Talk:Gender dysphoria/Archive 9

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I'm skeptical about using the term "treatments:" for one, it implies that there is something about being transgender or gender non-conforming that needs to be "fixed," that there is an inherent abnormality about being trans. When it relates to "psychological treatments," perhaps it can be rephrased to "psychological intervention" or "psychological mediation." In this respect, not every change a trans individual elects to undergo is a "biological" treatment—they are not changing their sex.

Also, we may need to update the term "transexualism." While there are individuals who use that term, it is quite outdated and excludes those who choose not to medically transition, bringing up issues of transmedicalist rhetoric that promote the idea that you must undergo surgery and hormone replacement therapy to be considered trans (when the criteria is simply to not resonate with your assigned gender at birth)

Regarding "sex reassignment surgery:" this is an outdated term, and, as stated above, surgery does not alter one's sex. A more appropriate and liked term at present is gender affirming surgery, since it helps align the individual more to their desired body. — Preceding unsigned comment added by Swimfly814 (talk • contribs) 16:25, 11 February 2022 (UTC)

The treatments do, however, treat "the distress a person feels due to a mismatch between their gender identity...and their sex assigned at birth", which is what gender dysphoria is. The article already recognizes via separate headings that not all treatments are biological.

I don't see where the term "transsexual" and derived terms needs to be replaced. Unless I missed it, it seems to be used when referring to specific statements from the past in which changing it would change the meaning and misrepresent the source.

"Sex reassignment surgery" is still the

this discussion. Crossroads ^-talk-

16:15, 12 February 2022 (UTC)

I agree with

Please ping me!

18:03, 12 February 2022 (UTC)

@Swimfly814 - You raise important points and concerns, and experts have been debating these issues for many years.^[1][2] So take solace that you are not alone, and, if I may be so bold, peruse the literature to enhance your understanding of the ongoing discussions. The article (Gender dysphoria) summarizes some of the debates with cited references that might serve as a good jumping off place for further study. Mark D Worthen PsyD (talk) [he/him] 05:28, 13 February 2022 (UTC)

This article was the subject of a Wiki Education Foundation-supported course assignment, between 24 January 2022 and 13 May 2022. Further details are available on the course page. Student editor(s): Nataliiemacias (article contribs). Peer reviewers: Ashleyjenkins2002. — Preceding unsigned comment added by ACHorwitz (talk • contribs) 18:34, 11 March 2022 (UTC)

Just wanted to drop in a potential resource to use when we're thinking about how wording and framing can aid in harm reduction. Here's the about page: https://consciousstyleguide.com/about/ and a reference page for gender, sex, and sexuality terminology: https://consciousstyleguide.com/gender-sex-sexuality/ that I have found to be beneficial. — Preceding unsigned comment added by Swimfly814 (talk • contribs) 14:30, 16 March 2022 (UTC)

Why is there no mention of social dysphoria in this article? Aren't there any academic studies confirming social dysphoria to be a type of gender dysphoria? Nonbinary individuals often mention feeling primarily social dysphoria regarding their identitities. I really don't see how anyone can say that Nonbinary individuals aren't experiencing dysphoria, even if that dysphoria isn't necessarily physical, for instance. 2601:98A:400:8910:60FE:DB:5205:9E81 (talk) 03:10, 6 March 2022 (UTC)

"Social dysphoria" as, like, a counterpart to bodily dysphoria or something? I've never encountered "social dysphoria" in the psychiatric literature (although I am not an expert), but the DSM makes it pretty clear that the distress can be focused on social factors or focused on physiology. So what I'm saying is "social dysphoria" is dysphoria, but the literature makes no distinction between social dysphoria and other dysphoria, it's all one thing. Do you think this article implies otherwise? If so, perhaps more emphasis on social factors is needed. Of the universe (talk) 08:03, 11 March 2022 (UTC)

I have also not encountered much psychiatric literature on social dysphoria, but it is very much a well know and understood term in the trans community. Social and body dysphoria are often co-morbid, but are still distinctly separate experiences (with social dysphoria manifesting through feelings of discomfort based on how one—or one's gender— is perceived by others). I'm also wondering if the page would benefit from a mention/acknowledgement that not every trans individual experiences dysphoria. Again, there's not much literature on this idea, but there has been a push to steer away from gatekeeping the trans experience in the last few years. Swimfly814 (talk) 14:50, 16 March 2022 (UTC)

re: not every trans individual experiences dysphoria, I didn't realize this wasn't in the article. I agree it should be in the article, probably in the lede. Psychiatric sources wise, the DSM^[1] basically explicitly states as much, although the wording is a bit opaque: "Gender dysphoria refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. Although not all individuals will experience distress as a result of such incongruence..." (emphasis added). Of the universe (talk) 17:27, 17 March 2022 (UTC)

@Swimfly814, I found a more explicit source, so I went ahead and added it to the article. According to the APA^[2], "Not all transgender or gender diverse people experience dysphoria." Of the universe (talk) 17:56, 17 March 2022 (UTC)

"It is common for people assigned male at birth who have late-onset gender dysphoria to cross-dress with sexual excitement."

This statement cites the DSM-5 section on gender dysphoria, but upon reading it, it says nothing of the sort. I propose deletion — Preceding unsigned comment added by Snokalok (talk • contribs) 03:29, 4 April 2022 (UTC)

I can't find that anywhere either. EvergreenFir (talk) 03:46, 4 April 2022 (UTC)

Courtesy ping for Crossroads who re-added it most recently after a removal a few months ago. Firefangledfeathers (talk | contribs) 03:53, 4 April 2022 (UTC)

I looked on an archived copy of the first page of the cited section of the DSM V as well as other secondary sources outlining symptoms and saw nothing of erotic/fetish crossdressing for teens/adults. EvergreenFir (talk) 04:13, 4 April 2022 (UTC)

It's definitely in the DSM-5, but a few pages in. Google Books isn't cooperating with me this time. I will request the relevant section from DSM-5-TR (an updated version) from

WP:RX. Crossroads ^-talk-

06:41, 4 April 2022 (UTC)

Found it on page 456 of DSM-5: Adolescents and adults with late-onset gender dysphoria frequently engage in transvestic behavior with sexual excitement.

