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Treatment guidelines for Gender Identity Disorder in development
July 5th, 2012
10:32 AM ET

Treatment guidelines for Gender Identity Disorder in development

In recent years, stories about transgender people have been front page news. The transformation of Chaz Bono, son of singers Sonny and Cher, from female to male is perhaps the most well known.

"In puberty, I felt like my body was betraying me," Bono said in an interview.  Now the nation’s top psychiatrists are beginning to talk about developing treatment guidelines for transgender people.

Mental health experts say Bono and people like him have Gender Identity Disorder (GID). “People with GID are distressed with the sense that they were born in the wrong body”, says Dr. William Byne, chair of the American Psychiatric Association Task Force that recommended forming the guidelines.

As children, for example, people with GID may insist they are a boy when they are biologically female.  Experts say it becomes a problem if they become anxious because of their gender and it interferes with their relationships and work.

It’s difficult to know exactly how many people have GID. Ken Zucker, Psychologist-in-Chief at the Centre for Addiction and Mental Health in Toronto, estimates 1 in 1,000 children have the disorder, but many grow out of it. Only about 1 in 30,000 adult males and 1 in 100,000 adult females seek sex-reassignment surgery.

The Task Force believes that the guidelines will help psychiatrists improve the quality of care for transgender people.

“For all age groups, we hope that having guidelines will increase the number of psychiatrists and other mental health professionals who are trained to provide care in this area,” Byne said.

Among the issues the task force says should be considered:

  • That the patient knows all treatment options
  • That the mental health needs of transgender people are addressed
  • And that ethical issues surrounding treatment are discussed

The biggest concern is how to treat children. Experts say when it comes to treatment, one size doesn’t fit all.  Byne hopes the guidelines will help parents make informed decisions about what’s best for their child: Should they wait and watch, discourage the cross-gender actions, or just encourage cross-gender identity?

The Task Force report was published in the journal Archives of Sexual Behavior.

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Filed under: Psychology • Sex

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soundoff (48 Responses)
  1. anna

    Chaz Bono really is a dreadful looking person, Cher must cringe every time she sees him.

    July 5, 2012 at 13:31 | Report abuse | Reply
    • stephany

      appearence is only skin deep, maybe if you ask Chaz Bono how she deems your appearence you might get the same respone to you as you gave to him!

      July 5, 2012 at 15:22 | Report abuse |
    • Janet Smithson

      You can say that again!

      I cringe every time I see a photo of this overweight non-celebrity.

      July 5, 2012 at 16:25 | Report abuse |
    • leah1026

      Your transphobia is showing.

      July 6, 2012 at 16:29 | Report abuse |
    • Icurheinie

      100% agreed. And just because we agree that she looks like a science experiment gone bad doesn't mean we're "phobes". That's pathetic and the first tool out of the box for the sympathizers. Sympathize all you want but Chaz would look so much better in her "natural" state. It's all about accepting and dealing with reality – one's biological truth.

      July 9, 2012 at 23:02 | Report abuse |
    • Freyja

      @Ichurheinie Biological truth? Ah, do you know yours? Tell me, have you recieved a sex chromosomal screening? If not you may be intersex, XXY for example and never know.

      I've known many trans people who look 'better' after having transitioned then in their 'natural' state.

      I would hesitate to use the term 'transphobia' when in you being uneducated on the complexities of transsexualism, but more so, you show that you ahve no comprehension of the deeper philosophical consequences of the statements you are making. You speak, ENTIRELY, from a place of opinion and act as if it is established fact (even the concept of fact and truth can be hard terms to use if one follows a philosophy of Ontological Perspectivism). I speak of a place of opinion as well, that I do not deny, but I do belive that I have a greater grasp of what I'm saying and what the deeper meaning can be then what you have been saying throughout this comment section.

      August 14, 2012 at 18:10 | Report abuse |
  2. Kathryn

    The suicide rate for untreated trans-people is staggeringly high, I'm sure that Cher would rather have a living son instead of a dead daughter. I myself am a trans-female and I, along with my family, would rather that I stay alive as a female, even it means that some would consider me to be as ugly as sin. In my case, I simply had no choice, I was VERY close to suicide before I started my transition. Helping children who suffer from this disorder early is their ONLY hope for a "normal" life.

