Gender Dysphoria: The Complete Guide Singapore (2022)

Updated: Jan 12


What is gender dysphoria and what resources and support avenues can you seek for gender dysphoria? Find out more with this article.

Gender dysphoria affects many trans or gender non-conforming individuals. frankie takes you through the resources for gender dysphoria in Singapore.


In this article

  1. What is gender dysphoria

  2. Gender dysphoria in the DSM-5

  3. What are causes of gender dysphoria?

  4. How is gender dysmorphia diagnosed?

  5. Treatments for gender dysphoria

  6. What happens if gender dysphoria is not treated?

  7. Where to get treatment for gender dysphoria in Singapore?

  8. Resources for trans people in Singapore

  9. Gender dysphoria in children

  10. Gender dysphoria in adults

  11. How to support someone with gender dysmorphia?

  12. Self-help for gender dysmorphia


What is gender dysphoria?


Gender dysphoria is the discomfort and unease that a person might experiences when their gender identity differs from the sex assigned at birth, based on their physical characteristics.


According to a sex health review in 2017, it reported that the estimated prevalence of gender dysphoria based on self-reporting stood between 0.5 to 1.3%. Though more accurate numbers are not available, and the DSM-5 consider it a rare diagnosis, evidence strongly suggests the increase of gender dysphoria worldwide. [1]


Gender dysphoria in the DSM-5


Historically, gender dysmorphia had a slightly different name – gender identity disorder. This meant the assumption that any diverse gender identities were considered dysfunctional. The negative connotations of labelling gender incongruence worked against the de-stigmatisation of mental health and further marginalized the LGBTQIA+ community. [2]


As such, the American Psychological Association (APA) took up a term that was already floating around in the professional psychology space. Gender dysphoria officially replaced gender identity disorder in the DSM-5 that was published in 2013. [3]


Another guide that psychologists use internationally is the International Classification of Diseases (ICD). The ICD is published by the World Health Organization (WHO), and is used by all countries as a diagnostic tool, and includes updated global health-related statistics.


In 2019, WHO said that the newest edition of the ICD, will follow suit and replace gender identity disorder with gender dysmorphia. Furthermore, the eleventh volume of the guide will categorize gender incongruence under sexual health instead of mental disorders. [4]


What are causes of gender dysphoria?


The causes of gender dysphoria are not known. Furthermore, most of the studies done on the causes of gender dysphoria look for the reason for the incongruence, and not the causes for the dysphoria, or distress.


There are some scientific explanations for gender incongruence.


Hormonal causes – androgen insensitivity syndrome

Neuroscience studies have found that there may biological factors that explain why someone may not identify with their gender given at birth.


Brain scans were taken of transgender women and were more similar to cisgender women that were used as controls. The results of the study showed the absence and presence of certain hormones in transgendered people that corresponded with gender identity formation.


Brain scans taken of transgender women were more similar to cisgender women than male. The results of the study proved that the absence and presence of certain hormones in transgendered people corresponded with gender identity formation. It also found that the lack of sensitivity of a foetus to female hormones in their mother’s system, known as androgen insensitivity syndrome (AIS) was also a factor. [5]


Hermaphroditism

Hermaphroditism, or people born with intersex conditions, have reproductive organs that do not fit into the usual binary categories. [6]


Due to better fit into society, parents of children with hermaphroditism will raise the child as a preferred gender until they are old enough to choose for themselves.


How is gender dysmorphia diagnosed?


Gender dysphoria is complex. Like personality disorders, gender dysphoria does not necessarily manifest physically. Cross-dressing or dressing androgynously may be a tangible exhibition of gender dysphoria but even that may be done privately.


Doctors will observe a patient expressing distress about their gender for a period of six months before any referrals to gender clinics.


A study observing correlations between gender dysphoria and other psychiatric disorders showed that a little more than half of the sample experienced mental illnesses at one point in their life. The research also showed that mood disorders were the most prevalent in the studied demographic, followed by anxiety disorders and substance abuse. [7]


As such, they may also rely on the presence of comorbidities as evidence of the patient’s anguish. Not all transgendered people face gender dysphoria.


