Gender identity disorder has become a controversial topic over the last few decades. research on the medical and psychological protocols a person would need to follow if considering gender reassignment

Perform a search on the Internet or the online library (LIRN) for the term "gender identity disorder." Find at least one-peer-reviewed professional resource in LIRN.

 

The term gender dysphoria appears as a diagnosis for the first time in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to refer to those persons with a marked incongruence between their experienced or expressed gender and the one they were assigned at birth. It was known as gender identity disorder in the previous edition of DSM. The term gender identity refers to the sense one has of being male or female, which corresponds most often to the person's anatomical sex. Persons with gender dysphoria express their discontent with their assigned sex as a desire to have the body of the other sex or to be regarded socially as a person of the other sex. 

Step-by-step explanation

The term gender dysphoria appears as a diagnosis for the first time in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to refer to those persons with a marked incongruence between their experienced or expressed gender and the one they were assigned at birth. It was known as gender identity disorder in the previous edition of DSM. The term gender identity refers to the sense one has of being male or female, which corresponds most often to the person's anatomical sex. Persons with gender dysphoria express their discontent with their assigned sex as a desire to have the body of the other sex or to be regarded socially as a person of the other sex. 

Protocols for gender reassignment surgery depends per institution, as well as per health insurance company covering the procedure. The following protocol is cited from the BlueCross BlueShield of Western New York website:

Gender reassignment surgery is the irreversible component of a treatment regime which may also include psychotherapy and hormone therapy. A variety of surgical procedures may be directed at altering an individual's physical appearance and function to align with that of the desired gender (i.e., male to female or female to male). The permanency of surgical intervention necessitates that medical and psychological evaluations, behavioral trials, and medical treatment are considered prior to this final step.

POLICY

Gender reassignment surgery may be considered medically necessary when all of the following criteria are met:

1. The individual is 18 years of age or older or 21 years of age or older if the surgery will result in sterilization; and
2. The individual has capacity to make fully informed decisions and consent for treatment; and
3. The individual has a persistent and well documented diagnosis of gender dysphoria and has been an active participant in a gender dysphoria treatment program with a Licensed, Qualified Behavioral Health Specialist. 

GENITAL SURGERIES

In addition to the criteria 1-3, criteria 4-6 must also be met for individuals undergoing the following genital surgeries: (female to male) hysterectomy, ovariectomy and (male to female) orchiectomy:

4. The individual has undergone a minimum of 12 months of continuous hormonal therapy when recommended by a mental health professional and provided under the supervision of a physician, unless medically contraindicated or the individual is otherwise unable or unwilling to take hormones; and

5. Any significant medical or mental health diagnosis that is present including severe psychiatric disorders and impaired reality testing (e.g., psychotic episodes, bipolar disorder, dissociative identity disorder, borderline personality disorder) which may require psychotropic medications and/or psychotherapy, and including Substance Use Disorder, must be reasonably well controlled before surgery is contemplated; and

6. Two referrals from qualified mental health professionals who have independently assessed the individual are documented. The first referral must be from the individual's qualified mental health professional that has had the treatment relationship with the individual and the second referral should be from a qualified mental health professional with clinical expertise in this area who has only had an evaluative role with the individual.

Note: Criterion 7 is required in addition to criteria 1-3 and 4-6, only for (female to male) metoidioplasty, phalloplasty and (male to female) vaginoplasty.

7. Documentation (including the start date) that the individual has completed a minimum of 12 months of successful continuous full time living in the social role congruent with their desired gender which encompasses all life experiences expected to occur as part of family, work and social relationships. (see Policy Guidelines) BREAST/CHEST SURGERY In addition to the criteria 1-3 and 5 above, the following criterion must also be met for individuals undergoing breast/chest surgeries:

8. One referral from a qualified mental health professional who has independently assessed the individual is documented.

Gender reassignment surgery is considered not medically necessary when one or more of the criteria above have not been met.

A review by Masumori (2012), diagnostic procedures based on the Diagnostic and Therapeutic Guidelines for Patients with Gender Identity Disorder, 4th edition in Japan are briefly described, along with the etiology and epidemiology of GID (gender identity disorder). In addition, physical treatments, especially the details of surgical procedures and outcomes of SRS at Sapporo Medical University, Sapporo, Japan, are introduced. Finally, clinical problems of physical treatment of GID in Japan are discussed as well.

The diagnosis and treatment of GID in Japan are based on the Diagnostic and Therapeutic Guidelines for Patients with Gender Identity Disorder, 4th edition.  A medical care team composed of experts who have an understanding of and interest in diagnosis and treatment of GID in various fields is organized, and gender identity is determined after a detailed interview regarding the histories of nurture, lifestyle and sexual behavior, the actual status of gender dysphoria, such as a discomfort and disgust with one's sex, a strong and persistent cross?sex identification and requirement for a cross?gender role, are investigated according to the DSM?IV?TR1 and ICD?10.

Treatment of GID is divided into treatment in the psychiatric field and physical treatment. Treatment in the psychiatric field consists of psychological support (taking a history of present illnesses, empathy and acceptance), preparation for coming out to family, friends and co?workers, and real?life experience. Real?life experience is a trial in which the patients are required to live as their desired sex in everyday activity to assess whether such a situation is acceptable in daily life and if it is possible to overcome problems and/or difficulties in daily life as the opposite sex, if there are any. It is mandatory to confirm whether the patient can calmly deal with the various situations. In the guidelines, there is no minimal requirement for the duration of treatment in the psychiatric field, though usually more than 12 months of real?life experience is necessary to consider the start of physical treatment. Treatment in the psychiatric field is continued during and even after physical treatment.

Physical treatments, such as administration of cross?sex steroids, mastectomy for FtM and SRS, are considered if the patients desire it. The medical team has to inform the patients of the benefits and risks of physical treatment to facilitate their self?determination. The patients can select any type of physical treatment with any order based on their self?responsibility. The indication for physical treatment must be comprehensively deliberated on by the medical team and the ethical committee. A persistence of incongruence between physiological sex and gender identity with strong suffering even after treatment in the psychiatric field, sufficient preparation for psychological, family and social difficulties according to the change in physical appearance, and coping ability with unpredictable events are also necessary conditions to transit to physical treatment.