Discovered



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Gender Dysphoria and Autism Spectrum Disorders

Information for service users, parents and

Professionals *[1]

Contents:

• Introduction to Gender Dysphoria:

o What is Gender Dysphoria

o ASD and Gender Dysphoria

o Symptoms

o Causes

o Diagnosis

o Treatment

• Support and information

• Books and articles

• Professionals in Ireland

• Glossary of terms

Introduction

What is Gender Dysphoria/Gender Identity Disorder (GID)?

According to the DSM-V (2013), Gender Dysphoria is the distress resulting from an incongruence between assigned and experienced gender. In DSM-V, GID is the psychiatric diagnosis used when a person has (1) a strong and persistent cross-gender identification and (2) persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex, and the disturbance (3) is not concurrent with physical intersex condition and (4) causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

GID is a controversial issue. Many trans people see GID as an unwanted psychiatric diagnosis that is stigmatising and pathologising and does not represent their experience or does not acknowledge gender diversity. To others it is a useful diagnostic tool that accurately describes a medical condition and facilitates medical treatment. Some people prefer the term ‘gender dysphoria’ instead of GID; this avoids the negative connotation of the word ‘disorder’.

Estimates of Gender Dysphoria in adults range from 1:10,000 -1:20,000 in men and 1:30,0000-1:50,0000 in women (Zucker & Lawrence, 2009)

In most gender dysphoric children, gender dysphoria will cease when they reach puberty, whereas adolescents with a gender dysphoria will likely pursue their wish of sex reassignment into adulthood (Cohen-kettenis and Pfafflin 2003; Wallien and Cohen-Kettenis, 2008).

Gender Dysphoria and ASD:

There is a reported incidence of 7.8% ASD in the gender dysphoria population (Annelou et al, 2010) - this means that ASD occurs more frequently in gender dysphoric individuals than expected by chance. It is felt that this was an underestimation of the actual prevalence.

As with typical children and adolescents, children under 12 with a co-occurring ASD, gender dysphoria alleviated and in adolescents between 12-18 years their GID persisted.

Annelou et al (2010) also reported that:

-Individuals with an ASD frequently received a GID-NOS diagnosis: behaviours were sub threshold, atypical or unrealistic. (e.g. that social communication difficulty would be alleviated by taking estrogens).

Symptoms

In most cases, a person with gender dysphoria will begin to feel that something is wrong with their sex and gender identity during early childhood. For others, this may not happen until adulthood.

The behavioural symptoms of children, teenagers and adults with gender dysphoria are explained below. Recent research using the Empathy and Systemising Quotients have shown that on average adolescents with GID, specifically who are female-to-male, have lower empathy skills than typical peers. (Di Cegile et al, 2014)

Children: If a child has gender dysphoria, their behaviour may include:

• insisting that they are of the opposite sex

• disliking or refusing to wear clothes that are typically worn by their sex and wanting to wear clothes that are typically worn by the opposite sex

• disliking or refusing to take part in activities and games that are typically meant for their sex, and wanting to take part in activities and games that are typically meant for the opposite sex

• disliking or refusing to pass urine as their sex usually does, for example a boy may want to sit down to pass urine and a girl may want to stand up

• insisting or hoping that their genitals will change, for example a boy may want to be rid of his penis, and a girl may want to grow a penis

• feeling extreme distress at the physical changes of puberty

Children with gender dysphoria may display some or all of these types of behaviour. However, in many cases, behaviour such as this is just a part of childhood and does not necessarily mean that your child has gender dysphoria.

For example, many girls behave in a way that can be described as 'tomboyish', which is often seen as part of normal female development. It is also not uncommon for boys to role play as girls and to dress up in their mother's or sister's clothes. Although this may be seen as being less acceptable, it is usually nothing more than a phase.

Most children who behave in these ways do not have gender dysphoria and do not become transsexuals. Only in rare cases does the behaviour persist into the teenage years and adulthood.

Teenagers and adults: If the feelings of gender dysphoria are still present by the time a child is a teenager or adult, it is likely that they are not simply a phase or a stage of development.

If you are a teenager or an adult whose feelings of gender dysphoria started in childhood, you may now have a much clearer sense of your gender identity and the way you want to deal with it. Many people with extreme cases of gender dysphoria are fully transsexual by the time they are in their teens.

The ways that gender dysphoria affect teenagers and adults is different to the way that it affects children. If you are a teenager or adult with gender dysphoria, you may feel:

• without doubt that your gender identity is at odds with your sex

• comfortable only when in the gender role of your preferred gender identity

• a strong desire to hide or be rid of the physical signs of your sex, such as breasts, body hair and muscle definition

• a strong dislike for and a strong desire to change or be rid of the genitalia of your sex

These feelings can often be very difficult to deal with and, as a result, many transsexuals and people with gender dysphoria may experience depression or suicidal feelings.

