Finding who I am: a case report

Abstract

Introduction: An individual’s gender identity reflects a profound and deeply experienced sense of their gender. In recent years, we have seen a significant increase in reports of gender incongruence, making it essential to update health professionals on this issue. So, we intend to remind the criteria for an early identification of gender incongruence and a suitable follow-up by the family doctor.

Case description: We report on the case of a 14-year-old overweight girl who was brought to a medical appointment by her mother due to concerns about low self-esteem and isolation. In the appointment, multiple dietary errors and feelings of sadness stand out, as she considers herself gender fluid, which the family does not accept. Lifestyle changes were advised and referred to clinical psychology. One month later, obesity was realized, so an analytical study and a nutrition appointment were requested. Seven months later, the patient identifies herself as male gender and intends to change sex. In this appointment, signs of self-harm behaviour and unstructured suicidal ideation were identified. Given this depressive disorder, with self-harm behaviour, escitalopram was prescribed. After beginning this therapy, a good adaptation to the medication was observed, with a decrease in episodes of binge eating in BMI and an absence of self-harm behaviour and suicidal thoughts. Subsequently, the patient was referred to pedopsychiatry.

Comment: The family doctor is, most times, the patient’s first contact with health care, assuming a privileged position for the early diagnosis of gender incongruence and appropriate referral. The family doctor must understand the development of the individual’s gender identity, current experience, and future goals to improve the psychological well-being, quality of life, and sense of self-realization of the patient, often following up on the path for the individual’s gender change and the acceptance by the family.