It's definitely something we should check as to whether or not it's in the DSM-5-TR. Sideswipe9th (talk) 13:06, 4 April 2022 (UTC)

The statement appears in the DSM-5-TR, though more equivocally: on page 520 in the GD section, In some cases of postpubertal-onset gender dysphoria in individuals assigned male at birth who are attracted to women, cross-dressing with sexual excitement is a precursor to the diagnosis of gender dysphoria. (emphasis mine). Will send to both of you via email, just a sec. —0xf₈e₈ 💿 (talk) 16:26, 4 April 2022 (UTC)

Received that through now. Thanks.

Based on this, I think we do need to change the statement slightly. Not only to address the change between "common" and "some cases" but also the qualifier on sexuality re "attracted to women" which was introduced in the revised text. Sideswipe9th (talk) 16:48, 4 April 2022 (UTC)

Actually there may be more that needs reviewing. The information that is cited to Guillamon, Junque, and Gomez with respect to attraction to men/women in late-onset individuals doesn't appear to have a corresponding note within the DSM-5-TR. I don't have time to look into this now, so I'm just leaving a note here for anyone who also has access to confirm please. Sideswipe9th (talk) 16:58, 4 April 2022 (UTC)

There may be more to update based on the TR edition, but for now I brought back a revised version in accord with your comment above, so the initial matter here appears settled at least. Crossroads ^-talk- 03:12, 5 April 2022 (UTC)

@

Transvestic disorder, which by definition involves sexual excitement in connection with cross-dressing. The point of "differential diagnosis" is that "Gender dysphoria" is one thing, and "Transvestic disorder" is another. They can co-occur, and then someone gets both diagnoses. However, to assert that someone with GD (only) has sexual excitement from cross-dressing is incorrect; that is part of the description of Transvestic disorder only. See § DSM-5 TR excerpt. All that statement really asserts, is that in people with both, TD often comes first. Thus, the OP is correct: the citation does not support the statement, or at best, it's SYNTH. Mathglot (talk

) 06:14, 8 April 2022 (UTC)

The research upon which DSM-5 bases that statement, conducted in the 1970s and 1980s, has not been cross-validated in a persuasive manner. But the statement is in the DSM, which trumps almost any evidence-based argument to the contrary. Mark D Worthen PsyD (talk) [he/him] 04:54, 6 April 2022 (UTC)

If you have a reliable source that says as much, it's worth including. Of the universe (talk) 16:38, 7 April 2022 (UTC)

Certainly the first part of what @Markworthen: has said is verifiable. In the text of the DSM-5-TR, that sentence cites only Ray Blanchard's Topology of male-to-female transsexualism (link to Wiki article, DOI citation), specifically chapter 14, pages 247-261 if anyone wants to read it. The inclusion of it in the (original) DSM-5 was controversial, and it has received significant criticism both for its terminology and by the transgender community. As for the later half, re cross-validation, I'm not immediately familiar with any academic sources asserting this, but I can't rule it out either. Sideswipe9th (talk) 18:11, 7 April 2022 (UTC)

Thank you Of the universe and Sideswipe9th for your helpful feedback and additional insights (Sideswipe9th). I'll try to dig into this some more - in my initial literature search, I could not find any cross-validation studies but I could have missed something. Mark D Worthen PsyD (talk) [he/him] 20:25, 7 April 2022 (UTC)

On a more general note, there are some questionable practices regarding re-use of datasets by some of the more prominent researchers in this topic area. If you haven't already, you may wish to check papers by Florence Ashley, Kelley Winters, and Julia Temple Newhook. While the work I'm familiar with from them is in the area of desistance rates, in response to improper use of datasets by Kenneth Zucker and Thomas Steensma, they may have also published research into some of Blanchard's claims. Sideswipe9th (talk) 20:50, 7 April 2022 (UTC)

It may also be worth checking the WPATH 8 SoC, if you have access to the draft chapters (release date was delayed), as it may have relevant info for this point. Sideswipe9th (talk) 21:03, 7 April 2022 (UTC)

DSM-5 TR excerpt

This is from the 'Differential diagnosis' section of GD in DSM-5 TR:

Differential Diagnosis

Nonconformity to gender roles Gender dysphoria should be distinguished from simple nonconformity to stereotypical gender role behavior by the strong desire to be of another gender than the assigned one and by the extent and pervasiveness of gender-variant activities and interests. The diagnosis is not meant to merely describe nonconformity to stereotypical gender role behavior (e.g., “tomboyism” in girls, “girly-boy” behavior in boys, occasional cross-dressing in adult men). Given the increased openness of gender-diverse expressions by individuals across the entire range of the transgender spectrum, it is important that the clinical diagnosis be limited to those individuals whose distress and impairment meet the specified criteria.

Transvestic disorder

Transvestic disorder is diagnosed in heterosexual (or bisexual) adolescent and adult males (rarely in females) for whom women’s clothing generates sexual excitement and causes distress and/or impairment without drawing their assigned gender into question. It is occasionally accompanied by gender dysphoria. An individual with transvestic disorder who also has clinically significant gender dysphoria can be given both diagnoses. In some cases of postpubertal-onset gender dysphoria in individuals assigned male at birth who are attracted to women, cross-dressing with sexual excitement is a precursor to the diagnosis of gender dysphoria (Blanchard 1985)^[1].