    July 5, 2012 at 14:39 | Report abuse | Reply
    • Kkthegenerous

      Well, talking about sin, I don't think you are committing a sin. I'm personally not sure what religion you are, Christian maybe? I'm not being offensive, I'm just overheard that they dislike gays or transgender, stuff like that, so maybe the sin you are talking about is that.
      I'm Buddhist by the way, just in case you're curious. I'm so glad to hear that you didn't commit suicide, and chose to do what's right, make yourself happy. You proved yourself that you are strong to face what (kinda evil) society out there will respond/judge. :D So don't worry, and be happy. You know that there are people out there who understand you as you are.
      Oh, and please help me understand whatever I have written on my first paragraph. Thanks :)

      July 9, 2012 at 04:04 | Report abuse |
  3. stephany

    What happened to the Harry Benjimen standards of care? As someone who has GID, and have gone through years of therapy as well as all the changes that the body goes through during HRT and GRS, I am glad to see that the medical community is opening their narrow minds to the fact that life is not black and white, but a rainbow of different people, and species that throughout time have adjusted their biology to adapt. GID is not a curse, but a gift, we are the great arbitrators of human gender, we see both sides of the coin.

    July 5, 2012 at 15:18 | Report abuse | Reply
    • David

      I am not Trans, but I am Gay and I think you are absolutely right about seeing both sides of the coin! I've always thought a person who was Trans was a lucky person for being able to see things in a way most humans cannot. THANK YOU!

      July 8, 2012 at 01:09 | Report abuse |
  4. Dizzyd

    Have u not read Stephany's response? You ppl need to stop hating on everyone who doesn't look like a supermodel. That makes YOU the real ugly ones!

    July 5, 2012 at 18:04 | Report abuse | Reply
  5. Axes

    Anna/Janet Smitson :-(
    Your Ignorance is making you Stupid.
    Read up on the subject.
    This article is just an eye opener.
    When u know more about any given topic, you'll be less likely to "judge a book by it's cover".
    By the way, I think Chaz Bono is a handsome young man.

    July 5, 2012 at 18:37 | Report abuse | Reply
  6. Eddie

    This is the most ridiculous medical diagnosis I have ever heard of.

    July 5, 2012 at 18:55 | Report abuse | Reply
    • Kathryn

      No, "Recto-cranial inversion" is a rediculous diagnosis, but Eddie, Anna, and Janet seem to be suffering from it.

      July 6, 2012 at 04:28 | Report abuse |
    • ORLY?

      Just wait until there's a disorder for all those ugly girls who know deep down inside they were meant to be pretty. We'll need to pay for the nip tucks and reconstructions so they too can outwardly resemble how they feel inside.

      July 6, 2012 at 11:31 | Report abuse |
  7. B.

    So...are you a medical doctor? Does your opinion matter at all to anyone? Well, then, what a waste of time for us all.

    July 6, 2012 at 01:39 | Report abuse | Reply
  8. Sean

    I personally think Chaz is handsome, beauty is in the inside, and it took courage for him to go through this change as it takes all us Trans-genders to take courage to go through the change and be the person we feel inside, I am glad more Medical professionals are taking a closer look to help us out, for I am FTM and started my T-shots, and I feel free inside, it is very depressing when you have to look at your self and not see who you see inside, and yes the suicide rate is high because their are allot of Trans-gender people who do nto know were to turn for help or they can not afford it.

    July 6, 2012 at 02:11 | Report abuse | Reply
  9. www.velanhcs.com

    Your article is very rich in content and very useful and interest to ready.

    July 6, 2012 at 03:45 | Report abuse | Reply
  10. Kathryn

    Also, the haters will be upset to learn that as of 4/23/12, we finally have legal protection from discrimination.
    Obama 2012!

    July 6, 2012 at 04:35 | Report abuse | Reply
  11. lauren

    I never knew that Chaz Bono was Cher's son

    July 6, 2012 at 05:10 | Report abuse | Reply
  12. Mary stark

    As a parent with a transgender son. My husband and I just found out that our son is transgender. We are just relieved that he didn't committee suicide.

    July 6, 2012 at 12:16 | Report abuse | Reply
  13. Meg

    Can we please drop the "disorder" off of this? I in no way feel disordered.

