Gender Identity Disorder

What is gender identity disorder?

Gender identity disorder is ongoing discomfort about your biological sex. People with gender identity disorder are males who want to be females, or females who want to be males. GID is equally common in men and women.

This disorder is often called transsexualism. Most healthcare providers use the term transsexual only if the person desires a sex change operation.

People who have this disorder are not likely to be sexually aroused by dressing in women's clothing (transvestite). Men who are aroused by cross-dressing are known in psychiatric terms as having transvestic fetishism.

What is the cause?

The exact cause of this disorder is unknown. Research points to biological and genetic causes.

People who have gender identity disorder may have had the disorder since childhood. Or they may have developed the disorder in early to middle adulthood. In men, this often starts with cross-dressing.

What are the symptoms?

In boys, cross-gender identification is most often noticed when a boy behaves like a girl. Boys may:

• Prefer typical girls' toys such as dolls and female fantasy figures, and enjoy playing house.
• Avoid rough and tumble play and common boys' toys.
• Prefer to dress like a girl.
• Wish they were girls or that they will grow up to be a woman.

Girls with gender identity disorder:

• Avoid traditional girl activities.
• Seek "tomboy" play and boys as best friends.
• Dress and try to look like a boy. Some girls refuse to urinate in the sitting position. These girls frequently claim that they will grow a penis and become a man.

As adults, people with this disorder want to live as a person of the opposite sex. They may be very uncomfortable with being seen as a member of their biological gender and may go to great lengths to look like and act like the other gender. Cross-dressing is very common, in private if not in public. People with this disorder may want to have hormonal and surgical treatments for a sex change. Gender identity disorder is not the same as homosexuality. Homosexual people do not desire to be the opposite sex.

How is it diagnosed?

A healthcare provider or therapist will ask about your symptoms and how long you have had them. He or she will ask how they affect your daily life.

For children, a clear diagnosis may not be possible until the teenage years because many children grow out of gender identity problems.

People who have a gender identity disorder may have other mental health problems. Most common among these are anxiety, depression, and personality disorders. People with gender identity disorder are as likely to marry and have children as people without the disorder.

How is it treated?

Psychotherapy can be helpful to clarify if you have true gender identity disorder. Psychotherapy also can help you and your family understand options and figure out the changes you want to make.

If your symptoms are long lasting, you may wish to physically change your sex. A sex change is usually a three-step process:

• Dressing and behaving as the desired sex for 1 or 2 years.
• Taking hormonal treatment to modify physical sex characteristics. For example, men's breasts grow fuller while women develop facial hair and bigger muscles. Most men have electrolysis at this stage to remove facial hair.
• Having sexual reassignment surgery to change the sex organs. (This is expensive, so many people with GID have hormonal treatment but not surgery.)

Most adults who choose gender reassignment say they are much happier in their new sex role.

How long will the effects last?

Children between the ages of 2 and 4 with gender issues are not uncommon. However, most children grow out of the wish to change their gender before adulthood.

If a person does not receive treatment for GID, he or she will probably continue to have problems throughout life.

What can I do to help myself or my loved one?

• Ask for patience and support from friends and family. Getting clear about the nature and degree of identity issues is a process that takes months. For children, it may take until well into the teen years.
• Find a support group that meets regularly and offers social support.
• Don't insist that someone give up the desire to change his or her sexual identity. Your loved one may withdraw from you if he or she feels pressured.

For more information, contact Mental Health America at 1-800-969-NMHA (1-800-969-6642). The Web site address is http://www.nmha.org.