…sometimes called transsexualism (not to be confused with transvestism) is a conflict between a person’s actual physical gender and that to which they actually identify. The term Gender Identity Disorder (GID) was coined by Dr. Kenneth J. Zucker and is used to describe those who believe they were born into the body of the wrong sex. GID is a mental disorder identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. It’s a persistent feeling of severe discomfort with one’s own anatomical sex accompanied by a strong wish to be rid of one’s genitals and to live as the opposite sex. For example, a person who’s physical gender is a boy may actually feel and act like a girl.
Typically, the parents may note that the patient acts in ways that are stereotypic of the opposite sex. This might be a boy playing with and dressing up female dolls and wearing female clothing more typical of adult women or it might be a girl who cuts her hair short, wears boys clothing and exhibits “tough guy” play. These children experience a great deal of negative feedback from their families, other adult caretakers, and from their peers. Many of these children come from families where there is significant psychopathology in one or both parents.
GID is more common in young children than adolescents because 80-98% of cases resolve once the children experience the effects of their innate sex hormones. The psychological challenges are numerous in these patients and need to be fully addressed by mental health professionals who have no social or politically-driven agendas to “recruit” the patient to a specific sexual orientation. The fluidity of the child’s orientation leaves the child vulnerable to manipulation.
There are recommendations from some professionals to encourage the child’s gender-atypical behavior inside and outside the home (i.e. school) and to create an environment of “tolerance for different lifestyles” by encouraging cross-dressing and by teaching students from grades K and upward that human sexual orientation is just a continuum and that maleness and femaleness are arbitrary endpoints. There are no studies to support this concept as valid. The adolescent brain has been shown to mature progressively and not necessarily in the same fashion in all patients. To allow an early-to-mid adolescent the option of making irreversible life-changing decisions, such as consenting to hormone suppression therapy and sex-reassignment surgery, could have grave consequences. Even the use of reversible hormone suppression therapy could theoretically negatively impact those patients who would otherwise assimilate their biological sex in response to going through puberty naturally.
Published studies by Professor David Barlow, Ph.D., and Professor Stewart Agras, M.D., indicate that GID in adolescence and young adults can also be successfully treated to normalize GID to match one’s sexual anatomy1,2. The number of patients with true GID persisting into adulthood is very small.3,4,5,6,7,8,9
Barlow, D. H., Reynolds, E. J., & Agras, W. S. (1973). Gender identity change in a transsexual. Archives of General Psychiatry, 28, 569-576.
Barlow, D. H., Abel, G. G., & Blanchard, E. B. (1979). Gender identity change in transsexuals. Archives of General Psychiatry, 36, 1001-1007.
Rekers, G. A. (1995). Assessment and treatment methods for gender identity disorder and transvestism. Chapter 13 in G. A. Rekers (Ed.), Handbook of Child and Adolescent Sexual Problems. New York, NY: Lexington Books of Macmillan/Simon & Schuster, 1995, pages 272-289.
Rekers, G. A., & Kilgus, M. D. (1997). Cross-sex behavior problems. Chapter 80 in R. A. Hoekelman, S. B. Friedman, N. M. Nelson, H. M. Seidel, M. L. Weitzman, & M. E. H. Wilson (Eds.), Primary Pediatric Care: Third Edition. St. Louis, MO: C. V. Mosby Publishing Company, pages 718-721.
Rekers, G. A., & Oram, K. B. (2009). Child and adolescent therapy for precursors to adulthood homosexual tendencies. Chapter 7 in Julie Harren Hamilton and Philip J. Henry (Eds.), Handbook of Therapy for Unwanted Homosexual Attractions: A Guide to Treatment. Palm Beach, FL: Xulon Press, 2009, pages 247-320.
Zucker, K. J., & Bradley, S. J. (1995). Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. London: The Guilford Press.
Zuger, B. (1984). Early effeminate behavior in boys: Outcome and significance for homosexuality. Journal of Nervous and Mental Disorders, 172, 90-97.
Zuger, B. (1978). Effeminate behavior present in boys from childhood: The additional years of follow-up. Comprehensive Psychiatry, 19, 363-369.
Zuger, B. (1988). Is early effeminate behavior in boys early homosexuality. Comprehensive Psychiatry, 29, 509-519.
Buhrich N Bailey JM and Martin NG, Sexual Orientation, sexual identity, and sex-dimorphic behaviors in male twins, Behavior Genetics 1991; 21:75-96.
De Vries AL Doeeleijers TA and Cohen-Kettenis PT, Disorders of sex development and gender identity outcome in adolescence and adulthood; understanding gender identity development and its clinical implications, Pediatr Endocrinol Rev. 2007;4:343-351.
Johnson SB Blum RW and Giedd JN, Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy, Journal of Adolescent Health 2009;45:216-221.
Selvaggi G et al, Gender identity disorder; general overview and surgical treatment for vaginoplasty in male-to-female transsexuals, Plast Reconstr Surg. 2005;116:135e-145e.
Tangpricha V et al, Endocrinologic treatment of gender identity disorders, Endocr Pract. 2003;9:12-21.
Wisniewski AB et al, Psychosexual outcome in women affected by congenital adrenal hyperplasia due to 21-hydroxylase deficiency, J Urol 2004;30:343-355.
Zucker KJ (2006 Gender Identity Disorder, p 535-562). In David Wolfe and Eric Mash (eds.), Behavioral and Emotional Disorders in Adolescents (pp. 535-562). New York; Guilford.