Gender identtinbound7516198114527289476.pptx

Gender identity

1. TIONGSON TITCO ULTRA VALERO VALEZA GENDER DYSPHORIA PSYCHIATRY REPORT

2. Gender Dysphoria Persons with marked incongruence between their experienced or expressed gender and the one they were assigned at birth Referred to in early versions of the DSM as gender identity disorder.

3. Transgender Those who identify with a gender different from the one they were born with. Transsexuals Those who want to have the body of another sex. Genderqueer Those who feel they are between genders, of both genders or of neither.

4. Epidemiology Children >12yrs: Boys, 10% reported desire to be other sex Girls, 5 % B>G; 5:1 Adults Feeling different from other children of their same sex, although, in retrospect, many could not identify the source of that difference Feeling extensively cross-gender identified from the earliest years, with the cross-gender identification becoming more profound in adolescence and young adulthood

5. etiology Biological Factors: For mammals, the resting state of tissue is initially female; as the fetus develops, a male is produced only if androgen is introduced. Without testes and androgen, female external genitalia develop. Thus, maleness and masculinity depend on fetal and perinatal androgens.

6. Sex steroids: Testosterone- increases libido and aggressiveness in women Estrogen- decrease libido and aggressiveness in men.

7. Psychosocial Factors Children usually develop a gender identity consonant with their sex of rearing (also known as assigned sex). The formation of gender identity is influenced by the interaction of children's temperament and parents' qualities and attitudes. Culturally acceptable gender roles exist: Boys are not expected to be effeminate, and girls are not expected to be masculine.

8. Some children are given the message that they would be more valued if they adopted the gender identity of the opposite sex. Rejected or abused children may act on such a belief. Mother's death, extended absence, or depression, to which a young boy may react by totally identifying with her that is, by becoming a mother to replace her.

9. TITCO, ROBERT Diagnosis and clinical feature

10. Diagnosis and Clinical Features Children DSM -5 defines gender dysphoria in children as incongruence between expressed and assigned gender. It is the most important criteria being a desire to be another gender or insistance that one is another gender.

11. Children Prefer clothing typical of another gender, preferentially choose playmates of another gender. Enjoy games and toys associated with another gender. Take on roles of another gender during play. May express a desire to have different genitals, state that their genitals are going to change, or urinate in the position (standing or sitting) typical of another gender.

12. Differential Diagnosis of Children Predicted to be more likely than others to identify as transgender as adults. Differentiated from other gender nonconforming children by statements about desired anatomical changes. Persists over time may make repeated statements about a desire to be or belief that they are another gender. Medical history is important to distinguish between those children with intersex conditions and those without.

13. Differential Diagnosis of Children Standards of care for intersex children have changed dramatically over the last few decades due to activism by intersex adults and supportive medical and mental health professionals. Historically, intersex babies were often subjected to early surgical procedures to create more standard male or female appearances.

14. Adolescents and Adults Diagnosed with gender dysphoria must also show an incongruence between expressed and assigned gender. They must meet at least two of six criteria, half of which are related to their current secondary sex characteristics or desired secondary sex characteristics. They include a strong desire to be another gender, be treated as another gender, or belief that one has the typical feelings and reactions of another gender.

15. Adolescents and Adults Most adults who present to mental health practitioners with reports of gender-related concerns are aware of the concept of transgender identity. Maybe interested in therapy to explore gender issues or maybe making contact in order to request a letter recommending hormone treatment or surgery.

16. Adolescents and Adults The cultural trope of being “trapped in the wrong body” does not apply to all, or even most, people who identify as transgender, clinicians should be aware to use open and affirming approaches, taking language cues from their patients. D SM-5 criteria are noticeably open to the idea that some people do not fit into the traditional gender binary and desire alternative genders, such as genderqueer.

17. Adolescents and Adults Like diagnosis in childhood, adolescent and adult diagnosis also requires that those diagnosed be personally distressed or impaired by their feelings, rather than their behaviors or identities being pathologized by others. Adolescent and adult criteria contains a post-transition specifier, which can be used for those people who live in their affirmed genders. To have undergone or be preparing to undergo at least one medical or surgical procedure in order to qualify for this specifier.

18. Differential Diagnosis of Adolescents and Adults Meet the criteria for a diagnosis of gender dysphoria must experience clinical distress or impairment related to their gender identity. Certain mental illnesses in which transgender identity maybe a component of delusional thinking, such as schizophrenia. Body dysmorphic disorder maybe differential diagnosis for some patients who present with a desire to change gendered body parts.

19. Differential Diagnosis of Adolescents and Adults Paraphilic disorders chapter of the DSM-5 contains the diagnosis transvetic disorder, which is defined as recurrent and intense sexual arousal from cross-dressing that causes clinically significant distress or impairment. Diagnosis is differentiated from gender dysphoria by the patients gender identity being consistent with their gender assigned at birth, and by sexual excitement linked to cross-dressing coming to interfere with the person’s life.

