Diagnosis

Gender Dysphoria (previous known as gender identity disorder) remains a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, not all patients who identify as transgender will meet such criteria, commonly because not all will have the associated clinically significant distress.

The presence of this diagnosis in the DSM is controversial. However the rebranding of gender identity disorder as gender dysphoria has largely been viewed as a positive shift towards pathologizing the resulting distress of identifying as transgender, as opposed to the transgender identity itself. It is suspected that in the future, gender dysphoria will no longer be a DSM diagnosis, and as management of transgender patients evolves, there is already beginning to be a deemphasis on a formal diagnosis. Currently however, a patient undergoing hormone therapy usually has a preceding diagnosis of gender dysphoria. While there is the potential for stigmatization, this diagnosis is usually a prerequisite for a specialist referral for either medical or surgical intervention, and Moncton is no exception.  Diagnosis of gender dysphoria is also required to receive available financial coverage (e.g. for gender-confirming surgeries).

The DSM-5 has criteria for gender dysphoria in both children and adolescents/adults. WPATH recommends that this formal diagnosis be made by a mental health professional who has speciality training/experience in diagnosing and managing gender dysphoria. While traditionally this is a psychologist or psychiatrist it is also appropriate for an experienced family physician or social worker to play this role, especially if a diagnosis of gender dysphoria is clear.

Recommended qualities needed to diagnose gender dysphoria in adults (American Endocrine Society clinical guidelines):

• Competence in using the DSM for diagnostic purposes;
• The ability to diagnose gender dysphoria/gender incongruence and make a distinction between genderdysphoria/gender incongruence and conditions that have similar features (e.g., body dysmorphic disorder);
• Training in diagnosing psychiatric conditions;
• The ability to undertake or refer for appropriate treatment;
• The ability to psychosocially assess the person’s understanding, mental health, and social conditions that can impact gender-affirming hormone therapy;
• A practice of regularly attending relevant professional meetings.

Gender Dysphoria in Adolescents and Adults (DSM 5)

1. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least two of the following:
   1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).
   2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).
   3. A strong desire for the primary and/or secondary sex characteristics of the other gender.
   4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).
   5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
   6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).
2. The condition is associated with clinically significant distress or impairment in social, occupational or other important areas of functioning.

There is no one way that trans people experience gender dysphoria. Dysphoria and a desire for gender-affirming medical or surgical care can emerge at any age. Some people feel dysphoric about certain aspects of their bodies and other people feel discomfort with the gender role associated with their assigned sex.