distress  
  • Depression or anxiety

Calling your health care provider

Make an appointment with your health care provider if you observe the symptoms of this disorder and desire help, especially with anxiety and depression.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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