Exact estimation of its prevalence is hindered by the social stigma attached to gender non-conformity and the lack of a standard definition.
Estimations of frequency vary widely, depending on the definition used and the population studied. Two key points stand out from the revision of the available studies: 1 an increasing number of children and adolescents visit multidisciplinary clinics for the evaluation and management of gender identity problems, and 2 while many children and adolescents sometimes behave as if they were members of the opposite sex, significantly fewer of them go on to desire physical or social transition to the opposite sex during adolescence or adulthood..
On 28 September the European Parliament passed a binding text for all member states on sexual orientation and gender identity. We are progressing towards a substantial step that requires the reformulation of Spanish protocols and standards for treating people with GID in many aspects, including the de-pathologisation of GID in general. The diagnostic criteria used in the fifth edition of the DSM are relevant. Section F64 of the ICD applies almost the same change, although it is unclear whether GID is included in the new context following its re-definition as no longer a mental disorder.
These are standards of care for the healthcare of transsexual and transgender individuals as well as those with gender non-conformity, and they include a specific chapter on the care and treatment of children and adolescents with GID. Although psychotherapy disappears as an eligibility criterion, they underline the fact that apart from making the diagnosis, psychiatrists or clinical psychologists also advise patients to help them in their transition as far as is possible.
International standards recommend: - A positive evaluation of GID that makes it possible to confirm the suitability of hormone therapy, together with patient consent, all in a letter to the endocrinology specialist that also requests that the mental health specialist confirms this by telephone if he does not form a part of the multidisciplinary team in the same hospital..
No period of real-life experience is required, as this term has been completely eliminated from the seventh version of the Care Standards the sixth version required having lived for 3 months in the desired role of the opposite sex [real-life experience] or having undergone 3 months of psychotherapy before the administration of hormones, as well as diagnosis and examination by the clinical specialist ; hormone treatment is only a recommendable criterion, and it is not obligatory.
For sex reassignment surgery it is necessary to have lived for one year in the role of the desired sex, apart from recommendation by the mental health specialist. Eligibility for access to relatively minor surgical operations mastectomy or mammoplasty requires: documentation accrediting persistent GID, patient capacity to take informed decisions, a minimum age and, if concomitant psychopathologies exist, they have to be properly controlled.
At least 12 months of hormone therapy is required in the case of mammoplasty so that the breasts can develop sufficiently.. There are different requisites for sex reassignment surgery depending on the operation in question:. Ovariectomy-hysterectomy and orchiectomy: 2 independent psychomedical reports are required together with uninterrupted hormone therapy during at least 12 months unless contraindications exist, the patient experiences a reaction or lacks resources.. Genital sex reassignment phalloplasty or vaginoplasty : apart from the evaluation of GID and continuous hormone therapy during 12 months, this requires having lived uninterruptedly for one year in the gender role congruent with the gender identity of the patient.
The whole process evaluation of GID, hormone therapy and living in the desired role may be completed in one year, with multidisciplinary collaboration by different doctors. The new Spanish guide for the care of individuals with GID, which updates the first version of the guide that was published in , stands out for its richness of details and numerous explanations, as well as because it is written in a language aimed at the different specialists involved psychiatrists, psychologists and plastic surgeons, etc. The 10 functions of Mental Health Workers..
It sets a time criterion of 6 months and requires 6 of the 8 indicators in criterion A. The presence of the first indicator A1 is a necessary but not sufficient condition for the diagnosis. This makes the 2 criteria which refer to physical anatomy or sexual characteristics unnecessary. Unlike the previous manuals, the DSM-V does not exclude people with sexual differentiation disorders.
Gender dysphoria in children, It is not clear exactly when children learn about gender. Nevertheless, they are aware of gender differences during infancy. At this age the majority of children play with the toys and games that correspond to their anatomic sex.
Caring for individuals with a difference of sex development (DSD): a Consensus Statement
Although at first children may consider gender to be subject to variation and change, by the age of 5 or 6 years old their vision of gender is more constant.. Young children accept gender stereotypes for themselves and others; preschool children start sexual segregation, playing more with their companions of the same sex.
They promote social constructions that can be generalised together with roles and rules that fit their gender.