A Sound Mind in a Sound Body: Psychological Support for Gender Dysphoria

In discussions about transgender individuals, topics often cover medical interventions like gender reassignment surgery or hormone replacement therapy. Seldom do people talk about psychological education and support. Maria Teresa Gustilo Villasor, PhD, a Clinical Psychologist from the Philippines’ premier health institution Makati Medical Center, asserts that psychoeducation and counseling are necessary, and should actually be the first steps for anyone dealing with transgender issues.
 
“Transgender” is used to describe people whose sex at birth and their own internal gender identity do not match. “Gender identity” is a person’s internal sense of being a man or a woman.
 
People in the transgender community may describe themselves using one or more terms, including (but not limited to) transgender, transsexual, genderqueer, trans man (female at birth but whose gender identity is that of a man) or trans woman (male at birth but whose gender identity is that of a woman). The terms “gay”, “lesbian”, or “bisexual”, on the other hand, refer to sexual orientation, or who a person is attracted to. 
 
Transgender people often seek ways to bring their bodies in alignment with their internal gender identity, as this misalignment often causes physical distress and unhappiness. According to Dr. Gustilo-Villasor, adolescents with gender dysphoria—a condition where a person experiences discomfort or distress because there’s a mismatch between their biological sex and gender identity—are particularly at risk for depression, suicidal thoughts, and suicide attempts.
 
“Psychoeducation followed by counseling are primary tools in dealing with transgender issues and establishing mental health,” she says. “Research shows that family acceptance — along with peer support and identity pride — are strong predictors of resilience for transgender people. A transgender person’s sense of well-being is enhanced when those around him/her have a better understanding of the condition.”
 
She cites studies showing that “developing interventions focused on increasing family and peer support as instrumental in buffering the effects of stigma and abuse that transgender people face in the family and workplace.”
 
Other than stigma and abuse, the transgender community also faces the issue of not getting access to proper healthcare. “Getting better access to healthcare is a major issue for the transgender community, especially in reducing HIV risk,” she says. “In the 2011 Injustice at Every Turn survey, 19 percent of respondents said they were denied medical care because of their gender identity and half of those surveyed had to teach their medical providers about transgender healthcare.”
 
Dr. Gustilo-Villasor says gender dysphoria can be experienced at a young age. In children, the disturbance may manifest early. To make a diagnosis of gender dysphoria, six or more of the symptoms listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders V) should occur for a duration of at least six months. The symptoms include (partial list only): repeatedly stated desire to be, or insistence that he or she is, the other sex; in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing; and a strong rejection of typical toys or games typically played by one’s sex.
 
“Many individuals with gender dysphoria become socially isolated, whether by choice or through ostracization or exclusion by peers.  This can contribute to low self-esteem and may lead to school aversion or even dropping out,” Dr. Villasor adds. “Peer ostracism and teasing are especially common for boys. The disturbance can be so pervasive that the mental lives of some individuals revolve around activities that lessen gender distress. They are often preoccupied with appearance, especially early in the transition to living in the opposite sex role.”
 
Treatment for gender dysphoria aims to help people with the condition to live the way they want to, in their preferred gender identity. This has to be taken in the context of the society and culture one lives in. It is recommended that a team of specialists together with the patient work on a treatment tailored to patient’s needs. Dr. Gustilo-Villasor noted that “gender dysphoria exists in the Philippines, however, its diagnosis and treatment respects cultural, religious, and social norms. For this reason, medical intervention and surgical services generally offered for this condition are not readily available in the Philippines.”
 
Without readily available medical or surgical services for this condition, some individuals with gender dysphoria resort to self-medication and hormonal pills or injections with hormones. Hormones control most major bodily functions, from hunger to reproduction. Among these are the sex hormones: the male hormone, testosterone, and the female hormone, estrogen. During adolescence, sex hormones prompt the development of secondary sex characteristics. For girls, these include breasts and menstrual periods. For boys, these include a prominent Adam’s apple and deepening of the voice. For transgender people who wish to change their bodies to be more feminine (male to female) or masculine (female to male), they may undergo hormone replacement therapy (HRT). Some resort to buying their hormone products online and taking them alone, essentially self-medicating.
 
“There’s some uncertainty about the possible risks of long-term masculinizing and feminizing hormone treatment.  Awareness of potential risks and the importance of regular monitoring before treatment begins is necessary,” says Dr. Gustilo-Villasor.
 
“If you or someone you know exhibit symptoms of gender dysphoria, please consider seeking psychological help first before any other intervention,” says Dr. Gustilo-Villasor. “Psychologists and psychiatrists can offer much-needed support to help you or the people you love understand what you are going through.”
 
 
For more information, please contact MakatiMed On-Call at +632.8888 999, email [email protected], or visit www.makatimed.net.ph.