Reference no: EM133485755

A 25-year-old patient called Charles requested gender affirmation surgery. Charles had been born a female but for 3 years had lived socially and been employed as a male. For the past two years, Charles had been the house maker, economic provider, and husband-equivalent of a bisexual woman who had fled from a bad marriage. Her two young children regarded Charles as their stepfather, and there was a strong affectionate bond between them.

The patient appeared to have experienced delayed sexual development in puberty and may have been hormonally deficient. Charles' voice was pitched low, but not as low as most males. Bulky clothing was worn to camouflage tightly bound, flattened breasts. A strap-on penis produced a masculine looking bulge in the pants; it was so constructed that, in case of social necessity, it could be used for urinating in the standing position. Without success the patient had tried to obtain a mastectomy so that in summer only a T-shirt could be worn while working outdoors as a heavy construction machine operator. Charles had also been unsuccessful in trying to get a prescription for testosterone, to produce male secondary sex characteristics and suppressed menstruation.

The history was straightforward and its account of progressive recognition in adolescence of being able to fall in love only with a woman, following a tomboyish childhood that finally consolidated into a transgender identity.

Physical examination revealed normal female anatomy, which the patient found personally repulsive, incongruous, and the source of continual distress. The endocrine laboratory results were within normal limits for a female.

a. Dissociative Identity Disorder

b. Gender Dysphoria

c. Body Dysmorphic Disorder

d. Schizophrenia

e. Depersonalization/Derealization Disorder