Typical gender development

Much of the crucial gender development that determines your gender identity happens in the womb (uterus). During early pregnancy, all unborn babies are female because only the female sex chromosome (the X chromosome) that is inherited from the mother is active. At the eighth week of gestation, the sex chromosome that is inherited from the father becomes active, which can be either an X chromosome (female) or a Y chromosome (male).

If the sex chromosome that is inherited from the father is X, the unborn baby (foetus) will continue to develop as female with a surge of female hormones. The female hormones work in harmony on the brain, gonads (sex organs), genitals and reproductive organs, so that the sex and gender are both female.

If the sex chromosome that is inherited from the father is Y, the foetus will go on to develop as male. The Y chromosome causes a surge of testosterone and other male hormones, which initiates the development of male characteristics, such as testes. The testosterone and other hormones work in harmony on the brain, gonads (sex organs) and genitals, so that the sex and gender are both male.

Therefore, in most cases, a female baby has XX chromosomes and a male baby has XY chromosomes.

Causes

The exact cause of gender dysphoria is unknown and there is much debate over the condition's possible causes. 

Gender dysphoria was traditionally thought to be a purely psychiatric condition, which meant that its causes were believed to originate in the mind. However, recent studies have challenged this and suggested that gender dysphoria may have biological causes associated with the development of gender identity before birth.

More research is needed before the causes of gender dysphoria can be fully understood, but it is widely agreed that it cannot be thought of as a purely psychiatric condition.

Malfunctioning hormones

In rare cases, the hormones that trigger the development of sex and gender may not work properly on the brain, gonads and genitals, causing variations between them. For example, the sex (as determined physically by the gonads and genitals) could be male, while the gender (as determined by the brain) could be female.

This could be caused by additional hormones in the mother's system or by the foetus's insensitivity to the hormones, known as androgen insensitivity syndrome (AIS). In this way, gender dysphoria may be caused by hormones not working properly within the womb.

Other rare conditions

Other rare conditions, such as congenital adrenal hyperplasia (CAH), and intersex conditions (also known as hermaphroditism) may also result in gender dysphoria.

In CAH, a female foetus's adrenal glands (two small, triangular-shaped glands located above the kidneys) cause a high level of male hormones to be produced. This enlarges the female genitals. In some cases, they may be so enlarged that the baby is thought to be male when she is born.

Intersex conditions cause babies to be born with the genitalia of both sexes (or ambiguous genitalia). In such cases, it was recommended that the child's parents should choose which gender to bring up their child. However, it is now thought to be better to wait until the child can choose their own gender identity before any surgery is carried out to confirm it

Treatment

Treatment for gender dysphoria aims to help people with the condition live the way they want to in their preferred gender identity. What this means will vary from person to person, and some people will need more treatment than others.

Once you or your child has been diagnosed with gender dysphoria, different treatments can be considered. Counselling (a talking therapy) should be offered to you or your child about the range of available treatment options and their implications.

The various treatments for children and adults with gender dysphoria are detailed below.

Treatment for children

If your child is under 18 years of age, they should be referred to a specialist child and adolescent psychiatrist. These clinics can offer ongoing assessment for children with gender dysphoria, and specialised treatment and support for children and their families. Your child will be fully assessed before any treatment begins.

Your child's treatment should be arranged with a multi-disciplinary team (MDT), a team of different healthcare professionals working together. Your child's MDT may include:

• a mental health professional, who is trained in dealing with gender dysphoria in children and teenagers

• a paediatric endocrinologist, a specialist in hormone conditions in children

Children before puberty

If your child is diagnosed with gender dysphoria before they reach puberty (when a child progresses into a sexually developed adult), they will not receive endocrine treatment. Endocrine treatment is treatment with hormones (powerful chemicals). It is the first step to developing the physical signs of your preferred gender.

Guidelines from the Endocrine Society in the UK do not recommend endocrine treatment for young children because a diagnosis of transsexualism cannot be made before a child has reached puberty. Transsexualism is a life-long and extreme form of gender dysphoria, when someone seeks to change their sex.

The Endocrine Society found that 75-80% of children who were diagnosed with gender dysphoria before they reached puberty did not have the condition after puberty. Therefore, endocrine treatment is not recommended until after puberty, when a diagnosis of gender dysphoria can be confirmed.

Children up to 16

If your child has been diagnosed with transexualism and they have reached puberty, they may be treated with gonadotrophin-releasing hormone (GnRH) analogues. These are synthetic (manmade) hormones that suppress the hormones naturally produced by your body.

The recommendation for endocrine treatment must come from a mental health professional, and they must continue to be part of your child's ongoing care. An endocrinologist (a specialist in hormonal conditions) must also confirm your child's diagnosis.

