Gender dysphoria, or gender incongruence, has been classified by the World Health Organization as a psychiatric condition. However, as stated by the American Psychiatric Association in 2013, gender incongruence assigned at birth is not considered a mental disorder in itself.
Gender dysphoria can lead to social isolation, anxiety disorders, loneliness, depression, or even other symptoms.
What causes gender dysphoria?
The origin of gender dysphoria remains unknown, but it appears to be influenced by biological (genetic, hormonal) and environmental factors.
How can gender dysphoria be diagnosed?
Diagnosis is complex, as gender dysphoria is often accompanied or overlaid by psychological or psychiatric issues. Confirmation must be made by specialized physicians with relevant experience, strictly adhering to age-specific criteria—particularly in the case of children and adolescents.
For adults, the diagnostic process is less difficult due to the individual’s psychosocial maturity, which enables them to make a conscious decision. However, for children, questions arise regarding when treatment should begin.
Pre-adolescence: It is advisable to avoid any intervention prior to the onset of puberty, as in the majority of children, gender dysphoria does not persist into adolescence or adulthood. Physical changes, the development of social intelligence, and the exploration of sexuality lead either to the intensification or the diminishing of this dysphoria.
Adolescence: When gender dysphoria persists into adolescence, a medical assessment should be sought to determine whether to initiate treatment. The decision regarding hormone therapy should not be made hastily.
Gender dysphoria: The role of the endocrinologist
Throughout the process, the role of the endocrinologist is pivotal, given their expertise in hormonal changes and their impact on the adolescent’s body. For this reason, their collaboration is invaluable at all stages of treatment.
Following the diagnostic phase, during which the nature and characteristics of gender identity are explored, we begin treating transgender adolescents by suppressing puberty through specific hormonal interventions, provided the following criteria are met:
- A diagnosis of gender dysphoria has been made.
- Adolescence has begun.
- Long-standing and intense gender dysphoria is present.
- Co-occurring medical and psychological problems have been addressed.
- There is consent from the adolescent, or from the parents if the adolescent is not of an appropriate age to provide consent themselves.
Puberty suppression is achieved through the use of gonadotropin-releasing hormone analogues, which prevent the development of unwanted secondary sexual characteristics. This is a transitional stage allowing the adolescent the necessary time to make definitive decisions before proceeding with permanent gender-affirming interventions.
At this stage, the endocrinologist may initiate gender-affirming hormone therapy, provided they determine that all necessary criteria are met. It is strongly recommended to maintain hormone levels corresponding to the desired gender within the normal range and to conduct regular monitoring for complications or adverse risks.
At the final stage of gender-affirming surgery, the individual undergoes a re-evaluation. The endocrinologist continues to regularly monitor transgender individuals for the potential development of cancer, as well as for any adverse effects resulting from the administered sex hormones.