And the researchers also found disagreement as to the minimum age at which gender reassignment therapy is considered safe, and that therapy options offered to individual patients seem to depend on the individual psychiatrist.

Gender identity disorder is characterised by a strong and persistent desire to be the opposite sex, together with discomfort with one's own sex. It is estimated that, worldwide, between 0.001 and 0.002 per cent of people are affected by this disorder.

Dr Joost a Campo, from Mondriaan Zorggroep Hospital in Heerlen, and colleagues observed that a patient with delusional schizophrenia exhibited cross-gender confusion which disappeared once his schizophrenia had been successfully treated.

This suggested that cross-gender delusions in schizophrenic patients could mimic true cross-gender identification in patients with gender identity disorder, presenting psychiatrists with considerable diagnosis and treatment difficulties. However, a literature search failed to identify how frequently this diagnostic difficulty occurred.

To address this, Dr a Campo and colleagues sent questionnaires to 382 Dutch psychiatrists, asking about their experiences diagnosing and treating patients with gender identity disorder. A total of 186 psychiatrists replied, and provided information on 584 patients with cross-gender identification difficulties.

The research team found that in 39 per cent of the cases reported, gender identity disorder was the primary diagnosis. In three-quarters of the remaining patients, gender identity confusion was secondary to other psychiatric disorders, such as mood disorders, dissociative disorders, or psychotic disorders.

However, of 142 psychiatrists who had actually treated patients with cross-gender confusion, only 40 had ever referred a patient to a gender reassignment clinic, and 30 of these had only referred one patient.

And the researchers also found that only 51 per cent of psychiatrists were willing to specify at what age it was appropriate to start gender reassignment therapy.

Reference: a Campo et al, American Journal of Psychiatry 2003;160:1332-1336

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Last updated: 07/28/2003 - 08:27 PM