Puberty is divided into stages. These are called Tanner stages, named after James Mourilyan Tanner who first identified them. GnRH analogues may be suitable for children who have reached Tanner stage two, which means a number of physical changes have taken place, such as pubic hair starting to grow. In girls, this is around 11 years of age and in boys it is around 12 years of age.

Some of the changes that take place during puberty are driven by hormones. For example, the hormone testosterone, which is produced by the testes in boys, helps stimulate the development of the penis. As GnRH analogues suppress the hormones that are produced by your child's body, they also suppress puberty.  

GnRH analogues can be taken until your child reaches 16 years of age, after which cross-sex hormones can be taken. 

Children over 16

If your child has been taking GnRH analogues for several years and are still diagnosed as transsexual, they may be offered cross-sex hormones. These can alter your child's body further to fit with their gender identity. The effects of these hormones are only partially reversible, so they are not offered to children who are under 16 years of age.

Once your child reaches adulthood at 18 years of age, they can begin the process of gender confirmation surgery, which will change their gender irreversibly (also known as transition). Not all children who experience gender dysphoria will go on to transition. In fact, the number of children who go on to become transsexuals is very small.

For more information about cross-sex hormone treatment and gender confirmation surgery, see the section below about treatment for adults.

The amount of treatment that your child has will depend on how strong and long-lasting their feelings of gender dysphoria are. However, all children and their families should be offered counselling and support through their gender identity clinic.

Treatment for adults

Adults who have been diagnosed with gender dysphoria and transsexuals should be referred to a specialist gender identity psychiatrist. They can offer ongoing assessment for people with gender dysphoria. They can also provide support and advice about living in your preferred gender role, including:

• mental health support

• hormone treatment

• ways to dress in your preferred gender role

• ways to behave in your preferred gender role 

• language and speech therapy

• hair removal treatments

• peer support groups to meet other people with gender dysphoria

• relatives' support groups for your family

For some people, support and advice from a clinic are all they need to feel comfortable in their gender identity. However, others will need more extensive treatment, such as a full transition from one sex to the other. The amount and extent of treatment you have is completely up to you.

Once you have been referred to a gender identity clinic, it is likely that you will have another full assessment, for a period of approximately three months. This will usually be with the input of a psychiatrist (a doctor who treats mental and emotional health conditions). This assessment is necessary to confirm your diagnosis and, if you want to have hormone therapy, means that you can take the necessary health tests first.

Cross-sex hormone therapy

Cross-sex hormone therapy means taking the hormones of your preferred gender:

• a trans man (female becoming a male) will take testosterone

• a trans woman (male becoming a female) will take oestrogen

The aim of hormone therapy is to make you more comfortable with yourself, both in your physical appearance and how you feel psychologically (mentally). These hormones start the process of changing your body into one that is more female or more male, depending on your gender identity.

Hormone therapy may be all the treatment you need to live with your gender dysphoria. The hormones may improve how you feel and mean that you do not need to start living in your preferred gender or have surgery.

Trans woman

If you are a trans woman, some of the changes that you may notice from hormone therapy include:

• your penis and testicles may get smaller

• you may have less muscle

• you may have more fat on your hips

• your breasts may become lumpy and may increase in size slightly

• you may have less facial and body hair

Hormone therapy will not affect the voice of a trans woman. To make the voice higher, trans women will need vocal therapy and possibly vocal cord or trachea (windpipe) surgery. Hormone therapy may make it harder to get an erection and have an orgasm.

Trans man

If you are a trans man, some of the changes that you may notice from hormone therapy include:

• you may have more body and facial hair

• you may have more muscle

• your clitoris (a small, sensitive part of the female genitals) may get bigger

• your periods may stop

• you may have an increased sex drive (libido)

Hormone therapy can also cause baldness and acne in trans men. Your voice may get slightly deeper, but it will not be as deep as other men's voices.

Monitoring

While you are taking these hormones, you will need to go for regular check-ups at your gender identity clinic. You will be assessed to find out whether the hormone treatment is benefiting you, as some people may find the effects of hormone treatment unpleasant.

If you do not think that hormone treatment is right for you, discuss it with the healthcare professionals who are treating you. If necessary, you can stop taking the hormones, although some changes are irreversible such as:

• a deeper voice in trans men

• breast growth in trans women

Alternatively, you may be frustrated with how long hormone therapy takes to produce results, as it can take a few months for some changes to develop. Hormones cannot change the shape of your skeleton, for example how wide your shoulders or your hips are. It also cannot change your height.

Hormones for gender dysphoria are also available from other sources, such as the internet, and it may be tempting to get them from here instead of through your clinic. However, hormones from other sources may not be licensed and, therefore, may not be safe. If you decide to use these hormones, let your clinic know so that they can monitor you.