Mathglot (talk) 06:14, 8 April 2022 (UTC)

• Based on that I don't think it should be included at all; it's a tangential note about another condition which may be confused with or occasionally occur alongside gender dysphoria but is specifically described as distinct. This also explains my confusion the last time I removed it - I read the entire section, but naturally would have skipped the differential diagnosis section, which is specifically about things that are not gender dysphoria. I ought to have paid more attention when it was restored and double-checked so it could have been kept out back then. Focusing on it here seems undue, especially since we're not giving comparable weight to any other aspects of the differential diagnosis section and this one seems to be specifically indicated to be rare. More generally it's important to understand the context of a differential diagnosis section - it exists to help differentiate gender dysphoria from other diagnoses it might be confused with; it isn't intended to describe significant aspects of gender dysphoria itself, and therefore isn't really an appropriate thing to devote an entire sentence to in the signs and symptoms section. The current wording of the article, even in its rewritten version, implies by including it that that this is a possible sign or symptom of gender dysphoria, when in fact the source is saying the precise opposite (ie. it is a possible indicator of a different diagnoses, though the two occasionally occur together.) --Aquillion (talk) 06:53, 8 April 2022 (UTC)

  It would make more sense, then, to move the bit and expand more on the matter of differential diagnoses. And the text of the DSM is still saying that it is a precursor to GD. Crossroads ^-talk- 06:58, 8 April 2022 (UTC)

  It is saying that it is a precursor to the diagnosis. I'm not seeing the significance here; we shouldn't just dump the entire DSM in per

  WP:NOTINDISCRIMINATE, and the differential diagnosis section is a highly-technical part aimed at guiding diagnosis when distinguishing between conditions that might be confused. Citing the DSM for a high-level overview of the major points of gender dysphoria makes sense, but this is way beyond that - it's a random point pulled out and inserted here for unclear reasons. If you want to summarize the entire differential diagnosis section (something I don't think we usually do?), you're going to have to show that it has relevance to justify that weight by producing additional sources talking about it... and of course we'd have to give equal weight to all other sections in the DSM as well, in accordance to their length and focus there. I don't think that that's reasonably possible given the amount of text cited solely to the DSM that that would leave us with... which means we have to triage based on stuff that receives extensive coverage there and stuff that has additional coverage in other sources. As far as I can tell, this fails those points. --Aquillion (talk

  ) 18:18, 8 April 2022 (UTC)

  To be clear on my motivations: I included this here not because I thought there was any DUEness for adding something about it to the article (others might disagree), but merely to illustrate the point that there was more backstory than was being presented about about whether the proposal to delete the sentence quoted at the top of this section should be supported or not, and that the "differential diagnosis" was the key piece that needed to be read and understood in order to draw an informed conclusion about the proposal. Also, quoting from, or sourcing from the diff. diag. without making clear that that's what it was, was misleading. So for me, the diff. diag. stuff is "deep background", it needn't be stated or summarized in the article, and imho shouldn't be in the article, because it's only

  peripherally related to the topic, and it's too much PRIMARY. If some 2ary sources turn up that explore this topic in some detail, maybe something could be said about that, but I don't see that. So basically, "what Aquillion said". Mathglot (talk

  ) 00:25, 9 April 2022 (UTC)

  Only chiming in to say I definitely agree with Aquillion and Mathglot here that even in more-qualified form the statement is probably too undue to remain in the article. Wanted to comment more on this more when initially posted the quote above but have been caught up with other things recently; apologies for the lack of clarity re its placement in the diff diag section. More generally I think the signs and symptoms section probably use a bit of trimming/adding other secondary sources so it isn't quite so heavily reliant on the Guillamon review, which as its title suggests seems to be more concerned with brain structure than reviewing how early-onset/late-onset might affect signs of GD (so not sure the greatest

  WP:RSCONTEXT source, it mostly just briefly refs the -5 to do so), though I am open to discussion as to the specifics. —0xf₈e₈ 💿 (talk

  ) 04:17, 9 April 2022 (UTC)

  Quick note for the record that as far as I can remember, in the original DSM-5, this was with the other signs and symptoms-type material. It moved in the new edition, but the placement made sense when the original was cited. Crossroads ^-talk- 07:37, 12 April 2022 (UTC)

  The DSM is already a secondary source and is the most important publication in psychiatry. It inherently carries as much

  WP:WEIGHT as one can get on this topic. There is no basis for requiring other, lesser sources to do anything to justify summarizing the differential diagnosis material. Crossroads ^-talk-

  04:40, 9 April 2022 (UTC)

  We don't cover every single thing it says, though; we are giving this particular single-sentence mention there an unusual amount of weight relative to the rest, and in a way that implies more significance than it has even in the DSM. In any case, given the repeated challenges to this text and the fact that (per

  WP:ONUS) verifiability doesn't guarantee inclusion, I think it's probably best to have an RFC to settle this once and for all. --Aquillion (talk

  ) 22:50, 10 April 2022 (UTC)

  Not sure we need an RfC for this? It seems as though, aside from Crossroads consensus is pretty strongly against including it? Sideswipe9th (talk) 23:04, 10 April 2022 (UTC)

  If Crossroads concedes that point then of course an RFC is unnecessary and I'll close it. Otherwise (while I guess we could just go ahead and remove it) it might be best to make things as clear as possible. --Aquillion (talk) 23:08, 10 April 2022 (UTC)

Accessibility from TWL

I did want to check in with editors here (@Crossroads and Aquillion:), about whether you are able to access DSM via the Wikipedia library. Somewhere, I complained about the fact that the general search link for TWL doesn't always turn up the link I'm looking for. Such as the last link in this search, which I hoped would link me to DSM-5, but did not:

Find sources: Google (books · news · scholar · free images · WP refs) · FENS · JSTOR · TWL

Note that it doesn't turn up the DSM-5 itself (although, there seem to be several possibly useful secondary sources for the article, although perhaps not for the specific question under discussion in this section). However, if you go to the My Library link at TWL, and then browse to the specific database (APA, in this case) within TWL and search from their access-collection link, then it does find the DSM-5.

Oh, a serendipitous tip: I hit the wrong button and got APA's ToU instead: "American Psychiatric Association allows a maximum of 500 words be excerpted into a Wikipedia article." That's handy to know, and a generous amount; the long quotation including the headers, and the two paragraphs from DSM-5 TR in the subsection #DSM-5 TR excerpt above is 224 words. Mathglot (talk) 00:45, 9 April 2022 (UTC)

Both Crossroads and I received a copy of the autism chapter by email via

WP:LIB. A quick check shows both the 5 and 5-TR don't require searching if you browse to the "American Psychiatric Association collection", which opens in a new tab with a "DSM Library" dropdown menu at the top of the screen (on desktop). Sideswipe9th (talk

) 02:37, 9 April 2022 (UTC)

Just don't do what I did initially, and go down the "American Psychological Association" rabbit hole, because they both use the APA acronym. Sideswipe9th (talk) 02:38, 9 April 2022 (UTC)

Thanks. Ha ha, I've made that mistake before. (Just keep your finger away from pressing on the "American Proctologist Association"; you never know where it's been.) Mathglot (talk) 06:47, 9 April 2022 (UTC)

Right, the RfC concerning the transvestitic fetishism line has been silent for a week, with the final consensus leaning overwhelmingly towards “exclude”, with only one voice arguing for “include”. Therefore, I find it reasonable to exclude, and shall be removing it posthaste.

