Gender Identity Disorder

Gender identity disorder (GID) is identified by strong and long-lasting gender identification that is opposite to one's biological sex. A person with this condition insists that he or she is of the other sex or desires to be the opposite sex. People with this condition are often referred to as transsexuals.

What Is Gender Identity Disorder?

To understand this disorder, a few terms must be defined:

• Gender: is the category (male or female) a person is assigned to on the basis of sex. The term is used in discussing the different roles, identities, and expectations that our society associates with males and females.
• Gender identity: This term refers to a person's own perception of their maleness or femaleness.
• Feminine and masculine: These terms often are used to describe behaviors generally associated with females or males. For example, contact sports have long been considered primarily masculine activities, and taking care of babies has been considered a feminine activity.
• Sex: This term usually refers to the biological (physical) differences between females and males. Specifically, these characteristics are the sex chromosomes ^* and certain anatomical features, for example, the penis or the vulva ^* .

Some people identify with, or conform to, traditional roles and expectations the culture sets for males and females. Others do not. For example, someone who is biologically female may like to play football, and someone who is biologically male may like to ballet dance. Still, under most circumstances, this does not interfere with people's sense that that they are female or male, and does not mean that they have gender identity disorder.

What Is Cross-Gender Identification?

GID goes beyond a failure or reluctance to identify with traditional roles or expectations about being female or male. A person with GID who is biologically female has the sense of being male. Likewise, a person with GID who is biologically male has a strong inner sense of being a female. When cross-gender identification causes much distress or impairs a person's functioning in life, that person is said to have GID.

Distress

GID distress may result in a person's refusal to attend school or social events where feminine or masculine clothing or behavior is expected, because they fear teasing or rejection by their peers. This may result in isolation from other children because of the person's insistence on behaving and acting like a member of the opposite sex. Children with this disorder often express wishes to be the other sex or beliefs that they will "grow up to be" the opposite sex. Young children with this condition may be unhappy about their assigned sex. Older children may fail to develop age-appropriate same-sex relationships with their peers. For adolescents, GID can be very difficult, because the person may struggle with feelings of uncertainty about the cross-gender identification or be concerned about being unacceptable to his or her own family or peers.

Intersex conditions

GID is not the same as physical intersex conditions. Intersex conditions may be marked, for example, by genitals ^* that are not completely male or female. Or the person with this condition may be genetically ^* male but physically female (or the reverse). For example, a male with an intersex condition would have the XY sex chromosomes of males, even though his genitals might appear female. GID should not be confused with nonconformity to traditional or typical gender roles, as may be seen in the case of "tomboyism" or "stay-at-home dads." People who do not conform with all aspects of traditional gender roles seldom have any desire to be the opposite sex.

Cross-dressing

There also is a difference between GID and transvestitism. A person who is a transvestite becomes sexually excited by dressing in the clothes of the opposite sex, that is, cross-dressing. This behavior, engaged in for the sole purpose of sexual excitement, most often occurs among heterosexual ^* or bisexual ^* men. Transsexuals (people with GID) cross-dress to gain a sense of physical and emotional completeness rather than sexual excitement.

Sexual Reassignment

The causes of GID are uncertain. Some researchers think that biological factors play a role, and others think that environmental factors, such as social learning, are involved. No one can really say why GID occurs. The more important question may be how to resolve the problems that GID may create.

The distress GID causes is real, and, for some adults with this condition, the only effective relief for this distress is a sex-reassignment procedure, which usually involves sex-change operations. These procedures are the subject of a great deal of controversy, and the scientific community continues to debate the possible benefits of sex-change surgery. These procedures can take several years to complete.

Screening

These sex-change procedures begin with lengthy and detailed screening interviews. These interviews determine the existence and severity of GID. The person then is instructed about adopting a lifestyle that agrees with his or her gender identity. If people successfully adjust to this lifestyle change over a period of several months to a year, they begin hormone therapy to develop more of the physical traits of the desired sex. This step also can last one year or longer.

Surgery and other treatment

If the person continues to adjust successfully to these activities, the final stage is hormone ^* therapy and sex-change surgery. For males wishing to become females, hormone treatments may produce enough breast development, although some people choose later to have breast enlargement surgeries. In male to female reassignment, body and facial hair growth is reduced by the hormone treatments and hair may also be removed by electrolysis ^* . People who undergo sex-change surgery to become females are able to have sexual intercourse.

Females wishing to become males have surgeries to remove the breasts, the uterus ^* , and the ovaries ^* and to seal off the vagina ^* . The operation to construct a penis is extremely complicated, and the resulting penis is not capable of a natural erection. There are, however, artificial devices available that can help the person successfully engage in sexual intercourse.

Follow-up

There have been several worldwide studies conducted to assess the outcomes of sex-change surgery. These studies have shown that 9 of 10 transsexuals who undergo hormonal and surgical sex-reassignment procedures experience a satisfactory result. One of the studies found that 94 percent of the people who underwent the surgery and answered questionnaires stated that if they had it to do over again, they would make the same choice.