GENDER

DYSPHORIA
 DEFINITION OF TERMS
SEX/SEXUAL refers to the biological indicators of
male and female, (understood in the context of
reproductive capacity) such as in sex chromosome,
gonads, sex hormones and non ambiguous internal and
external genitalia.
TRANSSEXUAL denotes an individual who seeks
or has undergone, a social transition from male to
female or female to male
involves somatic transition by cross-
sex hormone and sex reassignment
surgery
GENDER used to denote the public (usually legally
recognized) lived role as boy or girl, man or woman and
some other category
GENDER NON-CONFORMING refers to people
who do not conform to society’s expectations for their
gender roles or gender expressions
GENDER IDENTITY is a category of social
identity and refers to an individual identification as
male, female or occasionally, some category other than
male or female
TRANSGENDER refers to an individual who
transiently or persistently identify with a gender
different from their natal gender
 “THE MORE I TRIED TO BE A
GIRL, IT JUST WASN’T RIGHT.”
 DEFINITION
Gender dysphoria refers to the distress that may accompany the
incongruence between one’s experienced or expressed gender
and one’s assigned gender.

-DSM-5
DIFFERENTIAL DIAGNOSIS
1. Nonconformity to gender roles.
2. Transvetic Disorder
3. Body dysmorphic disorder
4. Schizophrenia and other psychotic disorder
PSYCHOPATHOLOGY
 BIOLOGICAL FACTORS PSYCHOSOCIAL FACTORS
• Congenital adrenal hyperplasia • Psychoanalytic theory
• Disorders of sex development • Family Dynamics
• Testosterone and estrogen levels
• Twin studies

IN ADULTS GENDER DYSPHORIA IN CHILDREN

Signs and Symptoms

Signs and Symptoms
• Despite having the anatomical characteristics of a given gender, has the
self-perception of being the opposite gender
• Do not feel comfortable wearing clothes of their assigned gender
• Engaged in cross-dressing
• Find their own genitals repugnant
• Repeatedly submit for hormonal and surgical gender reassignment
• Depression and anxiety due to the inability to live in a desired gender role
• The insistence of being the opposite gender
• Disgust with one’s own genitals
• Belief that one will grow up to become the opposite gender
• Refusal to wear clothing of the assigned gender
• Desirous of having genitals of the opposite gender
• Refusal to participate in the games and activities culturally
associated with assigned gender

DISTURBED PERSONAL IDENTITY

IMPAIRED SOCIAL INTERACTION
LOW SELF-ESTEEM
DIAGNOSTIC
CRITERIA
TRAJECTORIES FOR DEVELOPMENT OF GD
1. Early-onset gender dysphoria starts in childhood and continues into adolescence and adulthood
• there is an intermittent period in which the gender dysphoria desists and these individuals self-identify
as gay or homosexual, followed by recurrence of gender dysphoria
• are almost always sexually attracted to men (androphilic)
• Among adult natal males with gender dysphoria, the early-onset group seeks out clinical care for
hormone treatment and reassignment surgery at an earlier age than does the late-onset group.
• the most common course
• Adolescent and adult natal females with early-onset gender dysphoria are almost always gynephilic.

2. Late-onset gender dysphoria occurs around puberty or much later in life

• these individuals report having had a desire to be of the other gender in childhood that was not
expressed verbally to others
• parents often report surprise because they did not see signs of gender dysphoria during childhood
• Adolescents and adults with late-onset gender dysphoria frequently engage in transvestic behavior
with sexual excitement. The majority of these individuals are gynephilic or sexually attracted to other
posttransition natal males with late-onset gender dysphoria. A substantial percentage of adult males
with late-onset gender dysphoria cohabit with or are married to natal females.
TRAJECTORIES FOR DEVELOPMENT OF GD
• The late-onset group may have more fluctuations in the degree of gender dysphoria and be more
ambivalent about and less likely satisfied after gender reassignment surgery
• Parents of natal adolescent females with the late-onset form also report surprise, as no signs of
childhood gender dysphoria were evident.
• Adolescents and adults with the late-onset form of gender dysphoria are usually androphilic and after
gender transition self-identify as gay men. Natal females with the late-onset form do not have co-
occurring transvestic behavior with sexual excitement.
TREATMENTS
PSYCHOSOCIAL INTERVENTION (in children)
 Behavior Modification Therapy serves to help the child embrace the games and activities of their assigned
gender and promotes development of friendship and peers. The goal is acceptance of culturally appropriate
self-image without mental health concerns from discomfort associated with the assigned gender.
 Group, marital and family therapy for a helpful and supportive environment.
 true gender self child therapy

BIOLOGICAL/PHARMACOLOGIC/SURGICAL
INTERVENTION
 Hormone Therapy
• Gonadotropin-releasing hormone agonist suppresses pubertal changes
• Spirolactone
PSYCHOSOCIAL INTERVENTION (in children)
 Some adults seek therapy to learn how to cope with their altered sexual identity, helping to build
resilience, working within existing family structures
 when addressing adult patients with gender dysphoria more specifically, begin with the least intrusive
step of full psychological evaluation and education
 Minority Stress Theory
BIOLOGICAL/PHARMACOLOGIC/SURGICAL
INTERVENTION (in Adult)
 Surgical Treatment
• Sex reassignment surgery includes but not limited to the ffg:
1. Vaginoplasty
2. Breast Augmentation
3. Thyroid chondroplasty surgery
4. Pitch-raising vocal fold surgery
5. Chest reconstruction surgery
6. Phalloplasty
7. Penectomy

 Hormone Therapy
• Male receive estrogen which results to a more feminine changes in their body
• Women receives testosterone which also causes of body image of a man.
NURSING MANAGEMENT
PLANNING
Short-Term Goals
■ Client will verbalize knowledge of behaviors that are appropriate and culturally
acceptable for assigned gender.
■ Client will verbalize desire for congruence between personal feelings and behavior
and assigned gender.

