Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-24T07:23:08.110Z Has data issue: false hasContentIssue false

Chapter 11 - Gender Incongruence

Key Considerations in Transitioning

Published online by Cambridge University Press:  14 October 2021

By
Anne M. Doherty  and
Todd B. Nippoldt
Edited by
Anne M. Doherty ,
Aoife M. Egan  and
Sean Dinneen
Anne M. Doherty
Affiliation:
University College Dublin
Aoife M. Egan
Affiliation:
Division of Endocrinology and Metabolism, Mayo Clinic, Minnesota, USA
Sean Dinneen
Affiliation:
School of Medicine, National University of Ireland, Galway
Get access

Summary

People who are transgender and gender non-conforming (TGNC) include people whose experienced gender is different from their assigned sex at birth, and they have specific healthcare needs. As the number of people identifying as TGNC is increasing internationally, it is important that endocrinologists, psychiatrists and indeed all health professionals have a good understanding of the issues related to the physical and mental healthcare of transgender people. People who identify as TGNC experience a disproportionate amount of violence, discrimination and stigma, and these factors contribute to poorer outcomes. There is also a high rate of comorbidity in young people who are TGNC, including mood disorders, eating disorders, suicidal ideation and self-harm. Compounding these mental health problems are the effects of social exclusion (including educational and employment), which often places TGNC people at risk, especially during transitioning. Transgender people should have access to expert guideline-based care that allows them to transition safely and to optimise their health and well-being.

Keywords

gender identitysuicidemental healthendocrinologygender dysphoria
Type
Chapter
Information
Mental Health, Diabetes and Endocrinology , pp. 116 - 126
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