Real life experience (RLE)

If you want to have gender confirmation surgery, you will first need to live in your preferred gender identity full time for at least a year. This is known as real life experience (RLE) and will help confirm that permanent surgery is the right decision.

Once your hormone treatment is under way, you can start as soon as you are ready with the support of your clinic. The length of RLE varies from person to person, but is usually between one and two years.

You may have various other surgical treatments during your RLE to prepare for full transition surgery, including:

• mastectomy (removal of the breasts) for trans men

• mammoplasty (cosmetic breast surgery) for trans women

• feminising facial surgery for trans women

Trans women should continue with hormone therapy for at least 18 months before having a mammoplasty to ensure that the treatment has had the maximum effect on the development of the breasts.

Gender confirmation surgery

Once you have completed your RLE and you and your multi-disciplinary team (MDT) feel that you are ready, you may decide to have surgery to permanently alter your sex.

Trans man surgery

For trans men, surgery may involve:

• a hysterectomy (removal of the womb)

• a salpingo-oophorectomy (removal of the fallopian tubes and ovaries)

• construction of a penis using a phalloplasty or a metoidioplasty

A phalloplasty uses the existing vaginal tissue and skin taken from the inner forearm to create a penis. A metoidioplasty involves creating a penis from the clitoris, which has been enlarged through hormone therapy.

The aim of this type of surgery is to create a functioning penis, which allows you to pass urine standing up and to retain sexual sensation. You may need to have more than one operation to achieve this.

Trans woman surgery

For trans women, surgery may involve:

• an orchidectomy (removal of the testes)

• a penectomy (removal of the penis)

• construction of a vagina from the leftover tissue of the penis (known as a vaginoplasty)

The vagina is created and lined with skin from the penis, and tissue from the scrotum (the sack that holds the testes) is used to create the labia. The urethra (urine tube) is shortened and repositioned. The aim of this type of surgery is to create a functioning vagina with an acceptable appearance and retained sexual sensation.

After surgery

After surgery, the vast majority of transsexuals are happy with their new sex and feel comfortable with their gender identity. One review of a number of studies that were carried out over the last 20 years found that 96% of people who had gender reassignment surgery were satisfied. However, some of these studies may not have been of high quality.

Following gender confirmation surgery, one possible complication is that people may face prejudice or discrimination because of their condition. Treatment can sometimes leave people feeling:

• isolated if they are not with people who understand what they are going through

• stressed about or afraid of not being accepted socially

• discriminated against at work

Sexual orientation

Once transition has been completed, it is possible for a trans man or woman to experience a change of sexual orientation. For example, a trans woman who was attracted to women before surgery may be attracted to men after surgery. However, this varies greatly from person to person, and the sexual orientation of many transsexuals does not change after transition.

If you are a transsexual going through the process of transition, you may not know what your sexual preference will be until it is complete. However, try not to let this worry you. For many people, the issue of sexual orientation is secondary to the process of transition itself.

-Feminine interests of many gender dysphoric young boys with ASD concerned soft tissues, glitter and long hair and could be understood as a sensory preference.

-the majority of gender dysphoric adolescents with ASD were sexually attracted to partners of the other sex.

Bibliography

Di Cegile et al. (2014). Empathising ad Systemising in Adolescents with Gender Dysphoria. Opticon1826, (16) 6, 1-8.

Zucker, K.J & A.A Lawrence. (2009). Epidemiology of gender identity disorder: recommendations for the standards of care of the world professional association for transgender health. International Journal of Transgenderism, 11, 8-18.

teni.ie

hse.ie



Support and information

TENI (Transgender Equality Network Ireland):

TENI is a non-profit organisation supporting the trans community in Ireland. TENI seeks to improve the situation and advance the rights and equality of trans people and their families. TENI is dedicated to ending transphobia, including stigma, discrimination and inequality and continues in the struggle for social, political and legal recognition of trans people in Ireland. 

teni.ie

Teni CORK

The Cork Transgender Peer Support Group meets on the third Tuesday of every month. The group is organised as autonomous peer support, meaning it is led by the group participants themselves with a facilitator. They offer an open, friendly and safe environment in which to explore questions, seek information and make friends. Confidentiality is respected and assured. Whether you are admitting to questions about your gender identity for the first time, are sure of your feelings and acting on them, or have completed a transition, you are welcome to attend.

Time 7.30pm-9.30pm

Venue The Other Place, 8 South Main Street, Cork

Contact Darrin on 085 108 3935 or corkteni

Trans Guys Ireland: a new online Irish Group for Trans Men - videos, blog and facebook group.







Transgender.ie is an online forum community covering various aspects of trans life in Ireland.

 

TranscendIreland is an inclusive Irish Transsexual forum dedicated to support, activism and lols with a liberal moderation philosophy. 

