Sir,
Gender dysphoria (GD) is defined as a marked incongruence between their experienced or expressed gender and the one they were assigned at birth.[1] Persons with GD are not able to correlate to their gender expression when identifying themselves within traditional societal gender roles.
A 17-year-old male from low socioeconomic status presented with headache and repeated thoughts to perform sexual interaction with a male partner for the past 7 years. He also had depressive symptoms with suicidal ideas with a history of suicidal attempts. There was no physical ambiguity regarding his male sex at birth. During early age, he preferred to play with girls and enjoyed the role of females. He had constant feelings to be a female. His first sexual experience was homosexual, as a passive partner. Due to fear of social outcasting, he felt being forced to change his orientation. He was diagnosed with GD with severe depressive episodes and treatment was initiated.
His family members were informed, but they insisted to change his orientation. He firmly believed that society will not accept him if he preferred to remain with homosexual orientation. Therefore, he did not consider any treatment options suitable for him.
GD is a difficult psychiatric condition to deal and treat, especially in individuals with orthodox and low socioeconomic backgrounds. The case highlights the conflicts faced by the individuals having GD. The index case is battling with myriad of emotions and prefers to seek psychiatric help to make sense of his concerns. He is indecisive as the societal pressures are forcing him to be with his assigned gender, but he enjoys to be the opposite. His fears can be attributed to “homophobia,” a range of negative attitudes and feelings toward homosexuality.[2] The concern of the family focused on their son understanding his gender role. This can be attributed to “heterosexism,” a system of attitudes, bias, and discrimination in favor of opposite-sex sexuality and relationships.[3] Thus, the psychiatrists face great bioethical challenges and dilemmas. The most sensitive issues are the treatment of transgender youth, fertility, parenting, and the risk of regret after the irreversible part of the treatment. The stance of psychiatrist becomes an utmost important part of the management. Psychiatrists have to deal with situations where these individuals may seek help for varying issues ranging from coming out to getting treated of their homosexuality. They should make these individuals to understand the range of treatment options and their implications.[2,4] Personalized and continued care should be offered to confront the difficulties imposed due to cultural norms.
In 2018, the Supreme Court of India decriminalised homosexuality by declaring Section 377 IPC unconstitutional in respect of consensual homosexual sex between adults.[5] Still, legal protections such as anti-discrimination laws, same-sex marriages, and joint adoption, regardless of sexual orientation, are not clear.
Hence, there is an urgent need to create awareness to perceive gender expression as a continuum. This might help society to understand these individuals and reduce the burden of mental health problems associated with GD.
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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
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REFERENCES
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