Gender Identity Disorder | [Il disturbo di identità di genere]

Aim: The aim of this study is to overview the epidemiology, diagnosis, subtypes, comorbidity, treatment and outcome of Gender Identity Disorder (GID) in the scientific literature. Methods: We reviewed the literature focusing on this issue. Results: Transsexualism is a condition in which a person with apparently normal somatic sexual differentiation is convinced that he or she is actually a member of the opposite sex. Transsexuals live permanently in this situation of feeling that their physical body denies who they are. Gender dysphoria is the term for distress resulting from conflicting gender identity and sex of assignment. This phenomenon is not exclusive of Western societies. It may concern either females (female to male disorder, FtM) or males (male to female disorder, MtF) with a sex ratio m:f of about 3:1. The prevalence of transsexuals who reach surgical reassignment is about 1:10000 for the MtF and 1:30000 for the FtM (Table II). Classically two subtypes of GID, one early onset, the other late-onset have been observed. This finding has been recently confirmed and cares significance for treatment and outcome. The etiology of transsexualism is still largely unclear. Clinical examination, along with measurement of sex hormone levels and karyotyping, are unlikely to give anything more than confirmation of biological sex. A first indication of anatomic brain differences between transsesxuals and nontranssexuals has been shown. Also, certain parental rearing factors seem to be associated with transsexualism. The recommended procedure in the Standards of Care of the International Harry Benjamin Gender Dysphoria Association (now called World Health Professional Association for Transgender Health, WPATH), an international professional organization in the field of transsexualism, is to reach surgical reassignment decision in two phases. In the first phase, a diagnosis is made based on formal psychiatric classification criteria. In the second phase, one's capacity to live in the desired role and the strength of the wish for surgical reassignment, in the face of disappointment while living in the opposite gender role, is tested. Hormone therapy is taken throughout this second phase. Psychotherapy is not compulsory, but strongly recommended. There is no agreement regarding the level of psychiatric comorbidity, but anyway, no psychiatric disorder excludes necessarily the person suffering from transsexualism from medical and surgical reassignment. Although cases are limited, adequately treated GID patients seem to have a better outcome compared to those who do not come to a competent medical observation. Conclusions: Transsexualism is not a homogeneous phenomenon and this fact should be addressed as such in research as well as in clinical practice. To make future clinical decisions more empirically based, more large-scale prospective studies, more extensive case descriptions of persons with postoperative regrets, and more detailed accounts of psychotherapy with GID patients, preferably with long-term follow-up, are needed.