Organisations and Groups providing trans support in Ireland

BeLonG To

BeLonG To is an organisation for Lesbian, Gay, Bisexual and Trasgendered (LGBT) young people, aged between 14 and 23. Their group IndividualiTy is a social group for young trans people and those questioning their gender identity. It aims to provide a safe, positive and fun space where trans youth can relax, be themselves and make friends:



Gay + Lesbian Equality Network (GLEN)

Leading NGO with a track record of success in delivering positive change for lesbian, gay and bisexual people (LGB) in Ireland:



LGBT Diversity

The LGBT Diversity programme is a coordinated national response by twelve LGBT organisations, developed to build the capacity of the LGBT sector:



LGBTNoise

Independent non-party political group which is campaigning for the provision of civil marriage for all people in Ireland irrespective of gender and sexual identity. Noise is also active in highlighting other areas of discrimination against LGBT people:



Marriage Equality

Working for Civil Marriage for Gay and Lesbian people:



National Lesbian and Gay Federation

Irish voluntary non-governmental organisation (NGO) working for the betterment of Lesbian, Gay, Bisexual and Transgendered (LGBT) people:



The Other Place

A community and resource centre for LGBT people, their families and friends in Cork



ONLINE INFORMATION & SUPPORT

Transgender.ie

An Irish online trans forum.

TranscendIreland

An inclusive Irish Transsexual forum dedicated to support, activism and lols with a liberal moderation philosophy.

T-Vox

T-Vox aims to provide the most comprehensive advice, information and support website on the internet for genderqueer, intersex, transgender and transsexual people, their friends and their family.

Yay For Queers

This is a support group for new Trans folks. If you're looking for support, information, community, people to just talk to in real time, this is the place to be. (Please note that none of us is any kind of therapist; we're here as helpful friends, not proper counsellors.) We use the word Queers so as to be more inclusive of people who are questioning, and our friends/family/partners/allies. All respectful people are welcome in the channel.

We Happy Trans

A place for sharing positive trans experiences

FTM International

The longest-running, largest organization serving the female-to-male trans community in the world



This is an internet magazine for trans men, complete with written features on a variety of topic, product reviews, polls & surveys, and links to trans guy's blog:

Original Plumbing

Online quarterly that documents the diversity within trans male lifestyles through photographic portraits and essays, personal narratives and interviews:

Transition Resources for Trans Men

The Transitional Male

Information on health, surgery, transition, as well as resources and numerous FAQs.

Hudson's FTM Resource Guide

Information on binding, packing, shaving, surgery, hormone therapy and many other items of interest.

Supportive Books for Kids

10,000 Dresses, Marcus Ewert, Seven Stories Press, 2008. (6-9 years)

A modern fairy tale about becoming the person you feel you are inside. While Bailey dreams of beautiful dresses, no one wants to hear about it because he is a boy. Then an older girl comes along who is inspired by Bailey and they make beautiful dresses together.

The Adventures of Tulip, Birthday Wish Fairy, S. Bear Bergman, Flamingo Rampant, 2012. (5-9 years)

Follow Tulip as he deals with the birthday wishes of all the nine-year-olds in North America. Tulip receives a wish from a child known as David who wishes to live as Daniela. He doesn't understand how to help, so he seeks the wise counsel of the Wish Fairy Captain.

All I Want To Be Is Me, Phyllis Rothblatt, 2009. (5-9 years)

Gives voice to the feelings of children who don’t fit typical gender stereotypes, and who just want to be free to be themselves. Includes children who are fluid in their gender identity, as well as those that feel that their body doesn’t match who they really are.

Be Who You Are, Jennifer Carr. (6-10 years)

An elementary school age child called Nick feels like a girl inside. Nick starts school as a boy but draws a self-portrait as a girl. Nick’s family shows love and understanding. The child works with a gender counsellor and meets other children who have similar feelings. Nick decides to be called Hope and Hope’s parents work with the school to help with the adjustment.

The Boy in the Dress. David Williams and Quentin Blake (Illustrator), Razorbill, 2009. (10-13 years)

Dennis’s Dad is depressed since his Mom left and his brother is a bully. But at least he has soccer. Then he discovers he enjoys wearing a dress . Told with humour and respect.

Gender Now Activity Book: School Edition, Maya Christina Gonzalez, Reflection Press, 2011. (5-8 years)

A coloring and activity book that explores gender in its many forms. Looks at gender expression in history, nature and other cultures.

Play Free, McNall Mason and Max Suarez, MaxNme Studio, 2013. (5-7 years)

Journey in to the life and mind of a young gender variant boy who wants to be treated fairly and accepted for who he is. Colorful illustrations of assorted beings.