    July 6, 2012 at 15:24 | Report abuse | Reply
    • Katie

      According to the APA (American Psychology Association) it is a mental disorder. It is often treatable with therapy and other options. YOu can read up on it at the U.S. National Library of Medicine. The reason it is a disorder is because the depression and self-esteem issues often continue even after the gender reassignment surgery.

      It is a s much of a disorder as anorexia, only instead of urging the people to realize that they are beautiful as they are, we encourage them to stop eating. If you catch my analogy.

      July 17, 2012 at 16:55 | Report abuse |
    • Freyja

      @Katie You seem to misunderstand a very important distinction, depression DOES NOT cause transsexualism, transsexualism can cause depression. I've known many very happy transsexual individuals, many of which have left chronic depression behind by moving forward with transitioning. The depression is an effect of the obstacles associated with transsexualism.

      In regards to being depressed after surgery, I find this is because many transsexual individuals seem to place all their hopes on surgery as the end all be all, and while this may enable many of them, not including the Non-Ops, to be able to attain happiness, it is not happiness alone. After surgery there is still work, bills, and everything else. Many individuals have this idea that after surgery ALL their problems will be solved and their life will completely change, but they will still be socially viewed the same as we do not gender people based off genitalia. For many transsexual women, for example, more social changes can be made with Facial Feminization Surgery.

      In any case, the realization that their lives, though having changed much for the better, still have many of the same issues that come with life can be a damaging blow to moods sometimes. As stated previously, many have an idea that it is the end all be all and afterward everything will change.

      Another difference between transsexualism and Anorexia, are you used as an example, is that Anorexia has a starting point in social influences while transseuxalism is something existing outside the social sphere alone. Regardless of the social influences, transsexual individuals still have the same angst associated with their anatomy.

      August 14, 2012 at 18:01 | Report abuse |
  14. leah1026

    So many errors in this story.

    First, the internationally recognized Benjamin Standards of Care have been around since 1979! We don't need guidelines because they already exist. The current guideline are now in the 7th iteration.

    Next, you used Dr Zucker as a source? The man has been repressing trans people for many years. His theories about transsexualism have been proven wrong time after time. Kids born transsexual (yes it is a birth condition) do NOT "outgrow" it. When it comes to transsexualisms the man is nothing but a junk scientist. His program treated trans people so bad that it was investigated by the province of Ontario and has been forced to make changes.

    Next, the Benjamin Standards of Care also covers children and always has.

    Next, the article makes it sound like the treatment of transsexualism is new. Not so. People have been medically transitioning for more than 60 years. 60 years! The problem is the media and religious groups have worked hand in hand for decades to stigmatize and oppress trans people.

    Speaking as someone who transitioned several years ago I can tell you that the current Standards of Care already do a fine job in evaluating patients and assisting them to transition. What we do need is more public education and acceptance. As I like to say it is our society that has gender dysphoria, not us transsexual people.

    July 6, 2012 at 16:25 | Report abuse | Reply
    • Rights

      In fact, 80% of children diagnosed with GID will not have the condition as adults, so do your research. This says nothing about whether it is wrong or right.

      July 7, 2012 at 15:57 | Report abuse |
    • leah1026

      @Rights: Show me proof for your statistics. Do you have a link? The problem is the diagnosis of GID is used much too loosely when it comes to children. If appropriate guideling were followed this would not be an issue. Most children go through periods or episodes of gender variant behavior. However, gender variant behavior is not GID. GID is consistent and persistent behavior on the part of the child that lasts at least 6 months. Trouble is doctor are labeling kids way sooner than that adn that's probably were your false statistic comes from. Also, does the child actually identify themselves as trans or do the parents and care-givers ASSume that and misdiagnose? Careful diagnosis is the key.

      July 11, 2012 at 05:03 | Report abuse |
    • leah1026

      @Rights: This is why I don't believe the GID diagnosis should be used on children under age 11. Use the lesser term "gender nonconfroming" or "gender variant" until the case has firmly established and medical intervention becomes necessary.