If someone would like it brought back, use this thread to discuss it. Snokalok (talk) 19:05, 22 April 2022 (UTC)

Not that I'm challenging what you've said, as it does seem accurate, we should probably do a request for closure for this. Just to keep everything aboveboard. I'd say you or I could do it, however we're both involved having voted in the the RfC. Sideswipe9th (talk) 23:04, 22 April 2022 (UTC)

Request for closure filed here. Sideswipe9th (talk) 23:08, 22 April 2022 (UTC)

Sadly this ANRFC regular is INVOLVED in this one, but it should be closed before the RfC ends anyways — Ixtal ⁂ (talk) 09:29, 23 April 2022 (UTC)

Some issues here: 1) the second paragraph talking about early versus late- onset and how that relates to sexual orientation needs to be re-written in a way that makes it more clear that the data is correlational. Perhaps because some folks are also struggling with sexual identity, it takes them longer to figure it out so gender dysphoria also takes longer to manifest? 2) the last paragraph is overly binary, reductive, and not inclusive of non-binary and other gender nonconforming people who also experience dysphoria. Please re-write to include more nuance (e.g., "include the desire to be and to be treated as a different gender"). This last paragraph also conflates biological sex with gender, which is confusing and erroneous. Please add something to acknowledge that not all trans people experience gender dysphoria. The last sentence makes it seem like they're synonymous, which they aren't.2603:6081:2140:1FF5:589F:3636:DB56:F4C5 (talk) 01:13, 6 May 2022 (UTC)

Ah, I see that the "not all trans people have dysphoria" thing has already been addressed earlier in the article, so I rescind that comment. 2603:6081:2140:1FF5:589F:3636:DB56:F4C5 (talk) 01:22, 6 May 2022 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Of the universe (talk) 01:10, 7 May 2022 (UTC)

I changed the text in the article to "include the desire to be and to be treated as a different gender," as requested. For other changes, as stated above, please write the text you want changed specifically. Of the universe (talk) 01:23, 7 May 2022 (UTC)

We need to

WP:STICKTOSOURCE. So far this seems to be based on assumptions of what is correct rather than what the source actually says. Crossroads ^-talk-

01:30, 7 May 2022 (UTC)

I checked the source before making the change. The DSM uses the word "gender." See A.4 and A.5 in "Gender Dysphoria in Adolescents and Adults" https://archive.org/details/diagnosticstatis0005unse/page/452/mode/2up Of the universe (talk) 02:01, 7 May 2022 (UTC)

Of the universe is correct. That is consistent with the criteria under F64.0 of the DSM-5-TR and DSM-5, which list separately A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender). and A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender). As such, sticking to the source requires us to use gender. Sideswipe9th (talk) 02:24, 7 May 2022 (UTC)

This discussion has been quiet for about a week, and there was a close request;

WP:WHENCLOSE

is met.

Supporters of exclusion view the text as providing

WP:DUE

. Some contributors support a compromise where this information is presented in an explanatory note.

Based on weight of arguments and the considerable amount of editors who support exclusion, the consensus is to exclude the text. The compromise solution of an explanatory note had gained some support particularly towards the end of the discussion among contributors who could view the discussion as a whole. However, the compromise did not garner discussion at a large level. Therefore, there is no consensus for an explanatory note, but it could be looked into further in a future discussion or RfC.

(non-admin closure) Iamreallygoodatcheckers (talk) 01:47, 24 April 2022 (UTC)

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Should the article include or exclude a reference to cross-dressing with sexual excitement? --Aquillion (talk) 22:59, 10 April 2022 (UTC)

Poll

• Exclude. The only citation is to a single sentence in the DSM's differential diagnosis section, which is being given inappropriate weight here. In particular, the purpose of such sections is to help differentiate between multiple diagnoses - in this case, to distinguish gender dysphoria from transvestic disorder. The source does not say that it is a sign or symptom of gender dysphoria; in the context of a differential diagnosis section, it is just saying that that diagnosis sometimes precedes it (ie. the two are sometimes confused.) That's insufficient to justify a level of focus that implies that there is a serious link between the two. The lack of secondary coverage outside the DSM also shows that this sentence (intended to help physicians distinguish between different diagnoses) is being given undue weight. --Aquillion (talk) 22:59, 10 April 2022 (UTC)

  Exclude

  It's not reliably true and all it does it make things worse for a vulnerable minority group. Snokalok (talk) 04:54, 16 April 2022 (UTC)

• (Summoned by bot) To the exact question in this RFC, I think it should be included, since it's in DSM-5 and there are many papers discussing this, both with that exact wording, or similar one (e.g. sexually aroused by crossdressing). This !vote is not meant to support any particular way of including it, but just an acknowledgement that discussion of the topic seems to be due, in some form, given the existing sources. MarioGom (talk) 07:40, 11 April 2022 (UTC)
• Comment Not to be completely vague, but it depends on what the source says, and whether other sources define it as a symptom or sign. I'm being vague since I'm RfC hopping, am not really familiar with the topic, and don't have access to the source. If it's a single sentence which doesn't say it's a sign or symptom, then I would agree that would be undue weight for at most the purposes of the current sentence and the current source. SportingFlyer T·C 14:20, 11 April 2022 (UTC)

  SportingFlyer, there's an excerpt above here in case you missed it, as well as info on how to get a fuller version. Crossroads ^-talk- 23:02, 11 April 2022 (UTC)

  Thank you for that - don't know how I missed that section. Based on the reading of the source I would exclude that specific statement on undue weight grounds. I would also be curious to read the cited source there and the literature reviewing it as it is from several decades ago. SportingFlyer T·C 23:28, 11 April 2022 (UTC)

• Exclude I think this article as a whole puts too much emphasis on the DSM diagnosis, putting it first and retelling every detail. There should be at least see equal weight from newer ICD-11, not to mention other guidelines with secondary and tertiary source character. What is this article supposed to be about, a DSM diagnosis called "gender dysphoria" (and its history), or a broader sociological concept? It could go either way, but I would prefer to evolve towards the latter. So one point whose only merit is to reflect the DSM wouldn't be missed. CyreJ (talk) 17:12, 11 April 2022 (UTC)

  I agree that putting UNDUE weight on DSM is something we should try to avoid. This may not be limited to inclusion/exclusion, but can also be done through prominence of placement (i.e. placing something earlier on in the article gives it more prominence).