My Princess Boy, Cheryl Kilodavis, Aladdin, 2010. (5-8 years)

Dyson loves pink, sparkly things. Sometimes he wears dresses. Sometimes he wears jeans. He likes to wear his princess tiara, even when climbing trees. He's a Princess Boy.

Riding Freedom, Pam Muñoz Ryan, Blue Sky Press, 2002. (9-12 years)

A fictionalized account of the true story of Charley (Charlotte) Parkhurst who ran away from an orphanage, lived as a boy, moved to California, and became a stagecoach driver.

Wandering Son Series, Shimura Takako, Fantagraphics, 2011. (11 + years)

Shuichi and his new friend Yoshino have happy homes, loving families, and are well-liked. But they share a secret Shuichi is a boy who wants to be a girl, and Yoshino is a girl who wants to be a boy. Sensitive treatment of the topic. Manga. Translated from Japanese. Some explicit language.

Books that help Adults understand

Gender Born, Gender Made: Raising Healthy Gender-Nonconforming Children, Diane Ehrensaft, The

Experiment, 2011. A guidebook for the parents and therapists of children who do not identify with or behave according to their biological gender. Encourages caregivers to support gender-variant children as they explore

their gender identities.

Trans Forming Families: Real Stories About Transgendered Loved Ones. Mary Boenke (Editor), Oak

Knoll Press, 2003. Designed especially for families, friends and others interested in understanding and learning about transgender people. A quick read.

Transgender 101: A Simple Guide to a Complex Issue,

Nicholas M. Teich, Columbia University Press, 2012. A readable and thorough primer on the history, terminology, types, politics, and medical and social realities of the transgender population. Written for students, professionals, friends, and family members.

The Transgender Child: A Handbook for Families and Professionals, Stephanie A. Brill & Rachel Pepper, Cleis Press, 2008. A comprehensive guidebook on gender variance from birth through college. What will happen when your preschool son insists on wearing a dress to school? Is this ever just a phase? How can parents advocate for their children in elementary schools? What are the current laws? What do doctors and

therapists recommend?

Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their

Families, Arlene Istar Lev, Haworth Press, 2004. A guide for therapists working with transgender clients and their families from a clinical and theoretical perspective.

Transgender Explained For Those Who Are Not, Joanne Herman, AuthorHouse, 2009. Easy-to-read, short

explanations and stories by subject, designed for friends, family, colleagues, and journalists.

Transgender Warriors: Making History from Joan of Arc to Dennis Rodman, Leslie Feinberg, Beacon

Press, 1997. In this personal journey through history, the author uncovers persuasive evidence that throughout history there have always been people who crossed the cultural boundaries of sex and gender.

Transitions of the Heart: Stories of Love, Struggle and Acceptance by Mothers of Transgender and

Gender Variant Children, Rachel Pepper (Editor), Cleis Press, 2012. A collection by more than 30 mothers of diverse backgrounds and ages provides a window into what mothers of gender non-conforming children and

adults really think and feel about their children and their own journey of change.

Transparent: Love, Family, and Living the T with Transgender Teenagers, Cris Beam, Mariner Books,

2008. While volunteering at a school for gay and transgender kids, Cris found herself drawn into a pained and powerful group of transgirls. Both funny and heartbreaking. The girls struggle valiantly to resolve the gap between the way they feel inside and the way the world sees them.

Your Transgender Teen: A Guide for Parents, Irwin Krieger, Helping Genderwise Press, 2011. Krieger, as a clinical social worker, has years of experience helping transgender teens. Although written for parents, this

book is useful for paediatricians, therapists, educators and others who work with teenagers and young adults.

Information for professionals

1. Information for psychiatrists: Publication available to download at teni.ie



2. Information for psychologists: Publication available to download at teni.ie



3. Information for guidance counsellors: Publication available to download at teni.ie



4. Information on Gender Identity in the workplace. Available to download at teni.ie



Health Professionals and Clinics in Ireland with Gender Identity Experience. These are listed in alphabetical order.

GPS

Cork

Dr Paul John Deasy

Cove Street

South Street Bridge

Cork

Telephone: 021 4319453

Limerick

Corbally Clinic: Medical Centre & GP Surgery, Limerick

Dr Mary Gray

Corbally Road, Limerick

Telephone: 061 340 628



Dr Maurice Rowsome

Abbey River House

Charlotte Quay,

Limerick,

Telephone: 061 410355

 

Abbey River House, Charlotte Quay, Limerick, Co. Limerick 

t: +353 61 410355

- See more at:

Dr Maurice Rowsome

PSYCHOLOGISTS, COUNSELLORS AND THERAPISTS

Dr Lisa Brinkmann, Clinical Psychologist

Location: Clonakilty, West Cork

Email: mail@ 

Diamond Therapy Clinic

Provides general psychology services to individuals, couples and families: assessment, evaluation and psychotherapy services for people with gender identity issues.

