Science and statistics Gender medicine is a complex field in which research is still in its infancy and there are limited reliable statistics. There is significant discussion surrounding the scientific and medical understanding of gender and increasing debate about how the NHS should most appropriately assess, diagnose and care for those who present with gender incongruence and gender identity issues, particularly children and young people. There has also been a rapid rise in referrals to the Gender Identity Development Service (GIDS) and increased prescribing of medical interventions by way of hormone drugs. This chapter looks at some of the key areas of the changing nature of therapeutic interventions and the impact of a major review into treatment in this area.
Gender dysphoria Gender dysphoria is a “marked incongruence between one’s experienced/ expressed gender and assigned gender of at least six months duration”.30 • Studies suggest that approximately 1 in 10,000 males and 1 in 30,000 females experience gender dysphoria.31 • Children become aware of their gender identity between two and four years of age and so gender dysphoria can develop at a relatively young age. • There is no agreement as to the causes of dysphoria, but genetic, neurodevelopmental, and psychosocial factors may all contribute. • The clinical experience of Mark Yarhouse suggests that true gender dysphoria is
not a choice. Those who experience it generally find it distressing and often isolating, as it is not well understood. This area of medicine is changing rapidly. In 2011, James Barrett, one of the UK’s leading consultants in gender dysphoria, observed that rates of gender dysphoria seemed to be stable and constant. He described treatment as “drastic and irreversible” and noted that, “the least certain diagnosis is that made by the patient, made as it is without any training or objectivity.”32 In the years following, the situation shifted with referral rates rising rapidly, the view of the person being seen as central, and gender reassignment surgery increasing. Now with the Cass Review, we have seen a shift to a more cautious and holistic approach.
Therapeutic interventions There are three broad directions that interventions can take: 1. Give preference to a person’s gender identity altering their body to conform to that identity through hormones, breast binders or surgery. 2. Give preference to a person’s biological sex encouraging psychological treatment or counselling aimed at addressing their sense of gender identity. 3. Support the person through their experience of conflicting emotions. An NHS publication on gender identity clinics noted that, “There are currently no agreed measures of success or patient outcome measures. This makes determining
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