Gender Dysphoria

Finding The Right Treatment

How is gender dysphoria treated?

The goal of treatment is to alleviate Gender Dysphoria through the use of gender affirming treatments. Treatment for Gender Dysphoria is based on the individual needs of the client. Psychotherapy is recommended to assess symptoms of Gender Dysphoria and other mental health conditions that often co-occur with gender dysphoria. Assessment for severe depression with suicidal thoughts and suicide prevention are key.

For some people, symptoms of Gender Dysphoria improve when they receive a combination of hormonal therapy and surgical procedures. Others experience symptom relief without surgery, but benefit from hormonal treatments. Others require no medical or surgical interventions but prefer to affirm their gender through their attire and presentation. Treatment is client-focused and supports the client through the process of coming out and transition, in whatever form the client may choose. Post transition care is also recommended, especially for those undergoing gender affirming surgery.

Avoid conversion therapy

Conversion therapy aims to change a person’s sexual orientation or gender expression. The American Psychiatric Association (APA) has condemned the practice of conversion therapy, or similar therapies, as ethically and morally wrong. Furthermore, the APA characterizes conversion therapy as, “harmful and potentially deadly.”

Nevertheless, several states are legislating to mandate conversion therapy for those with diverse gender orientations and expressions. Rather than legally mandate conversion therapy, the use of it should be legally criminalized, due to its pernicious goals and harmful outcomes.

Treatment planning for Gender Dysphoria

Surgical and hormonal treatment

The comprehensive treatment of gender dysphoria involves an integrated team of medical, behavioral, and surgical specialists, trained in transgender care.

A diagnosis of gender dysphoria begins with a thorough behavioral evaluation and personal history conducted by a qualified behavioral health provider. This information is then compared with the diagnostic criteria in the DSM-V-TR. If the symptoms match the DSM-V criterion, a diagnosis of gender dysphoria is appropriate. Taking an assessment like MindMetrix can be a good starting point for information gathering.

The decision of how to express and affirm gender identity is highly individual. Some of those who are transgender may elect to have their gender identity affirmed in a number of ways including surgery, hormonal treatment, changing their name and pronouns, changing gender modifiers on legal papers, surgical gender re-assignment including vaginoplasty, facial surgery, breast augmentation or reduction, facial surgery, masculine chest reconstruction, hormonal intervention, and others. Some individuals may affirm their gender in other ways that do not include these interventions.

There are a range of surgical and medical options available for affirming gender identity. Medical treatment may include feminizing or masculinizing hormone therapy and/or masculinizing or feminizing surgery on external and internal genitalia, facial and body contouring, and vocal therapy. It is possible, and within reach, to achieve resolution to gender dysphoria. Some people report that doing so frees them to grow and enrich their lives without the burden of gender dysmorphia.

Sadly, some individuals feel compelled to suppress their gender identities. They perceive a sad dilemma: either conform to an identity which is arbitrarily ruled by their external genitalia or express their true nature risking rejection, humiliation, and loss of relationships. This path can lead to mental health complications and functional impairments. Those struggling with this problem are encouraged to talk to a mental health clinician or their primary care doctor.

Behavioral health treatment

The goal of psychotherapy is relief from gender dysphoria by helping the individual to identify what they need to feel comfortable expressing their gender identity. Gender affirmation therapy offers support to explore ways to affirm their gender and cope with the reactions of family, friends, work, and school.

Treatment begins with a thorough behavioral health evaluation and history. A comprehensive assessment of co-occurring symptoms is made and the client and therapist collaborate to create a treatment plan. Some of the goals of therapy may include:

• Establishing a safe, supportive therapeutic environment, free of judgment.
• Evaluating and treating co-occurring conditions.
• Coordinating with surgical, endocrinological, medication management members of the team, when needed.
• Identifying and treating co-occurring mental health or substance conditions
• Offering support while transitioning
• Identify sources of support, or if they are lacking, recommending support groups.
• Identify whether the individual is currently encountering discrimination, harassment, or other forms of abuse.
• Offering support and psycho-education while the client explores treatment options.
• Offering support for relationship stress or anticipated relationship stress.
• Offering communication tools.
• Offering support and after care if the client elects hormonal or surgical treatments.
• Providing referrals to support groups and community agencies, when needed
• Advocating for the client, when necessary
• Assessing symptoms of depression and preventing suicide

Complications of untreated Gender Dysphoria

Low self esteem, feelings of worthlessness, inappropriate feelings of guilt, changes in eating or sleeping, social isolation, and hopelessness are sometimes found in tandem with gender dysphoria. Alcohol, substance abuse, and eating disorders are additional complications. Severe depression and rates of suicidality for transgender individuals are disproportionately high. According to the DSM-V-TR, transgender individuals are at increased risk of suicide. Suicide assessment and prevention are critical treatment goals.

Symptoms of depression and other mental health conditions are, generally, treatable with medication management and trans-positive psychotherapy.

The decision to start therapy

Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Asking one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes one's insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.