Gender dysphoria: when no one is paying attention

Abstract

Introduction: Transgender health remains a challenge for healthcare professionals, given the fast evolution of concepts related to gender roles and sexual identity, with frequent updates to definitions and nomenclature. Also, being a delicate and divisive theme in society, it generates distress, suffering, and stigmatization for people experiencing these processes. Besides, there is often significant inaction by primary health care professionals when addressing these topics, thus failing to identify and help people in distress who are sometimes incapable of asking for help.

Case description: A person assigned male at birth, 56 years old, single, unemployed, living with her parents, who financially support her. The patient booked an appointment with the Family Physician, presenting frequent panic attacks. After the clinical interview, the patient revealed that she identifies as a woman, and not with her natal gender. She admitted feeling this way since adolescence, only now having the courage and determination to come out and engage in gender-affirming treatments. A careful clinical history allowed the identification of the distress this person experienced throughout her life, permitting a referral to secondary care facilities and psychological support.

Comment: A person suffering from knowing who they are but not knowing how to act or seek help generates severe problems for their biopsychosocial well-being.  Primary healthcare workers, being the frontline of healthcare systems, need to be alert to signs of struggle and distress and must be available to actively explore the gender and sexual dimensions of people’s lives. On the other hand, they also have a fundamental role in managing comorbidities and coordinating with secondary health care and other supportive entities, providing personalized and integrated care throughout the transition process.