Treatment for gender dysphoria aims to help people with the condition live the way they want to in their preferred gender identity. What this means will vary from person to person, and some people will need more treatment than others.
Once you or your child have been diagnosed with gender dyphoria, the different treatments available can be considered. Counselling should be offered to you or your child about the range of treatment options and their implications. The various treatments for children and adults with gender dysphoria are detailed below.
Treatment for children with gender dysphoria
If your child is under the age of 18, they should be referred to a specialist child and adolescent gender identity clinic. These clinics can offer ongoing assessment for children with gender dysphoria, and specialised treatment and support for children and their families. Your child will be fully assessed before any treatment begins.
Cross-sex hormones
If your child has been taking hormone blockers for several years, and their feelings of gender dysphoria are still strong, they may be diagnosed as transsexual. This means that they have the extreme and long-term form of gender dysphoria.
Your child may then be offered cross-sex hormones that can alter their body further to fit with their gender identity. The effects of these hormones are only partially reversible, so they are not usually offered to children under the age of 16.
The use of hormone blockers in children under the age of 16 is a controversial subject in the medical community. In some countries, such as the USA and Germany, hormone blockers are given to children if psychological screening shows that their gender dysphoria is likely to persist after puberty. Whereas the current policy of the clinicians who provide hormonal treatment in the UK is not to prescribe hormonal blockers until a child has finished puberty.
New guidelines relating to the issue are being written by the British Society for Paediatric Endocrinology and Diabetes, which are expected to provide a decision on this matter.
Once your child reaches adulthood at the age of 18, they can begin the process of gender confirmation surgery, which will change their gender irreversibly (also known as transition). Not all children who experience gender dysphoria will go on to transition; in fact, the number of children who go on to become transsexuals is very small.
The amount of treatment your child has will depend on how strong and long-lasting their feelings of gender dysphoria are. However, all children and their families should be offered counselling and support through their gender identity clinic.
The Department of Health has recently published advice for parents whose children are experiencing gender dysphoria.
Treatment for adults with gender dysphoria
Adults who have been diagnosed with gender dysphoria, and transsexuals, should be referred to a specialist gender identity clinic. These clinics offer ongoing assessment for those with gender dysphoria, and support and advice on living in your preferred gender role, including ways to dress and deportment, speech therapy and hair removal treatments. They can also offer peer support groups for those with gender dysphoria, and relatives' support groups for their families.
For some people, support and advice from a clinic will be all that they need to feel comfortable in their gender identity, while others will need more extensive treatment, such as a full transition from one sex to the other. The amount and extent of treatment you have is completely up to you.
Once you have been referred to a gender identity clinic, it is likely that you will undergo another full assessment, with the input of a psychiatrist, for a period of approximately three months. This is so that your diagnosis can be confirmed, and, if you want to have hormone therapy, so that you can take the necessary health tests first.
Hormone therapy
The first step of transition is hormone therapy, which is androgen therapy (masculinising hormones) for trans men, and anti-androgen therapy (feminising hormones) for trans women. These hormones start the process of changing your body into one that is more female or more male, depending on your gender identity.
For trans men, this will induce muscle growth, encourage body and facial hair, and lower the voice. For trans women, it will encourage breast growth and reduce body hair. Hormone therapy will not affect the voice of a trans woman. To make the voice higher, trans women will need vocal therapy and possibly vocal cord, or trachea (windpipe) surgery as well.
While you are taking these hormones, you will need to go for regular check-ups at your gender identity clinic.
Hormones for gender dysphoria are also available from other sources, such as the internet, and it may be tempting to get them from here instead of through your clinic, especially if you feel that this takes too long. However, hormones from other sources may not be licensed and therefore may not be safe. If you do decide to use these hormones, let your clinic know so that they can monitor you.
Real life experience (RLE)
If you want to have gender confirmation surgery, you will first need to live in your preferred gender identity full-time for at least one year. This is known as real life experience (RLE), and should help you to be sure that permanent surgery is the right decision.
Once your hormone treatment is under way, you can start as soon as you are ready, with the support of your clinic. The length of RLE varies from person to person, but it is usually between one and two years.
You may have various other surgical treatments during your RLE to prepare for full transition surgery, including mastectomy (removal of the breasts) for trans men, and mammoplasty (cosmetic breast surgery) and feminising facial surgery for trans women. Trans women should continue hormone therapy for at least eighteen months before having a mammoplasty, so that the treatment has had the maximum effect on the development of the breasts.
Gender confirmation surgery
Once you have completed your RLE, and you and your clinic feel that you are ready, you may have surgery to permanently alter your sex.
For trans men, this may involve a hysterectomy (removal of the womb), a salpingo-oophorectomy (removal of the fallopian tubes and ovaries), and the construction of a penis using a phalloplasty or a metoidioplasty. A phalloplasty uses the existing vaginal tissue and skin taken from the inner forearm to create a penis, and a metoidioplasty involves creating a penis from the clitoris, which has been enlarged through hormone therapy.
The aim of this surgery is to create a functioning penis, which allows you to pass urine standing up and retain sexual sensation. You may need more than one operation to achieve this.
For trans women, surgery may involve an orchidectomy (removal of the testes), a penectomy (removal of the penis), and the construction of a vagina from the left-over tissue of the penis (known as a vaginoplasty).
The vagina is created and lined with skin from the penis, and tissue from the scrotum (the sack that holds the testes) is used to create the labia. The urethra (urine tube) is then shortened and repositioned. The aim of this surgery is to create a functioning vagina, with acceptable appearance and retained sexual sensation.
After surgery, the vast majority of transsexuals are happy with their new sex and feel comfortable in their gender identity.
Sexual orientation
Once transition has been completed, it is possible for a trans man or woman to experience a change of sexual orientation. For example, a trans woman attracted to women prior to surgery may find that they are attracted to men after surgery. However, this varies greatly from person to person, and the sexual orientation of many transsexuals does not change after transition.
If you are a transsexual going through the process of transition, you may not know what your sexual preference will be until it is complete, but try not to let this worry you. For many people, the issue of sexual orientation is secondary to the process of transition itself.
