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Some case reports of boys noted that an actual physical loss of the mother (or a mother surrogate) preceded the emergence of feminine behaviors (e.g., Gilpin et al. 1979; Wallach 1961). This…

Influenced by Stoller’s (1968) claim that extremely feminine boys did not experience internalized conflict - and thus were not amenable to psychoanalysis - Green et al. (1972) developed a more eclectic and…

There is a large case report literature on the treatment of children with GID using psychoanalysis, psychoanalytic psychotherapy, or psychotherapy, some of which is quite detailed and…

Follow-up studies of boys with GID, largely untreated, indicate that homosexuality, not transsexualism, is the most common long-term psychosexual outcome (Green 1987). Some parents of children with GID request treatment, in part,…

In the DSM, the presence of a disorder, by definition, assumes that there is associated distress and/or impairment. Although the assessment of distress in child psychiatric disorders, including GID,…

A fourth rationale for the treatment of GID during childhood is that such treatment might prevent its continuation into adolescence and adulthood. For many clinicians, there is little disagreement…

Several theoretical perspectives suggest that GID in children originates within the context of family factors or psychopathology. Such factors include parental conflict and trauma related to gender identity issues in their own life…

As a point of departure, let us consider five rationales for intervention that have been discussed in the treatment literature to date.

Persons with GID are often economically disadvantaged as a result of legal discrimination in the workplace and inability to access appropriate medical and psychiatric health care. Some patients resort…

All treatment decisions involve the tacit decision to treat or to withhold treatment. Although often not expressed, the “not to treat” side of the analysis of risks versus…

Sex reassignment surgery (SRS), also referred to as gender confirmation (Hage et al. 1997) or “reconfirmation” surgery (Laub 1987), is generally considered the “icing on the cake” for gender-dysphoric…

Patients with GID often require ancillary treatments to improve their quality of life and their likelihood of being accepted in the opposite-gender role. Although the latter goal is not universally sought after…

FTM transsexuals have little in common with MTF patients other than their basic problem of gender dysphoria and confronting a society that is generally staunchly dichotomous in its approach to gender. Otherwise,…

Psychotherapy, which historically has been viewed as an adjunct treatment for gender disorder patients (especially surgery candidates) and only more recently as a primary treatment, has been successful in informing…

Cross-sex hormonal treatments play an important role in the psychological and anatomic gender transition process for properly selected adult patients with GID. Internationally recognized Standards of Care indicate that such…

Patients with severe and prolonged symptoms of gender dysphoria are described as desperate or intensely compelled individuals who have a “frantic preoccupation” (Stoller and Herdt 1982) with opposite-gender hormonal treatment and…

In the clinical assessment of patients, all aspects of sexual identity, sexual role, and sexual behaviors should be approached as variables independent of gender identity and role. One of the problems…

Although histories of psychiatric treatments for substance abuse, adolescent adjustment disorders, serious suicidal thoughts, and depression are not uncommon in gender-dysphoric patients (Dixen et al. 1984), there is no evidence of…

Patients with GID typically range from age 13 to 60 years, although some patients are referred as early as 4 years of age (Green 1974) and some as late as…

Most mental health clinicians will be asked to evaluate or treat at least one, if not more, patients with a GID during his or her career. This section is designed to inform…

Transvestic fetishism is a chronic condition that has its onset in the first decade of life and is characterized by a natural history that includes highly variable frequencies of cross-dressing and “remissions,” lasting from…

Marital partners of transvestites are more likely than their husbands to seek treatment from a psychiatrist (G. R. Brown 1994). In Prince and Bentler’s (1972) survey of 504 subscribers to a transvestite…

Prior to a discussion of treatment, it should be noted that some authors have questioned whether the act of cross-dressing in itself constitutes a psychiatric disorder meriting treatment (Brierley 1979; G. R. Brown 1995; Gert…