Helping Transgender Patients Deal with Gender Dysphoria, Substance Abuse, Body Image and/or Eating Disorders

When a transgender or gender non-conforming loved one embarks on a journey of transition, it’s crucial to address any psychological disorders they may be suffering as a direct result of their distress in trying to live happy and productive lives in the midst of conflicting feelings and gender confusion. Family members and long-time or close friends are in the best position to document and discuss such issues, which is why a strong support group is so important to successful treatment.

Being transgender does not automatically mean that a person is suffering from a “disorder,” although it is the rare individual who is content to be living in the gender identity assigned at birth when it conflicts with their own gender identification.

Terminology and Definitions

Activists for reform in the standards of diagnosis and treatment of transsexuality and the medical establishment that serves the transgender population are both questioning the validity of categorizing trans and gender non-conforming people as having a mental disorder for the purpose of establishing the diagnoses often required in order to maintain continued access to hormone therapy or plastic surgery under public or private health insurance plans.

In recent years, research and enlightened social reforms have raised social acceptance and improved access to treatment. WPATH published their 7th Version of Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC) in September 2011. One important change in the 7th Version of the SOC was redefining Gender Identity Disorder (GID) as Gender Dysphoria.

However, regardless of the terms used—transgender, transsexual, Gender Dysphoria, or Gender Identity Disorder (GID)—it has certainly been recognized by all concerned that living in a culture that assumes sex and gender are binary and that the sex and gender a person is assigned at birth are congruent and should remain stable through the lifecourse can cause distress and frustration .

Some of the effects of the resulting Gender Dysphoria are substance abuse, eating disorders and psychological problems caused by low self-esteem, lack of confidence and a poor body image. These are problems which must be diagnosed and treated in any framework of transitioning to the desired gender identity and expression.

Treating the Individual, not the Disorder

Some gender-related distress may be resolved as a transgender person matures (sometimes observed in the case of childhood gender dysphoria) or when the level of an individual’s personal distress is alleviated by living comfortably in their self-identified gender either with or without hormone therapy or plastic surgery.

More commonly, however, an individual desiring to alter their gender identity and expression usually does suffer from some form of Gender Dysphoria which can result in unhealthy behaviors. Some of these may include alcohol and drug abuse, anorexia or bulimia in attempting to change body image, an inability to form relationships or function in social situations, what is described in DSM-V (the proposed revision to the current DSM-IV) as “clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Seeking Professional Help

Finding a psychologist or psychiatrist familiar with transgender issues is the first step in diagnosing gender-related substance abuse, eating disorders, or other body image related psychological or pathological conditions. Treating such disorders will aid in making a successful transition and making a successful transition will aid in overcoming such disorders.

Diagnosis and treatment should be made by professionals, but partners, family members and friends play critical roles by being able to document patient history and by supporting the patient and in carrying out therapy.

Finding the right physicians to treat both mental and physical issues in another area in which family members and friends can provide assistance. It’s important to choose a physician or medical professional who has experience or special training in dealing with transgender patients. If and when the time comes for plastic surgery there is a clear advantage in choosing a board certified plastic surgeon  who both has the skills to perform SRS surgery and is familiar with the system of referrals and approvals that are required for moving smoothly through the transition process.

San Francisco transgender patients have found the ideal combination in Dr. Scott Mosser who is a board certified plastic surgeon  very well known for his expertise in FTM chest reconstruction and MTF breast augmentation surgery. He and his professional team offer an understanding and non-judgmental welcome to patients coming into his downtown San Francisco office, and are familiar with the local transgender scene. They stand ready to assist with coordination both before and after surgery with the patient’s support team of professionals and family, partner, or friends. Dr. Mosser respects the WPATH Standards of Care and is sensitive to the complexities of obtaining letters of recommendation and referrals prior to surgery. He does not view Gender Dysphoria as a “disorder,” but considers sex reassignment to be ‘gender confirmation surgery’, or surgery to confirm what is already a reality.

As with all his patients seeking plastic surgery, Dr. Mosser does everything in his power to ensure that they are physically, mentally and emotionally ready and able to make mature, informed decisions.