      July 11, 2012 at 05:07 | Report abuse |
    • Julia

      Thank you your analysis of the article is correc,t based on my information dealing with trans persons and physicians helping them. Most of the problems trans persons have are aggravated by social stigma and false beliefs of society. I have often felt that persons holding such beliefs and using reprisals against trans persons are the ones who need to be analyzed and treated.

      February 24, 2013 at 17:46 | Report abuse |
  15. No Name

    Chaz Bono is a hansom young man. The stress of having to tolerate an uneducated society with regards to GID is enough to make one's weight increase.
    I am the mother of a transgender daughter. She is a beautiful, talented and educated young lady. It is time for the American society to wake up, stop starring at an individual that looks slightly different from Barbi and Ted. Google Transgender and READ. Stop being so ignorant.

    July 6, 2012 at 20:13 | Report abuse | Reply
    • Icurheinie

      Your daughter is the ignorant one.

      July 9, 2012 at 22:53 | Report abuse |
  16. BO Failed

    Gender disorder is nothing form than freaks asking for us money to fund their fanaticism.

    July 7, 2012 at 15:18 | Report abuse | Reply
    • Kathryn

      I got SOME public assistance for my transition because I'm UNEMPLOYED, not because I'm trans. What we need is acceptance and the end of discrimination and ridicule. I was fired, legally, because I'm trans 2 years ago and I haven't been able to find work since due to discrimination. Haters like "BO Failed" would prefer trans-folks kill ourselves and not disrupt their closed-minded, and frankly, naive perception of society.

      July 7, 2012 at 17:32 | Report abuse |
    • Freyja

      Fanaticism? I've never heard it termed that before. Besides, you are not paying for someone's transition. There aren't government programs for that, in fact, most insurance companies won't cover trans related care,ALTHOUGH, most other countries in the developed world do include it within their National Healthcare Services. If you don't want to pay to help ease the suffering of transsexual individuals then you are in the right country.

      August 14, 2012 at 17:44 | Report abuse |
  17. Rithse

    DNA doesn't lie.

    July 9, 2012 at 16:59 | Report abuse | Reply
  18. Peter

    Some diseases can be prevented detecting early symptoms. There are number of tools like ESAGIL.ORG that can help online with medical diagnosis

    July 9, 2012 at 22:32 | Report abuse | Reply
  19. Icurheinie

    First of all, Chaz is a SHE. And there is nothing she can do to ever change the way she was born. Deal with your bodies people. It's your biological reality, the way God (or whoever it is up there) intended you to be. You can't put a Rolls Royce bumper on a Ford Pinto and call it a Rolls.

    July 9, 2012 at 22:52 | Report abuse | Reply
    • Freyja

      Wow, you seem to have extremely strong negative reactions to this. You do realize that you just sound like a hateful uneducated bigot, right? If that's what you are going for then you did it well, Icurheinie. Now, until you can come up with a civil and well-thought out response, one far better than 'Your daughter is the ignorant one', then please just continue your romp through life with a chip on your shoulder and head full of hate.

      August 14, 2012 at 17:49 | Report abuse |
  20. Freyja

    Hmm, well, one must first define sex. Sex is a socially constructed concept and it is up to each of us to define it for ourselves. For instance, one might say that sex is defined by genitals, another might say it is defined by chromosomes, or hormones, or secondary sex characteristics, or even mental sex. There are many ways to define it. In regards to the 'DNA doesn't lie' comment, no one REALLY knows what their chromosomal configuration is until tested. 'Abonormalities' in sex chromosomes are fairly common and it is really quite unknown for each individual until further testing.

    One could argue that a transsexual woman is, in fact, more of a woman than a cissexual (the term used for an individual who is comfortable with their at-birth anatomical configuration), in that they must fight to attain socially accepted womahood and therefore have an understanding of the value of it.

    You come at the concept of sex from a Platonic western philosophical tradition, having striking similarities to the idea of Forms in many regards BUT any scholar of Plato will tell you that one of the greatest issues with forms is that there is an epistomlogical relativism and you can never know the true character of a form, therein, the 'form' of sex could, in the Platonists world-view be in fact mental sex and nothing more.

    Before you start crucifying the individuals who suffer with being born with an uncomfortable anatomical configuration perhaps you all should better establish your arguements and think of the deeper connotations of your words before spouting silly things like 'DNA doesn't lie' or whatever.