Long-Term Goals
■ Client will demonstrate behaviors that are appropriate and culturally acceptable for
assigned gender
■ Client will express personal satisfaction and feelings of being comfortable in
assigned gender.
INTERVENTION
■ Spend time with the client and show positive regard. Trust and unconditional
acceptance are essential to the establishment of a therapeutic nurse-client relationship.
■ Be aware of personal feelings and attitudes toward this client and his or her
behavior. Attitudes influence behavior. The nurse must not allow negative attitudes to
interfere with the effectiveness of interventions.
■ Allow the client to describe his or her perception of the problem. It is important to
know how the client perceives the problem before attempting to correct
misperceptions.
INTERVENTION
■ Discuss with the client the types of behaviors that are more culturally acceptable.
Practice these behaviors through role-playing or with play therapy strategies (male and
female dolls). Positive reinforcement or social attention may be given for use of
appropriate behaviors. No response is given for stereotypical opposite gender
behaviors.
■ Behavioral change is attempted with the child’s best interests in mind. That is, to help
him or her with cultural and societal integration, while maintaining individuality. To
preserve self-esteem and enhance self-worth, the child must know that he or she is
accepted unconditionally as a unique and worthwhile individual
PLANNING
Short-Term Goal
■ Client will verbalize possible reasons for ineffective
interactions with others.
Long-Term Goal
■ Client will interact with others using culturally acceptable
behaviors.
INTERVENTION
Interventions
■ Once the client feels comfortable with the new behaviors in role playing or one-to-one
nurse-client interactions, the new behaviors may be tried in group situations. If possible,
remain with the client during initial interactions with others. The presence of a trusted
individual provides security for the client in a new situation, and also provides the potential for
feedback to the client about his or her behavior.
■ Observe client behaviors and the responses he or she elicits from others. Give social
attention (smile, nod) to desired behaviors. Follow up these “practice” sessions with one-to-
one processing of the interaction. Give positive reinforcement for efforts. Positive
reinforcement encourages repetition of desirable behaviors. One-to-one processing provides
time for discussing the appropriateness of specific behaviors and why they should or should
not be repeated.
INTERVENTION
■ Offer support if client is feeling hurt from peer ridicule. Matter-of-factly discuss the
behaviors that elicited the ridicule. Offer no personal reaction to the behavior. Personal
reaction from the nurse would be considered judgmental. Validation of client’s feelings is
important, yet it is also important that client understand why his or her behavior was the
subject of ridicule and how to avoid it in the future.
■ The goal is to create a trusting, nonthreatening atmosphere for the client in an attempt to
change behavior and improve social interactions. Long-term studies have not yet revealed
the significance of therapy with these children for psychosexual relationship development
in adolescence or adulthood. One variable that must be considered is the evidence of
psychopathology within the families of many of these children.
PLANNING
Short-Term Goal
■ Client will verbalize positive statements about self, including
past accomplishments and future prospects.

Long-Term Goal
■ Client will verbalize and demonstrate behaviors that indicate
self-satisfaction with assigned gender,
INTERVENTION
■ In an effort to enhance the child’s self-esteem, encourage him or her to engage
in activities in which he or she is likely to achieve success.
■ Help the child to focus on aspects of his or her life for which positive feelings
exist. Discourage rumination about situations that are perceived as failures or over
which the client has no control. Give positive feedback for these behaviors.
INTERVENTION
■ Help the client identify behaviors or aspects of life he or she would like to change. If
realistic, assist the child in problem-solving ways to bring about the change. Having
some control over his or her life may decrease feelings of powerlessness and increase
feelings of self-worth and self-satisfaction.
■ Offer to be available for support to the child when he or she is feeling rejected by
peers. Having an available support person who does not judge the child’s behavior and
who provides unconditional acceptance assists the child to progress toward acceptance
of self as a worthwhile person.
EVALUATION
■ Does the client perceive that a problem existed that requires a change in
behavior for resolution?
■ Does the client demonstrate use of behaviors that are culturally accepted
for his or her assigned gender?
■ Can the client use these culturally accepted behaviors in interactions with
others?
■ Is the client accepted by peers when same-gender behaviors are used?
■ If the client is refusing to change behaviors, what is the peer reaction?
EVALUATION
■ What is the client’s response to negative peer reaction?
■ Can the client verbalize positive statements about self?
■ Can the client discuss past accomplishments without dwelling on the
perceived failures?
■ Has the client shown progress toward accepting self as a worthwhile
person regardless of others’ responses to his or her behavior?