Treatments for gender dysphoria


There are three main categories of treatment to help people with gender dysphoria – behavioural, medical and surgical. With the recommendations of healthcare givers, individuals may choose to undergo a combination of treatments to alleviate their distress.


Psychological

While conversations around sexuality and transgendered people are taking place now more than ever, it is still a controversial topic, and especially in Asia. As such, transgender may encounter feelings such as shame, isolation and other comorbidities that are very damaging to the psyche. [8]


The type of therapy used to help individuals suffering with gender dysphoria is known as affirmative behavioural therapy. [9] Therapists specializing in this version of therapy are trained to help transgendered individuals in a more trauma-informed manner.


With affirmative behavioural therapy, its main aim is to increase the patient’s psychological well-being and quality of life. Counselling can assist in exploring gender expression, work towards self-acceptance and reduce the shame and distress around transitioning.


Given the comorbidity rates of gender dysphoria, talk therapies can also address other mental health issues that stem from the gender incongruence.


Pharmaceutical

Medications can be administered to transgender individuals who are looking to transition to their gender identity. This is known as hormone replacement therapy (HRT).


Hormones used for either feminizing or masculinizing can help achieve some of the physical attributes of the desired gender. For example, someone undergoing feminizing hormone replacement therapy might observe a reduction in facial hair, breast growth and so on.


Due to the side effects of the medication that can alter blood pressure levels and bone mineral density, patients must be stringently evaluated and deemed physically suitable to undergo treatment. Patients must also be made known of aftereffects. [10]


HRT has shown to improve the mental wellbeing of many suffering from gender dysphoria. Studies show that within a population with gender dysphoria, those undergoing various stages of hormone therapy were shown to have lower levels, or even the absence of comorbidities like anxiety and mood disorders. [11] [12]


Surgical

Gender confirmation surgery, previously also known as sex reassignment surgery, has proven to significantly decrease gender dysphoria.


However, due to the magnitude and permanence of the surgery, approving someone for the procedures can take a while. Typically, in preparation for the surgery, a healthcare professional will observe the patient for a minimum of six months to see if their mind changes.


Thereafter, the person will also have to live for a year in their desired gender and consistently go through hormonal therapy. Making sure that the person has a good support system to ensure good mental health after the transition may also come into play. [13]


What happens if gender dysphoria is not treated?


Without help, someone suffering from gender dysphoria may feel confused and isolated. This can lead to comorbidities like anxiety, depression and mood disorders. Though research shows that it is not common, substance abuse, suicidal ideation and genital self-mutilation are amongst other things that someone facing gender dysphoria might be susceptible to. [14]


Where to get treatment for gender dysphoria in Singapore?

Clinic/Organization

Address

Contact

Costs

Costs (unsubsidised)

​Institute of Mental Health

Buangkok Green Medical Park 10 Buangkok View

Singapore 539747


6389 2000 (24hr line)


imh_appt@imh.com.sg

$42

$39 (subsequent visit)

$105-$155

$72 - $103 (subsequent visit)


For counselling or support:

OogaChaga

57B Pagoda street, Singapore 059216,

Transbefrienders

7 Race Course Lane, Level 3.

Alicia Community Centre. Singapore 218734


(only by invitation)


*These clinics offer hormone therapy for other conditions. It may be advisable to call to ask if they are open to helping patients transition.


Resources for trans people in Singapore


Resources in Singapore for transgender and gender non-conforming individuals can be limited. Here is a comprehensive list of resources and helplines:

  • Transgender SG (for information)

https://transgendersg.com/

  • OogaChaga (support lines)

https://oogachaga.com/

  1. Whatsapp counselling:

8592 0609 or

https://wa.me/6585920609

b. Email counselling

Write in to their contact form on the website


If in need of emergency help, contact:

Samaritans of Singapore (SOS): 1-767 or 1-SOS


Gender dysphoria in children


According to an article by a Los Angeles hospital, gender dysphoria can manifest as early as 7 years old. [15] The incongruence is seeing higher rates of prevalence when compared against predictions and reports.


