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Abstract
There is an urgent need for ethical, conceptual, and clinical clarity regarding the diagnosis and treatment of gender dysphoria and transgender identification. In this essay, I highlight ten critical concerns in this arena, namely, those involving: (1) conceptual parallels between sexual reassignment surgery and elective limb amputation; (2) the lack of long-term data that demonstrates reliable long-term relief from gender dysphoria in those undergoing hormonal or surgical treatment for gender dysphoria; (3) special problems with informed consent in the context of “gender affirming” treatments; (4) the importance of very high desistance rates of gender dysphoria and transgender identification, particularly in children, even without treatment; (5) the extensive differential diagnosis and the need for thorough and subtle assessments in the face of gender-related complaints; (6) a deep religiously based objection to transgender ideology involving the ordering of creation; (7) controversies concerning the existence of rapid-onset gender dysphoria; (8) the recent depathologizing of gender dysphoria; (9) the roles of genetics and environment in transgender identification and gender dysphoria; and (10) reflections on the role of psychotherapeutic treatment in patients with gender dysphoria and transgender identification.
Keywords: transgenderism, gender dysphoria, transsexualism, sexual reassignment surgery, gender affirming care
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Cite as: A. A. Howsepian, “Ten Critical Ethical, Conceptual, and Clinical Cautions Concerning the Diagnosis and Treatment of Gender Dysphoria and Transgender Identification,” Ethics & Medicine 38, no. 1–2 (2022): Early access.
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About the Author
A. A. Howsepian, MD, PhD
A.A. Howsepian, MD, PhDis a former Staff Psychiatrist and Director of Electroconvulsive Therapy at the Veterans Affairs Central California Health Care System. Currently, he is a full-time forensic psychiatry consultant in private practice and has academic appointments at the University of California, San Francisco (Fresno Medical Education Program) and California State University (Fresno). He has over 50 publications in Psychiatry, Philosophy, and Neurology journals. His PhD is in Philosophy from the University of Notre Dame. He currently resides in Fresno, California.