Gender incongruence in children, adolescents, and adults

Susan Bewley; Damian Clifford; Margaret McCartney; Richard Byng

doi:10.3399/bjgp19X701909

Article Figures & Data

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Medical uncertainties	Response
What are the causes of gender dysphoria?	The causes of feeling uncomfortable with one’s biological sex are unclear but likely to be multifactorial and include society’s expectations of gender roles.
Is there a biological basis for the concept of ‘being born in the wrong body’?	Humans are sexually dimorphic, with rare intersex conditions being anomalous developments of dimorphic sexual classes. It is not possible to change biological sex. There is no agreed scientific basis for someone having the mind of someone from the opposite sex or being born in the wrong body.
How should a child or young person questioning their sexual or gender identity be supported?	Questioning is a normal part of growing up, as is discomfort during puberty. Young people should be encouraged to talk about their worries as they may not have other people they can trust outside of peer groups.
What do shared decision making look like in the absence of evidence?	Generalists should feel confident and supported to explore the potential links between gender questioning, emotions and cognitions, and the cultural context. Differences in views are likely to occur and provide the basis for each party to shift position.
How should we advise patients about the outcomes of medical treatments given the paucity of evidence?	Medical practitioners should be open and clear that, while satisfaction has been high for previous cohorts, we know little about the impact on physical (for example, fertility), emotional, and social (future intimate relationships) outcomes for the current younger and mainly female group presenting.