Rarely prescribed, puberty blockers can help children to transition to their secondary gender before physical attributes of their gender assigned at birth starts. However, because of the permanence of the treatment, it is not clinically common. Research also shows that 80% of GDC usually decrease by puberty, further cementing the fact that transitioning should start at a more mature age. [16] [17]


Gender dysphoria in adults


Gender dysphoria in adults do share similarities with children. For example, confusion and discomfort is a shared sentiment. However, given an adult’s exposure to society as compared to a child, feelings like shame might be more prevalent in adults as compared to children.


Another difference between the two demographics is the autonomy that an adult may have over their bodies. For example, adults with gender dysphoria may have more liberty changing their appearances to look more like the gender they identify with – binding, growing their hair out, and so on.


How to support someone with gender dysmorphia?


Transitioning can be a confusing time for transgendered people as well as the people around them. There are several ways to support gender non-conforming individuals.


Listening

Transitioning and living as a transgendered person may be difficult to navigate – many individuals face shame and the fear of intolerance from society. Providing a listening ear and sounding board can help them to figure things out.


Respecting pronouns and names

Not acknowledging someone by their preferred pronouns and name can make gender non-conforming people uncomfortable and unseen.


Learning to apologize

We all mess up. After knowing someone for a while, we are bound to slip up and momentarily forget their new pronouns or name. Glazing over the mistake might be disrespectful and increase the distress the person is going through. Learn how to apologize and address them as they prefer.


Research and education

There are many resources online that have guides to supporting a friend or family who is transgender. Asking the person directly can also help clear up the way they want to be addressed and so on.


Self-help for gender dysmorphia

Dealing with gender dysphoria can be isolating, especially in Asia. Not knowing anyone else going through the experience can also distance yourself social from others. While there are support groups available, here are some ways you can appreciate yourself more:


Affirmations

Listing things that you like about your transitioned self can help on hard days. Remember that you are living as your true self. Taping the list somewhere visible can also help to remind you on the not-so-great days.


Seek out friends that you are comfortable with

It’s important to be around people that make you feel comfortable. You don’t necessarily have to talk about your troubles, but knowing that you are seen and not judged can boost your psyche.


Gender dysphoria is still a long way from being properly talked about in Singapore. If you feel any of the symptoms and distress highlighted in the article, or knows someone who does, look to the available resources to support them. We see you, we appreciate you!

 

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About Our Writer

Rachel is an anxious INFJ with a slightly concerning obsession with coffee and true crime. She loves feeling smart and dislikes playing games she knows she will lose. Learning about mental health is her way of helping people around her. If the world was perfect, she wishes she could bring her friends flowers in a little red wagon.

 

This editorial section solely expresses the opinion of frankie and is not endorsed nor commissioned by any external party. The list is non-exhaustive. At frankie, we believe that your best provider of medical advice is your doctor. Please consult a doctor before undergoing any treatment or procedure.

 

References:


1. Zucker K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual health, 14(5), 404–411. https://doi.org/10.1071/SH17067 https://pubmed.ncbi.nlm.nih.gov/28838353/


2. Davy, Z., & Toze, M. (2018). What Is Gender Dysphoria? A Critical Systematic Narrative Review. Transgender health, 3(1), 159–169. https://doi.org/10.1089/trgh.2018.0014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225591/


3. Davy, Z., & Toze, M. (2018). What Is Gender Dysphoria? A Critical Systematic Narrative Review. Transgender health, 3(1), 159–169. https://doi.org/10.1089/trgh.2018.0014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225591/


4. BBC News. (2019, May 29). Transgender no longer recognised as “disorder” by WHO. https://www.bbc.com/news/health-48448804


5. Foreman, M., Hare, L., York, K., Balakrishnan, K., Sánchez, F. J., Harte, F., Erasmus, J., Vilain, E., & Harley, V. R. (2018). Genetic Link Between Gender Dysphoria and Sex Hormone Signaling. The Journal of Clinical Endocrinology & Metabolism, 104(2), 390–396. https://doi.org/10.1210/jc.2018-01105 https://academic.oup.com/jcem/article/104/2/390/5104458?login=true