  Please ping me!

  17:40, 11 April 2022 (UTC)

  What "broader sociological concept"? There is already an article on Transgender. Crossroads ^-talk- 22:58, 11 April 2022 (UTC)

• Include. The DSM is the most important publication in psychiatry and hence inherently carries as much
  WP:WEIGHT as one can get on this topic. There is no basis for requiring other, lesser sources to do anything to justify covering the differential diagnosis material. That other points in it are not mentioned is fixable, but does not justifying removing this; rather, it should all be summarized. Crossroads ^-talk-
  22:58, 11 April 2022 (UTC)

  That is a very Americocentric perspective. Arguably the ICD has greater weight than the DSM, as that is used in far more countries than the DSM, which last I check was the primary diagnostic manual in only one. Sideswipe9th (talk) 01:19, 12 April 2022 (UTC)

  The DSM is used internationally and is a detailed manual focused on psychiatry. The ICD-11 is a taxonomy covering all of medicine with 85,000 entries and only has 3 paragraphs on "gender incongruence" (one for it and each of its subtypes). [2] Crossroads ^-talk- 01:44, 12 April 2022 (UTC)

  Re; ICD-11 containing only 3 paragraphs on gender incongruence. See my reply below for why transvestic disorder was removed from the ICD-11.

  Re; The DSM is used internationally and is a detailed manual focused on psychiatry. Citation needed, as evidence exists to the contrary. Sideswipe9th (talk) 01:53, 12 April 2022 (UTC)

  Both of these sources note that the DSM is used for research worldwide. And no wonder; it remains true that the ICD has very little to say about anything listed in it. Crossroads ^-talk- 07:11, 12 April 2022 (UTC)

  Research worldwide. Not diagnosis world wide. If this is, as you have asserted multiple times, a biomedical article, then from a biomedical perspective the diagnosis of transvestic disorder is largely irrelevant outside of the US, as it has as I've said previously no counterpart in the ICD-11.

  As for the ICD having very little to say about anything listed in it, that is because the precise nature of the diagnosis at a country level is the purview of the country. Hence why organisations such as NICE, and its equivalent bodies produce much greater detail on clinical diagnosis pathways, however those pathways are still ultimately derived from the ICD-11.

  Frankly I'm a little concerned at the lack of

  WP:SOURCEGOODFAITH here towards the ICD-11. Sideswipe9th (talk

  ) 14:36, 12 April 2022 (UTC)

  Adding on to that, as was mentioned in an archived discussion, this 2018 "Abnormal Psychology: Contrasting Perspectives" source, from

  Macmillan International Higher Education, page 70, states, "When it comes to diagnosing emotional distress, the Diagnostic and Statistical Manual of Mental Disorders (DSM) (introduced in Chapter 1) and the mental, behavioral, and neurodevelopmental disorders section of the International Classification of Diseases (ICD) are the two most prevalent diagnostic systems. They are generally referred to as forms of psychiatric diagnosis because even though every kind of mental health practitioner uses them, primarily psychiatrists develop them. [...] Both manuals are used all over the world." On page 71, the source adds, "Despite being an American rather than international undertaking, some consider the DSM (rather than the ICD) the standard for research and practice throughout the world (Paris, 2015)." This 2013 "The Social Science Encyclopedia" source, from Routledge, page 681, states, "Although developed by psychiatrists in the USA, this classification is widely used by psychiatrists in other countries, and by other mental health professionals." (Emphasis added in both.) Crossroads ^-talk-

  07:49, 12 April 2022 (UTC)

• Exclude. Largely per Aquillion. When compared to the text this is taken from in the DSM-5-TR, the reference cross-dressing with sexual excitement is only applicable to one of four differential diagnoses, specifically tranvestic disorder. An interesting and relevant point here is that transvestic disorder was removed from the ICD-11, accordingly in a non-US context this differential diagnosis is an impossibility. Finally per this review in 2011, there seems to be little if any emperical testing or evidence surrounding transvestic disorder/transvestic fetishism. A brief search does not show any more recent papers or reviews in this area of relevance. Accordingly the presence of this text in the DSM-5 and 5-TR may have more to do with the influence of Ray Blanchard (cite note, author of this paper is Julia Serano) as lead of the drafting panel, than any evidence base for it. Sideswipe9th (talk) 01:48, 12 April 2022 (UTC)

  The 2011 review (by a

  WPATH

  work group no less) did not argue to delist it; rather: Our proposal is quite similar to that of what the DSM work group under the leadership of Blanchard recently proposed (Blanchard, 2010), which can be found in Table 5. Most importantly, we also recommend that the name of the disorder be changed to Transvestic Disorder to make clear that it does not apply to all transvestic behavior or interests. This is before the release of DSM-5 in 2013 and its revision in 2021, so the latter takes precedence and carries greater weight.

  The Serano source is not a scientific or medical article and is not even written in academic style (no citations, just hyperlinks). It is in a journal about forging creative connections between critical theory and political practice - not exactly a

  WP:MEDRS. Many, many more experts were involved in writing, editing, and approving the DSM text than Blanchard, and if it's just his idea than it shouldn't have survived the latest revision. Crossroads ^-talk-

  07:27, 12 April 2022 (UTC)

  And yet two years later, in 2013 the WPATH work group voted by 28-4 to remove the diagnosis. Do we really need to walk through every paper published on this, or would that be too much OR?