Dr James Kelly's practice is now based at this clinic, in addition to:

Maria Cullen, MSc, Psychotherapist: available to see children and adolescents.

Rachel Moore, BA, BSc: Speech and Language therapist.  

Location: 79 Queen Street, Dublin 7

For contact details see the individual's listing.

Patricia Green, Counsellor

Location: Kerry

Mobile: 086 101 8702

Insight Matters

Supporting Mental Health through psychotherapy, counselling and training services.

Anne Marie Toole: Director, Psychotherapist and Counsellor

insightmatters.ie

am@insightmatters.ie

Dr James Kelly, Clinical Psychologist

Location: Diamond Therapy, 79 Queen Street, Dublin 7

Email: dr.jameskelly@

Mobile: 087 622 9972

Rachel Moore, Speech and Language Therapist

Rachel accepts referrals from medical and mental health professionals. Current patients of Dr Kelly's Clinic may also contact her directly. Walk-in appointments are also accepted.

Location: Diamond Therapy, 79 Queen Street, Dublin 7

Email: rachelmoore.slt@

Mobile: 086 412 5422

Suzanne Walsh, Counsellor/Psychotherapist

Location: Waterford 

Email: suzannewalsh@

Mobile: 087 742 8431

Karen Ward, Counsellor

Location: The Rhiannon Clinic, St Paul's Grounds, North King St, Smithfield, Dublin 7

Website: 

Email: kward@iol.ie

 

Glossary of terms (adapted from teni.ie)

Gender Identity: Refers to a person’s deeply-felt identification as male, female, or some other gender. This may or may not correspond to the sex they were assigned at birth.

Gender Expression: The external manifestation of a person’s gender identity. Gender can be expressed through mannerisms, grooming, physical characteristics, social interactions and speech patterns.

Sexual Orientation: Refers to a person’s physical, emotional or romantic attraction to another person. Sexual orientation is distinct from sex, gender identity and gender expression. Transgender people may identify as lesbian, gay, heterosexual, bisexual, pansexual, queer or asexual (see definition of Transgender).

Androgynous or androgyne: A person whose gender identity is both male and female, or neither male nor female. They might present as a combination of male and female or as sometimes male and sometimes female.

Cisgender: A non-trans person (i.e. a person whose gender identity and gender expression is aligned with the sex assigned at birth). Cisgender is a newer term which is beneficial in acknowledging that everyone has a gender identity (i.e. a non-trans identity is not presented as normal or natural which stigmatizes a trans identity as abnormal or unnatural).

Cissexism: The assumption that a cisgender identity is more authentic or natural than a trans identity. The belief that a person’s sex assigned at birth always remains their real gender (e.g. suggesting that a trans woman is ‘really a man’ or a trans man is ‘really a woman’).

Coming out: The process of accepting and telling others about one’s gender identity, gender expression or sexual orientation. Many trans people will ‘come out’ as a different gender to the sex assigned at birth and may begin a social or physical transition (see definition of Transition).

Crossdresser: A person who wears clothing, accessories, jewellery or make-up not traditionally or stereotypically associated with their assigned sex.

There are numerous motivations for crossdressing such as a need to express femininity/masculinity, artistic expression, performance (e.g. drag queen/king), or erotic enjoyment.

'Transvestite' is a term sometimes used instead of Crossdresser. However, this term is generally falling into disuse and may be considered derogatory by some. This is due to the fact that transvestite is used as a formal psychiatric/diagnostic term suggesting that a person crossdresses for sexual gratification, which can be stigmatising.

Drag king: A person with a female gender identity who performs, dresses or presents in a stereotypically masculine role for entertainment purposes.

Drag queen: A person with a male gender identity who performs, dresses or presents in a stereotypically feminine role for entertainment purposes.

Disorder of Sex Development (DSD): A generic definition encompassing any issue noted at birth where the genitalia are atypical in relation to the chromosomes or gonads. Since 2006, this is the preferred term for intersex by some, but not all, medical practitioners in the area. DSD has been contested because it presumes an underlying ‘disorder’ and that there is something intrinsically wrong with the intersexed body requiring it to be fixed as either male or female (see definition of Intersex and Variation of Sex Development).

FTM: A female-to-male trans person (see definition of Trans man).

Gender Identity Disorder (GID): In DSM-V, GID is the psychiatric diagnosis used when a person has (1) a strong and persistent cross-gender identification and (2) persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex, and the disturbance (3) is not concurrent with physical intersex condition and (4) causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

GID is a controversial issue. Many trans people see GID as an unwanted psychiatric diagnosis that is stigmatising and pathologising and does not represent their experience or does not acknowledge gender diversity. To others it is a useful diagnostic tool that accurately describes a medical condition and facilitates medical treatment. Some people prefer the term ‘gender dysphoria’ instead of GID; this avoids the negative connotation of the word ‘disorder’.

