Volume 3 Issue 11 November, 2013
“There’s a gender in your brain and a gender in your body. For 99 percent of people, those things are in alignment. For transgender people, they’re mismatched. That’s all it is. It’s not complicated, it’s not a neurosis. It’s a mix-up.”
~ Chaz Bono, aptly described the condition of a transgender.
Although GID/Transsexualism/Gender Dysphoria gained lot of attention in last few years, it is well documented in Indian mythology in the form of Ardhanarinateshwara, Bruhandda (character lived by Arjun in Mahabharata), Shikhandi
(brother of Draupadi) etc. For many years the patients were known as transgenders and Hijaras. But with the modern midas touch of medical advances the picture is changing dramatically by removing the transgender state and making
them socially acceptable complete men or women as per patients wish.
To understand transsexuality one must understand concept of sex and gender. Sex is what seen as (external appearance) whereas Gender being the identity what one feels. Feeling of incongruence between sex and gender is
called gender dysphoria. Transexualism is extreme form of dysphoria where one feels he or she is trapped in a wrong
body. The disorder is found in 1 in 30,000 to 40,000. It is four times more common in males than females.
Etiology is not clear, but many factors are implicated like – genetic factors like 54 genes are linked with gender
dysphoria, unusual neurodevelopment like sexually dimorphic nuclei are found in hypothalamus, altered fetal and
perinatal androgens, faulty rearing practices and overvaluing opposite gender, absence of same gender parent in
childhood etc.
Clinical picture often shows, patients are continually occupied with the desire of being identified by opposite gender,
Often cross-dressing, being comfortable with opposite gender troop – boys tends to be more effeminate, girls more
masculine. The confirmation of diagnosis is done after following criteria are fulfilled: sense of discomfort and
inappropriateness about ones gender; a wish to get rid of ones genitalia and desire to live life as a member of opposite
sex; the discomfort has been continuously present over the period of 2 years and is not limited to period of stress; an
absence of physical intersex or genetic abnormality and; absence of mental disorder.
Treatment option includes hormonal therapy, sex reassignment surgery, psychosocial interventions and psychotherapy.
The patient’s battle is mostly long and lonely. The fight is not only against gender identity but initially against self, then
family, society, medical, surgical and very much legal too. Being Psychiatrists, it is essential to keep ourselves updated & aware about this sensitive issue, as decreasing the pain of the patient is our first priority, after all its not related to
“genitals”, it’s very much related to “mind “and also felt in mind.
Consultant Psychiatrist, Yashomati Hospitals, Bangalore
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