6. Zucker, K. J. (2002). Intersexuality and Gender Identity Differentiation. Journal of Pediatric and Adolescent Gynecology, 15(1), 3–13. https://doi.org/10.1016/s1083-3188(01)00133-4 https://www.tandfonline.com/doi/pdf/10.1080/10532528.1999.10559774?casa_token=_KtYgJDoEJkAAAAA:H2pUk160zcBAIkDxKFkSqeiH1XvmCJvc3AWJCn654C0u6EkBob-iMitLy4Sycga5I-g5d9qiBSOVvg


7. Freitas, L. D., Léda‐Rêgo, G., Bezerra‐Filho, S., & Miranda‐Scippa, N. (2019). Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry and Clinical Neurosciences, 74(2), 99–104. https://doi.org/10.1111/pcn.12947 https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12947


8. Hage, J. Joris M.D., Ph.D.; Karim, Refaat B. M.D., Ph.D. Ought GIDNOS Get Nought? Treatment Options for Nontranssexual Gender Dysphoria, Plastic and Reconstructive Surgery: March 2000 - Volume 105 - Issue 3 - p 1222-1227 https://journals.lww.com/plasreconsurg/Fulltext/2000/03000/Ought_GIDNOS_Get_Nought__Treatment_Options_for.63.aspx


9. Pachankis, J. E., & Safren, S. A. (Eds.). (2019). Transgender Affirmative Cognitive–Behavioral Therapy. Handbook of Evidence-Based Mental Health Practice with Sexual and Gender Minorities. Published. https://doi.org/10.1093/med-psych/9780190669300.001.0001 https://www.oxfordclinicalpsych.com/view/10.1093/med-psych/9780190669300.001.0001/med-9780190669300-chapter-4


10. Unger C. A. (2016). Hormone therapy for transgender patients. Translational andrology and urology, 5(6), 877–884. https://doi.org/10.21037/tau.2016.09.04 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182227/


11. Gómez-Gil, E., Zubiaurre-Elorza, L., Esteva, I., Guillamon, A., Godás, T., Cruz Almaraz, M., Halperin, I., & Salamero, M. (2012). Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology, 37(5), 662–670. https://doi.org/10.1016/j.psyneuen.2011.08.010 https://www.sciencedirect.com/science/article/abs/pii/S0306453011002629?casa_token=La-PiQhNbIIAAAAA:YW3Eqh1ullRYEPTBd_l2nSnlUpk9RQefnlj0g0d3EhpXseOYUHfPZj8r0XJWs3iPCGCjxoxZfg


12. Freitas, L. D., Léda‐Rêgo, G., Bezerra‐Filho, S., & Miranda‐Scippa, N. (2019). Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry and Clinical Neurosciences, 74(2), 99–104. https://doi.org/10.1111/pcn.12947 https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12947


13. Carroll, R. A. (1999). Outcomes of Treatment for Gender Dysphoria. Journal of Sex Education and Therapy, 24(3), 128–136. https://doi.org/10.1080/01614576.1999.11074292 https://www.tandfonline.com/doi/abs/10.1080/01614576.1999.11074292


14. Freitas, L. D., Léda‐Rêgo, G., Bezerra‐Filho, S., & Miranda‐Scippa, N. (2019). Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry and Clinical Neurosciences, 74(2), 99–104. https://doi.org/10.1111/pcn.12947 https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12947


15. Cedars-Sinai Medical Center. “Most Gender Dysphoria Established by Age 7: Cedars-Sinai.” Cedars, Cedars-Sinai Medical Center, 8 Apr. 2021, https://www.cedars-sinai.org/newsroom/most-gender-dysphoria-established-by-age-7-study-finds/.


16. Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: current perspectives. Adolescent health, medicine and therapeutics, 9, 31–41. https://doi.org/10.2147/AHMT.S135432 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841333/


17. de Vries, A. L. C., & Cohen-Kettenis, P. T. (2012). Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach. Journal of Homosexuality, 59(3), 301–320. https://doi.org/10.1080/00918369.2012.653300 https://www.tandfonline.com/doi/full/10.1080/00918369.2012.653300?casa_token=3-MuYeWjCEQAAAAA%3AaaUOpriQw_JLhoTDAw0FQ7EuwKnFohQxR2SHzAoIaoOwlUQ1XlBaPEXGX_lP0G7PaEi-hBfGBdY