  As for the Serano source, that link is the "open access" version of it and the most convenient to link. It also appeared, with citations, in Serano's book "Outspoken: A Decade of Transgender Activism and Trans Feminism", on pages 156-161. It's also worth pointing out that the journal is peer-reviewed, and that Serano is an expert in the field. Sideswipe9th (talk) 14:28, 12 April 2022 (UTC)

• Exclude. The idea that cross-dressing with sexual excitement is connected to gender dysphoria is more untrue than it is true, given the lack of reliable evidence, the tenuous connection at best, and the infrequency, especially in comparison to common belief. PBZE (talk) 05:53, 12 April 2022 (UTC)
• Include Ambivalent (see below). I don't see how a small sentence in the Signs and Symptoms section sourced to the DSM is
  WP:UNDUE; the DSM is as authoritative a source as you can get for psychiatric conditions. If people want to add more information from the ICD there's nothing stopping them, so I don't see a good reason to remove DSM-sourced information. Endwise (talk
  ) 10:26, 14 April 2022 (UTC)

  It is both undue and would be misleading in the signs and symptoms section, because in the current revision of the DSM the text in question is part of a differential diagnosis for Transvestic disorder. The full context of the excerpt can be seen in this comment by Mathglot, in the DSM-5-TR excerpt section above. Sideswipe9th (talk) 21:57, 14 April 2022 (UTC)

  See also my reply below to Popsofctown, for the cross relevance between the two separate conditions. Sideswipe9th (talk) 22:14, 14 April 2022 (UTC)

  I see. Having a look at the full excerpt I can see why In some people assigned male at birth who have postpubertal-onset gender dysphoria and who are attracted to women, cross-dressing with sexual excitement may presage the gender dysphoria in the section on signs and symptoms could be too much (i.e.

  undue). That said, I still don't think that information being part of the section on differential diagnoses means it should be excluded entirely on principle; this is a long article and there is plenty of room to add information. Whatever relevant information the DSM includes when talking about differential diagnoses for a psychiatric condition in general seems like good fodder for a Wikipedia article. Maybe something like Mathglot's proposal would be ideal? Moving the material or reducing its prominence? Endwise (talk

  ) 02:37, 15 April 2022 (UTC)

  Personally I would be against such a footnote. I do not think it would add anything of value to the article.

  I would also caution against referring to gender dysphoria as a psychiatric condition. Other prominent bodies, such as the

  WPATH (evidenced via a plethora of recent statements and the draft WPATH 8 Standards of Care) are explicitly against classifying gender dysphoria as a psychiatric disorder, due to the stigmatising effect that has. This is similar to previous psychiatric declassifications of homosexuality. Personally I find it regrettable that the DSM has not followed suit with other prominent bodies in this field in this regard. Sideswipe9th (talk

  ) 03:01, 15 April 2022 (UTC)

• Exclude with an asterisk: Is the excerpt Mathglot posted the entirety of the DSM's current treatment of the topic? If it is, the information is undue, a differential diagnosis against a disorder that's about a tenth as common is pretty outskirts.

If statements similar to the one in the cite exist in the current revision, I think there needs to be some mention but "according to the DSM5" word be better to add to the article text since the Blanchard angle isn't universally accepted. A line saying "according to the DSM5, blah blah blah" isn't undue, it is extremely influential in the field, both for better or for worse Popsofctown (talk) 18:02, 14 April 2022 (UTC)

@Popsofctown: To answer your first question, in the context of its relevance to gender dysphoria, yes the excerpt posted by Mathglot is the entirety of how the DSM relates gender dysphoria and transvestic disorder. As a differential diagnosis.

There is a separate entry for transvestic disorder, listed under paraphilic disorders, which goes into more detail about it specifically. However at that entry the only content of relevance to gender dysphoria is in the form of another note of it being one of three differential diagnoses. The other two being transvestism, and fetishistic disorder. Aside from the two conditions being differntial diagnoses for each other, in the DSM-5-TR (the current revision of the text) they are unrelated. Sideswipe9th (talk) 22:11, 14 April 2022 (UTC)

The

Wikipedia Glossary has an entry for reference

.

• Exclude, with explanatory note – It's slightly unfortunate that the otherwise ideally
  explanatory footnote at the bottom of the page.^[a] Mathglot (talk
  ) 01:54, 15 April 2022 (UTC)

  Where would the explanatory footnote go and what would it say? Endwise (talk) 02:25, 15 April 2022 (UTC)

  That's a reasonable question. Basically, whatever text those favoring including it want to have, put a brief version of that in a note instead. The "where" is a bit harder, because it needs a relevant hook, but anywhere that prevalence is discussed would be the right place, imho. You could add it at the end of the

  #Comorbidities section, perhaps something on the order of: "Other comorbidities have been reported.^[85]". Mathglot (talk

  ) 03:03, 15 April 2022 (UTC)

  If it's relegated there, it would probably be okay to be presented in the text IMO. Endwise (talk) 03:17, 15 April 2022 (UTC)

References (Rfc)

1. explanatory note
   is, in fact, also a type of note or "reference" at the bottom of the page, and I think it would be okay to mention it there.

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

DSM vs ICD usage

From past discussions, it seems that we are generally in the dark as to whether or where the DSM is the dominant system used in practice, with major impacts on how to write the article. I would like to add one clue to the record: in this 2018 report by the UN Independent Expert On Sexual Orientation and Gender Identity they decided to focus on the ICD ^[1], as "According to available information, some 70 per cent of psychiatrists around the world use the tenth revision of the International Classification of Diseases more than any other classification system in their daily practice.", citing in turn ^[2]. Feel free to collect any other evidence or hints here. CyreJ (talk) 20:02, 17 May 2022 (UTC)

I definitely think the ICD should be given priority over the DSM, for NPOV reasons Snokalok (talk) 22:53, 5 June 2022 (UTC)

References

1. ^ A/73/152
2. doi:10.1002/j.2051-5545.2011.tb00034.x
   .