WHO. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organisation, 1992.Google Scholar
APA. The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). American Psychiatric Publishing, 1994.Google Scholar
APA. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5). American Psychiatric Publishing, 2013.Google Scholar
Reed, GM, Drescher, J, Krueger, RB, Atalla, E, Cochran, SD, First, MB, et al. Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations. World Psychiatry. 2016; 15(3): 205–21.Google Scholar
Collin, L, Reisner, SL, Tangpricha, V, Goodman, M. Prevalence of transgender depends on the ‘case’ definition: a systematic review. J Sex Med. 2016; 13(4): 613–26.Google Scholar
Meyer, IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995; 36(1): 38–56.Google Scholar
James, SE, Herman, JL, Rankin, S, Keisling, M, Mottet, L, Anafi, MA. The Report of the 2015 US Transgender Survey. National Center for Transgender Equality, 2016.Google Scholar
Office, GE. National LGBT Survey Research Report. UK Government Department for Education, 2018.Google Scholar
Safer, JD, Coleman, E, Feldman, J, Garofalo, R, Hembree, W, Radix, A, et al. Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes. 2016; 23(2): 168–71.Google Scholar
Puckett, JA, Cleary, P, Rossman, K, Newcomb, ME, Mustanski, B. Barriers to gender-affirming care for transgender and gender nonconforming individuals. Sex Res Social Policy. 2018; 15(1): 48–59.Google Scholar
Ali, N, Fleisher, W, Erickson, J. Psychiatrists’ and psychiatry residents’ attitudes toward transgender people. Acad Psychiatry. 2016; 40(2): 268–73.Google Scholar
Hunt, R, Bates, C, Walker, S, Grierson, J, Redsell, S, Meads, C. A systematic review of UK educational and training materials aimed at health and social care staff about providing appropriate services for LGBT+ people. Int J Environ Res Public Health. 2019; 16(24): 4976.Google Scholar
Wright, T, Candy, B, King, M. Conversion therapies and access to transition-related healthcare in transgender people: a narrative systematic review. BMJ Open. 2018; 8(12): e022425.Google Scholar
Witcomb, GL, Bouman, WP, Claes, L, Brewin, N, Crawford, JR, Arcelus, J. Levels of depression in transgender people and its predictors: results of a large matched control study with transgender people accessing clinical services. J Affect Disord. 2018; 235: 308–15.CrossRefGoogle ScholarPubMed
Hanna, B, Desai, R, Parekh, T, Guirguis, E, Kumar, G, Sachdeva, R. Psychiatric disorders in the U.S. transgender population. Ann Epidemiol. 2019; 39: 1–7.e1.CrossRefGoogle ScholarPubMed
Clements-Nolle, K, Marx, R, Guzman, R, Katz, M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001; 91(6): 915–21.Google Scholar
Hoy-Ellis, CP, Fredriksen-Goldsen, KI. Depression among transgender older adults: general and minority stress. Am J Community Psychol. 2017; 59(3–4): 295–305.Google Scholar
Glidden, D, Bouman, WP, Jones, BA, Arcelus, J. Gender dysphoria and autism spectrum disorder: a systematic review of the literature. Sex Med Rev. 2016; 4(1): 3–14.Google Scholar
Lehmann, K, Leavey, G. Accuracy of psychometric tools in the assessment of personality in adolescents and adults requesting gender-affirming treatments: a systematic review. Eur Psychiatry. 2019; 62: 60–7.Google Scholar
Keo-Meier, CL, Herman, LI, Reisner, SL, Pardo, ST, Sharp, C, Babcock, JC. Testosterone treatment and MMPI-2 improvement in transgender men: a prospective controlled study. J Consult Clin Psychol. 2015; 83(1): 143–56.CrossRefGoogle Scholar
Heylens, G, Elaut, E, Kreukels, BP, Paap, MC, Cerwenka, S, Richter-Appelt, H, et al. Psychiatric characteristics in transsexual individuals: multicentre study in four European countries. Br J Psychiatry. 2014; 204(2): 151–6.Google Scholar
McNeil, J, Ellis, SJ, Eccles, FJR. Suicide in trans populations: a systematic review of prevalence and correlates. Psychology of Sexual Orientation and Gender Diversity. 2017; 4(3): 341–53.Google Scholar
Garcia-Vega, E, Camero, A, Fernandez, M, Villaverde, A. Suicidal ideation and suicide attempts in persons with gender dysphoria. Psicothema. 2018; 30(3): 283–8.Google Scholar
Marshall, E, Claes, L, Bouman, WP, Witcomb, GL, Arcelus, J. Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature. Int Rev Psychiatry. 2016; 28(1): 58–69.Google Scholar
Asscheman, H, Giltay, EJ, Megens, JA, de Ronde, WP, van Trotsenburg, MA, Gooren, LJ. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol. 2011; 164(4): 635–42.Google Scholar
Reisner, SL, White, JM, Bradford, JB, Mimiaga, MJ. Transgender health disparities: comparing full cohort and nested matched-pair study designs in a community health center. LGBT Health. 2014; 1(3): 177–84.CrossRefGoogle Scholar
Wiepjes, CM, den Heijer, M, Bremmer, MA, Nota, NM, de Blok, CJM, Coumou, BJG, et al. Trends in suicide death risk in transgender people: results from the Amsterdam Cohort of Gender Dysphoria study (1972–2017). Acta Psychiatr Scand. 2020; 141(6): 486–91.Google Scholar
Austin, A, Craig, SL, D’Souza, S, McInroy, LB. Suicidality among transgender youth: elucidating the role of interpersonal risk factors. J Interpers Violence. 2020; doi: 10.1177/0886260520915554.Google Scholar
Hembree, WC, Cohen-Kettenis, PT, Gooren, L, Hannema, SE, Meyer, WJ, Murad, MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017; 102(11): 3869–903.Google Scholar
Cavanaugh, T, Hopwood, R, Lambert, C. Informed consent in the medical care of transgender and gender-nonconforming patients. AMA J Ethics. 2016; 18(11): 1147–55.Google Scholar
WPATH. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. World Professional Association for Transgender Health, 2012.Google Scholar
Neblett, MF, 2nd, Hipp, HS. Fertility considerations in transgender persons. Endocrinol Metab Clin North Am. 2019; 48(2): 391–402.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×