Gender Dysphoria in a 62-Year-Old Genetic Female With Congenital Adrenal Hyperplasia.
We report a case of gender dysphoria (GD) in a 62-year-old genetic female patient, raising the pros and cons of performing corrective surgery later in life. This 46,XX DSD patient was registered and reared as a girl; CAH was diagnosed late in childhood. Poor adherence to treatment and lack of proper psychological management contributed to evident GD. Living for years as a male, the patient applied for a legitimate male identification document in his late 50s; thereafter, he requested a sex-reassignment surgery "to disguise his female body upon his death." We informed the patient and family about surgery hazards, while analytical therapy allowed the group to evaluate the actual wish for surgery. When the wish was brought up, the role of death urged the group to rethink the course of treatment. During the process, it became clear that the patient's desire for surgery, more than a wish for changing the genitalia, expressed an impulse related to issues of endorsement and acceptance of his male identity. This report raises interesting questions about sexuality in a social context and prompts the idea that sexuality is broader than sex itself, raising new questions on the psychological risks faced when considering a body change after years of living with a disorder of sex development.
Adrenal and Hypertension Unit, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina at Universidade Federal de São Paulo (EPM/UNIFESP), R. Pedro de Toledo, 781 - 13th Floor, São Paulo, SP, 04039-032, Brazil.
Mariana Telles
MT
Silveira
Psychology Program, Faculdade de Ciências Humanas e da Saúde at Pontifícia Universidade Católica de São Paulo (PUC/SP), São Paulo, SP, Brazil.
Felícia
F
Knobloch
Adrenal and Hypertension Unit, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina at Universidade Federal de São Paulo (EPM/UNIFESP), R. Pedro de Toledo, 781 - 13th Floor, São Paulo, SP, 04039-032, Brazil.
Carolina C P
CC
Silva Janovsky
Adrenal and Hypertension Unit, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina at Universidade Federal de São Paulo (EPM/UNIFESP), R. Pedro de Toledo, 781 - 13th Floor, São Paulo, SP, 04039-032, Brazil. kater@unifesp.br.
Claudio E
CE
Kater
D000312:Adrenal Hyperplasia, Congenital / Q000523:psychology*; D005260:Female; D000068116:Gender Dysphoria / Q000175:diagnosis* / Q000601:surgery; D005783:Gender Identity; D006801:Humans; D008297:