Children desistance section

The paragraph on desistance rate among children says "Studies have reported higher rates of desistance among young children" as the summary sentence, however then goes on to say that the studies used to back this statement up were of seriously flawed methodology and analysis. Therefore, I don't think we can quite say that "Studies have reported higher rates of desistance among young children", and should remove it accordingly. — Preceding unsigned comment added by Snokalok (talk • contribs) 23:27, 5 June 2022 (UTC)

Yeah, I agree, the statement is confusing, vague, and ultimately unsupported. "higher rates of desistance"... higher than what? I've edited it to more closely stick to source. Of the universe (talk) 00:54, 6 June 2022 (UTC)

Gender dysphoria primary study

Regarding the recent editing, see Wikipedia_talk:WikiProject_Medicine#Gender_dysphoria_primary_study. Crossroads ^-talk- 01:23, 9 June 2022 (UTC)

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Image for Gender Dysphoria

• 
  1
• 
  2
• 
  version with the blanked out face

Is it ever possible to have an image supporting Gender Dysphoria? I am unsure if it is. Would be helpful if there is an image that describes Gender Dysphoria on the article. Qwertyxp2000 (talk | contribs) 01:32, 31 July 2022 (UTC)

@Qwertyxp2000 Maybe something similar in concept to the painting by Van Gogh on Major depressive disorder? There's art that depicts gender identity distress, hopefully we can find something in the public domain or creative commons. Of the universe (talk) 03:35, 31 July 2022 (UTC)

There's one plausibly usable illustration on Commons (right). We could also go with something like this suitably licensed Flickr photo. Firefangledfeathers (talk / contribs) 03:53, 31 July 2022 (UTC)

I think I like that Flickr photo better than the illustration. Sideswipe9th (talk) 03:56, 31 July 2022 (UTC)

A dig through Flickr's creative commons might turn up more "person holding protest sign" options, perhaps ones that are even more suitable. Firefangledfeathers (talk / contribs) 04:03, 31 July 2022 (UTC)

As indicated below, the "Flickr photo" is already in the article. Firefangledfeathers (talk / contribs) 16:20, 31 July 2022 (UTC)

For an example of the type of artwork I'm talking about, see this image on deviant art. It's not creative commons, but hopefully there's something in a similar spirit published with a cc license. I think artwork like this would be appropriate and enrich the page. Of the universe (talk) 05:07, 1 August 2022 (UTC)

(but so far, searching for a suitable image in the creative commons has turned up nothing) Of the universe (talk) 05:09, 1 August 2022 (UTC)

• I think no image is significantly better than the two options suggested so far. Not that no image could in theory be suitable, but I think this is the kind of article which would be perfectly fine without an image. Endwise (talk) 04:26, 31 July 2022 (UTC)

  I don't object to leaving the article unillustrated pending a good option. I wouldn't describe the two I've brought here as suggestions, just options for consideration, found while procrastinating on some other work. Firefangledfeathers (talk / contribs) 04:32, 31 July 2022 (UTC)

Agreed, I don't think any image is necessary. Crossroads ^-talk- 05:38, 31 July 2022 (UTC)

• I'm not opposed to image ideas. I just don't think this is the one. Iamreallygoodatcheckers^t@lk 05:46, 31 July 2022 (UTC)
• I'm not sure what image could be helpful in genuinely illustrating the topic. An image of a person looking vaguely sad or distressed doesn't convey anything specifically about this topic and I really dislike the image to the right here. I can see what its creator was trying to do but it doesn't really work without explanation. It might appear unserious and I can imagine that it could even be distressing to some people. The Flikr suggestion from Firefangledfeathers isn’t awful but I also don't see that as a good lead image as it is primarily an image of text. Suitably cropped it might be good in the article body. DanielRigal (talk) 12:21, 31 July 2022 (UTC)

  Agreed, the image on the right looks goofy and could come across as downplaying the experience. The Flickr image is actually already in the article, in the society and culture section Of the universe (talk) 16:15, 31 July 2022 (UTC)

• I found this illustration on Commons, searching for "depersonalization". Currently it doesn't feel great but I'm experimenting with erasing the face in the mirror to make it more generic. The "tone" of the image may still be unfitting, though. Madeline (part of me) 21:26, 1 September 2022 (UTC)

  I personally like the mirror picture a lot. I find it compelling. It resonates with me. But I worry it might come across as amateurish, and therefore disrespectful. Of the universe (talk) 04:32, 2 September 2022 (UTC)

• I don't think the stick figure or the mirror cartoon is good enough / right for this, and the sign picture seems well-placed where it already is (further down in the body of the article). -sche (talk) 23:01, 1 September 2022 (UTC)

ADA covers gender dysphoria

• I feel like this belongs on the page somewhere but I don't know where. What do you all think? - https://www.cnn.com/2022/08/16/politics/americans-with-disabilities-act-transgender-gender-dysphoria/index.html 72.94.88.14 (talk) 03:47, 5 September 2022 (UTC)

  I added it to the section on classification as a disorder Feralcateater000 (talk) 19:24, 5 September 2022 (UTC)

  • Would you mind adding that it was covered starting in 2022, according to a ruling by the United States Court of Appeals for the Fourth Circuit? So people don't think it is covered everywhere in the US (only where the Fourth Circuit has jurisdiction) or since the ADA was created. Thanks. 72.94.88.14 (talk) 22:34, 6 September 2022 (UTC)

"The causes of gender dysphoria are unknown"

The causes of gender dysphoria are unknown but a gender identity likely reflects genetic, biological, environmental, and cultural factors. Maybe this sentence in the lead creates some problems. "Gender dysphoria" is defined as "the distress a person experiences". Are we here saying that the causes of the distress experienced by transgender people are unknown? Looking at the quoted sources, it looks they're saying that the causes of transgenderism are unknown - the causes of the mismatch between gender identity and assigned sex - rather then the causes of gender dysphoria. They refer to "gender identity disorder" [3], "transsexuality" [4] and "the epidemiology and natural history of transgenderism" [5]. Or am I wrong? Gitz (talk) (contribs) 10:56, 10 October 2022 (UTC)

Are we here saying that the causes of the distress experienced by transgender people are unknown? No. We know many, but not all, trans and non-binary people have gender dysphoria. We know from their experiences and a significant body of research how it manifests, what aggravates it, and what alleviates it. What we don't know is why they have it, what causes it to be expressed, why trans and non-binary people have a disconnect between their expressed gender identity and their assigned sex at birth. That sentence states that we don't know the cause of it, but have theories that it reflects genetic, biological, environmental, and cultural factors. Sideswipe9th (talk) 18:54, 10 October 2022 (UTC)

But then the sentence is ill-formed. It doesn't say that we don't know the causes of the disconnection between gender identity and assigned sex, it says that we don't know the causes of gender dysphoria (that is, experienced distress). Gitz (talk) (contribs) 19:04, 10 October 2022 (UTC)