20. ULTRA, KAREEN Course and prognosis

21. CHILDREN Age of 3 School Age Stereotypical/ Denial Puberty Identify as transgender adults (+) Gender nonconforming Higher rates than depressive d/o, anxiety d/o, impulse-control d/o ADULTS (-) Gender nonconforming Lesbian and gay communities Higher rates than depressive d/o, anxiety d/o, suicidality , self-harming behaviors, substance abuse Course and prognosis

22. CHILDREN Psychotherapy Reparative/ Conversion therapy ADOLESCENTS Psychotherapy GnRH agonist ADULTS Psychotherapy Hormonal Treatment Surgical Treatment treatment

23. History of poor treatment and medicalization Prescription of transition-related hormones require a letter from mental health provider who acts as the gate keeper Informed consent letter from the community clinics World Professional Association for Transgender Health (WPATH) Mental health problems

24. MEN TESTOSTERONE Acne, muscle mass, libido, menses cessation, voice deepening, increase body hair, clitoris enlargement Hmg / Hct levels, liver function, cholesterol, diabetes Fertility counseling WOMEN ESTROGEN, TESTOSTERONE-BLOCKERS, PROGESTERONE Skin softening, fat redistribution, breast growth (<cup B), decrease sex drive, no voice change 18-24 mos before breast augmentation BP, liver function, cholesterol, prolactin Permanent sterility hormones

25. TREATMENT Valero, John David G.

26. SURGERY Chest Surgery or Top Surgery Bottom Surgery Metoidioplasty Scrotoplasty Phalloplasty Vaginoplasty Orchiectomy Decrease production of androgen and testosterone

27. SURGERY Facial Feminization Self Surgery Silicone Injection (done to self) May cause infectoin , mutiliation , silicon blood clots that can lead to embolism and death.

28. O ther Specified Gender D ysphoria Presentation causes clinically significant distress or impairment but does not meet the full criteria for gender dysphoria . the clinician records the specific reason that the full criteria were not met.

29. U nspecified Gender Dysphoria when full criteria are not met and the clinician chooses not to specify why they are not met.

30. ICD-10/11 Gender identity issues appear under Disorders of Adult Behavior and Personality in the category Gender Identity Disorders (F64) FIVE DIAGNOSES Transesexualism Dual Role Transvestism Gender Identity Disorder of childhood Other Gender Identity Disorder Gender Identity Disorder, unspecified

31. ICD-10/11 For ICD-11 gender identity concerns be moved from the psychological sections and is considering options that would list these concerns in their own separate chapter, as medical diagnoses, or as part of a new chapter on sexual health and sexual disorders.

32. VALERO, JOHN DAVID INTERSEX CONDITION

33. INTERSEX CONDITION A variety of syndrome in which persons are born with anatomies that do not correspond with typical male or female bodies

34. Congenital Adrenal Hyperplasia E nzymatic defect in the production of adrenal cortisol. leads to overproduction of adrenal androgens. when the chromosome are XX virilization of the female fetus

35. Congenital Adrenal Hyperplasia ANDROGENIZATION Clitoral enlargement External genitals that look like normal scrotal sac, testes, and penis.

36. Androgen Insensitivity Syndrome formerly called testicular feminization tissue cells are unable to use testosterone or other androgens the person appears to be a normal female at birth and is raised as a girl later found to have cryptorchid testes, which produce the testosterone minimal or absent internal sexual organs

37. Androgen Insensitivity Syndrome Secondary sex characteristics at puberty are female. S mall, but sufficient, amount of estrogens, which results from the conversion of testosterone into estradiol.

38. VALEZA, ANDREW INTERSEX CONDITION

39. Turner Syndrome 1 sex chromosome missing ( X only ) Have female genitalia Short Shield-shaped chest Webbed neck Gender identity: FEMALE Dysfunctional ovaries > E xogenous estrogen

40. Klinefelter Syndrome Exta X chromosome ( XXY ) At birth, appears normal Excessive gynecomastia (adolescent) Testes small No sperm production Tall Eunuchoid body habitus

41. 5- α -Reductase Deficiency P revents conversion of testosterone to dihydrotestosterone (for prenatal virilization of genitalia) At birth, appears female R aised as girls > Virilized at puberty, changes identity to males I dentified as male adults Persons assigned to be FEMALE AT BIRTH , choose to become MALE AS ADULTS Persons assigned to be MALE AT BIRTH , choose to become FEMALE AS ADULTS Treatment: Ambiguous genitalia (decide if it will be a boy or girl)

42. Transvestic Disorder Under Paraphilic disorders At least 6 months of recurrent and intense sexual arousal from CROSSDRESSING Fantasy, sexual urge causes distress or impairment More common in males Remembers a fascination with female dressing in childhood Stress-related crossdressing > Sexual excitement Crossdressing reduces tension and anxiety Can co-exist with other paraphilic disorders (masochism or fetishism) Goal: cope with stressors Antianxiety, antidepressants Behavior therapy & hypnosis

43. Preoccupation with Castration Occurs when people do not have a desire to acquire the sex characteristics of the other sex Uncomfortable with assigned sex Fantasizes of what they would be like to be a different gender Asexual (lack interest in men or women)

44. TIONGSON TITCO ULTRA VALERO VALEZA THANK YOU