    August 14, 2012 at 17:35 | Report abuse | Reply
    • POWMIA

      But what's wrong with instead treating the belief that these people are the other sex? There are two ways to approach this situation no matter how you define "sex" and no matter what causes transsexuals to be that way: (1) you can do as you suggest and change the patient's physical characteristics via surgery and hormone supplements, or (2) you can attempt to treat the underlying belief that they person was supposed to be a sex other than their sex at birth. If you can figure out why the patient believes they were born with the wrong body, and you devise a successful treatment for whatever the problem turns out to be, then you can avoid the dangerous, permanent, and highly invasive surgical option that you prefer. If the patient winds up being happy in their own body (the one they were born with) and you avoid physically altering the patient's otherwise perfectly functional physiology, then isn't that a preferable solution to yours, which requires drastic changes that can never be reversed?

      September 5, 2012 at 10:08 | Report abuse |
  21. Sharon Kay

    I think Chaz' body is still betrying him/her.

    August 30, 2012 at 15:52 | Report abuse | Reply
  22. Mikhaila

    The brain is definatly the most important sex organ. The need for decency and compassion is prerequisit to understanding that.Seperates us from the beasts. .

    September 4, 2012 at 23:03 | Report abuse | Reply
    • anonymous

      Thank you for this comment :-) <3 <3

      July 30, 2014 at 13:11 | Report abuse |
  23. Know some of 'em

    I'm a gay man and happy about it, but I know a lot of T's from the clubs.

    They're on *a lot* of drugs. This exacerbates their gender distress. It's a "vortex". They are vulnerable people and often get involved in –terrorism– and other antisocial activities in exchange for drugs, illicit favors, etc. If they could realize the drugs are making their gender dysphoric feelings worse, they perhaps could settle for a less drastic solution to their conundrum, such as living androgynously, taking "gender holidays", etc.

    Again, t's the drugs. I know I am going to get a lot of flack for this post, but in a sense, T people are exacerbating their own manageable problems enormously. P.S.: This is not true of all T's. Some of them abstain from drugs but are so unhappy with their gender that they make the switch anyhow.

    September 6, 2012 at 08:37 | Report abuse | Reply
    • ConvertingErica

      As a gay man, you know nothing of what it is like to be trans. I am an attractive, intelligent, witty professional woman, in my early 30's with 3 post graduate degrees, a great job in a large company, a family who loves me, friends who knew me before and those who met me after who support me, and I have never done drugs. Never. I have never provided illicit favors in exchange for anything. I know you were not saying that all of us are like that, and honestly, I don't know where you are getting it from that we are all like that, because I know many trans* people and I don't know ANYONE like the people you are describing!

      November 29, 2012 at 13:31 | Report abuse |
    • Gryphon

      Key phrase: "but I know a lot of T's from the clubs." I'm sure that the segment of any demographic that fequents the clubs will show a higher rate of drug use than those who don't. Its like saying "I know a lot of African Americans from the hood..." or "I know a lot of Christians from westboro baptist church"

      February 5, 2013 at 03:24 | Report abuse |
  24. Lucía Scoth

    My name is Mrs lucia from united kingdom i got married at the age of 30 i have only one child and i was living happily .After 5 year of my marriage my husband behavior became so strange and i don't really understand what was going on, he packed out of the house to another woman i love him so much that i never dreams of losing him, i try my possible best to make sure that my husband get back to me but all to no avail i cry seeking for help i discussed it with my best friend and she promise to help me he told me of a man called priest Aluta he is a very great man and a real man that can be trusted and there is nothing concerning love issues he cannot do that is why they call him the great doctor. I contacted him And i told him everything that happen all he told me is that i should not worry that all my problems will be solved immediately. He told me what to do to get my husband back and i did, he said after 4 days my husband will come back to me and start begging, it really happen i was very surprise and very happy our relationship was now very tight and we both live happily again.So my advice for you now is to contact this same email address traditionalspellhospital (@)gmail .com if you are in any kind of situation concerning love issues and any other things that give you problems contact him.
    THANKS..

    December 24, 2013 at 09:05 | Report abuse | Reply
  25. migma

    Does Chaz have a penis?

    December 27, 2013 at 16:45 | Report abuse | Reply

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