The sentence and the sources do not refer to gender dysphoria, but to

ISSN 0140-6736. Therfore I'm now modifying the sentence accordingly. Gitz (talk) (contribs

) 14:34, 12 October 2022 (UTC)

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"Gender dysphoria (GD) is the distress"

Is GD the distress, or is the distress "The critical element of gender dysphoria" as per the reference at [6] With the Gender_dysphoria#Signs_and_symptoms section the article conflates the condition with the primary symptom. Would something along the lines of "Gender Dysphoria (GD) is a condition in which a person experiences symptoms including distress due to a ..." be more clear and accurate? 24.217.141.228 (talk) 17:36, 21 October 2022 (UTC)

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The gender euphoria section should be moved to a broader article about the experiences of trans people

First off, it's not exactly relevant to this article because it is the antithesis of what this article is talking about. Putting it here is like having a section about the concept of happiness on an article about depression. Second, it's not proven to be a common occurance (certainly not by the smattering of primary sources listed in that section) and even experts who agree that it exists have not concluded that it is a seperate phenomenon from just general happiness or relief from dysphoria. Gender euphoria is more or less just a term used by the trans community to refer to a vauge feeling, it is not a scientifically documented thing and doesnt belong on the article about the mental condition of gender dysphoria. It would better fit in an article like the main article about trans people, because it describes a common experience of trans people that hasnt been studied much. JuliaHM123 (talk) 16:07, 28 October 2022 (UTC)

I agree, the section uses way too many

WP:MEDRS speak about it. Crossroads ^-talk-

16:38, 28 October 2022 (UTC)

I also agree. I found a number of secondary sources I plan to include in the gender euphoria section to strengthen it, but the sources all indicate that gender euphoria is more specific to the transgender and non-binary experience. This is discussed in the article by Tebbe, Elliot A.; Budge, Stephanie L. (2022-09-26). "Factors that drive mental health disparities and promote well-being in transgender and nonbinary people". Nature Reviews Psychology: 1–14.

PMID 36187743. Leslie146 (talk

) 08:55, 29 November 2022 (UTC)

Although I agree that the gender euphoria section is not in the best location, I think gender euphoria should still be mentioned and perhaps briefly described in this article so that readers are aware of it. Leslie146 (talk) 09:00, 29 November 2022 (UTC)

Also agreed. To Leslie's comment, I'd say that a very brief mention here would be fine, along with a

wikilink to the broader article. Mathglot (talk

) 10:11, 29 November 2022 (UTC)

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Americans with Disabilities Act not complete coverage?

The page has a sentence that says “Gender dysphoria being a disorder also means it is covered by the Americans with Disabilities Act, which may aid transgender people in accessing legal protections they otherwise may be unable to” but then the source it links to (here: https://www.cnn.com/2022/08/16/politics/americans-with-disabilities-act-transgender-gender-dysphoria/index.html) says that opinion was only “issued by a three-judge panel with the US Court of Appeals for the Fourth Circuit” so it seems like it’s not covered by the ADA everywhere in the US and just saying it’s covered is misleading? Can somebody please figure out where it’s covered and add that to the sentence? Thanks. 100.11.62.231 (talk) 22:14, 21 December 2022 (UTC)

"Attempts to alleviate GD by changing the patient's gender identity to reflect assigned sex have been ineffective"

I think this statement is really in need of some non-tertiary sourcing; I've searched a few times for a review article that has made a conclusion one way or the other on this subject to no avail, and from what I've read in my attempts to do so, it seems like this statement can't truthfully be made with such certainty. Lameringuewrangler (talk) 06:22, 1 January 2023 (UTC)

The Merck isn't good enough? EvergreenFir (talk) 08:03, 1 January 2023 (UTC)

The Merck says it's ineffective, but there's no elaboration or citation included to back that conclusion. Lameringuewrangler (talk) 08:56, 1 January 2023 (UTC)

What about the citations in the GICE section at Conversion therapy? Mathglot (talk) 09:05, 1 January 2023 (UTC)

This? I can't access the study directly, but based on the article it sounds like it mainly focuses on the treatment of children on the basis of them being gender nonconforming, not necessarily expressing a gender identity that doesn't align with their sex. I think research that demonstrates repressive treatment for gender dysphoria in consenting adults to be ineffective would be more definitive material to cite here. Lameringuewrangler (talk) 01:51, 2 January 2023 (UTC)

Where are you seeing that the article focuses on gender nonconforming children? You're saying it's not necessarily about "expressing a gender identity that doesn't align with their sex." but the title of the chapter you linked to is "Gender identity change efforts:A summary" The abstract makes it clear it's talking about conversion therapy.

I think it would be great to have a more accessible citation. This is from the first citation in conversion therapy:

"efforts to change an individual’s sexual orientation, gender identity, or gender expression —is a practice that is not supported by credible evidence and has been disavowed by behavioral health experts and associations... Most importantly, it may put young people at risk of serious harm. "

Sativa Inflorescence (talk) 14:39, 2 January 2023 (UTC)

By "the article" I meant the Wikipedia article it's cited in, or more specifically the section that uses that citation. Again, I can't access the study itself, but the first sentence of the abstract at least implies the focus is on minors. Lameringuewrangler (talk) 11:34, 3 January 2023 (UTC)

Semi-protected edit request on 20 March 2023

This edit request to Gender dysphoria has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.

Add within "gender euphoria" before the last paragraph: Euphorias in gender, sex and sexuality variations have also been associated by sociologists with social factors such as institutional inclusion in education and healthcare; community connection; self-acceptance and social acceptance (Reference ISBN: 978-3-031-23755-3). 137.111.13.227 (talk) 20:27, 20 March 2023 (UTC)

 Not done for now: This would need to be supported by a more specific citation, i.e., a page number. Actualcpscm (talk) 22:19, 20 March 2023 (UTC)

Insurance Obstacles for Gender Dysphoria

Individuals with Gender Dysphoria that are needing medical treatment with prescriptions run into several Obstacles when it come to Prescription coverage on their insurance plans. Swo235 (talk) 21:55, 5 May 2023 (UTC)

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