Genderqueer: A person whose gender varies from the traditional 'norm'; or who feels their gender identity is neither female nor male, both female and male, or a different gender identity altogether.

Gender variant: People whose gender identity and/or gender expression is different from traditional or stereotypical expectations of how a man or woman ‘should’ appear or behave.

Hormone Replacement Therapy (HRT) or Hormones: The use of hormones to alter secondary sex characteristics. Some trans people take hormones to align their bodies with their gender identities. Other trans people do not take hormones for many different reasons (see definition of Transition).

Hermaphrodite: Generally considered derogatory; has been replaced by the term intersex.

Intersex: Refers to a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t fit the typical definitions of female or male.

A person with an intersex condition may have elements of both male and female anatomy, have different internal organs than external organs, or have anatomy that is inconsistent with chromosomal sex. These conditions can be identified at birth (where there is obviously ambiguous genitalia), at puberty (when the person either fails to develop certain expected secondary sex characteristics, or develops characteristics that were not expected), later in adulthood (when fertility difficulties present) or on autopsy.

Many individuals who are intersex do not identify as transgender or do not consider themselves covered by the transgender umbrella.

MTF: Male-to-female trans person (see definition of Trans woman).

Sex Change: Generally considered derogatory; has been replaced by the terms 'transition' or 'surgery' (see definition of Transition and Surgery).

Surgery: A set of surgical procedures that alter a person’s physical appearance or the functioning of their existing sexual characteristics. Other terms include Gender Confirmation Surgery, Gender Reassignment Surgery, Sex Reassignment Surgery, Genital Reconstruction Surgery, Sex Affirmation Surgery and so on.

Some trans people undergo surgery to align their bodies with their gender identities. Other trans people do not undergo any surgery for many different reasons.

Some trans people define themselves by their surgical status such as post-operative (post-op), pre-operative (pre-op) or non-operative (non-op). However, these terms place emphasis on genitals as a marker for gender identity and may be rejected by people who do not see their gender as related to surgical status.

Tranny: A slang term for many different trans identities. Some find this term highly offensive, while others may be comfortable with it as a self-reference, but consider the term derogatory if used by outsiders. It is recommended to avoid using this term.

Transgender: Refers to a person whose gender identity and/or gender expression differs from the sex assigned to them at birth. This term can include diverse gender identities such as: transsexual, transgender, crossdresser, drag performer, androgynous, genderqueer, gender variant or differently gendered people.

Not all individuals with identities that are considered part of the transgender umbrella will refer to themselves as transgender. For some, this may be because they identify with a particular term (such as transsexual or genderqueer) which they feel more precisely describes their identity. Others may feel that their experience is a medical or temporary condition and not an identity (for example they feel they have gender identity disorder but are not transgender).

Trans or trans*: Commonly used shorthand for transgender.

Transphobia: The fear, dislike or hatred of people who are trans or are perceived to challenge conventional gender categories or ‘norms’ of male or female. Transphobia can result in individual and institutional discrimination, prejudice and violence against trans or gender variant people.

Transition: A process through which some transgender people begin to live as the gender with which they identify, rather than the one assigned at birth. Transition might include social, physical or legal changes such as coming out to family, friends, co-workers and others; changing one's appearance; changing one’s name, pronoun and sex designation on legal documents (e.g. driving licence or passport); and medical intervention (e.g. through hormones or surgery).

Transsexual: A person whose gender identity is 'opposite' to the sex assigned to them at birth. The term connotes a binary view of gender, moving from one polar identity to the other. Transsexual people may or may not take hormones or have surgery.

Trans man: A person who was assigned female at birth but who lives as a man or identifies as male. Some trans men make physical changes through hormones or surgery; others do not.

Trans man is sometimes used interchangeably with FTM (female-to-male). However, some trans men don’t think of themselves as having transitioned from female to male (i.e. because they always felt male). Some people prefer to be referred to as men rather than trans men while others will refer to themselves as men of transgender experience.

Trans woman: A person who was assigned male at birth but who lives as a woman or identifies as female. Some trans women make physical changes through hormones or surgery; others do not.

Trans woman is sometimes used interchangeably with MTF (male-to-female). However, some trans women don’t think of themselves as having transitioned from male to female (i.e. because they always felt female). Some people prefer to be referred to as women rather than trans women while others may refer to themselves as women of transgender experience.

Transvestite: See definition of 'Crossdresser.'

Variation of Sex Development (VSD): Another term for ‘intersex’ preferred by some medical practitioners and intersex people in place of DSD as it removes the stigma of 'disorder' from the nomenclature (see definition of Intersex and Disorder of Sex Development

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[1] The information in this booklet has been partially scourced from Teni.ie and hse.ie

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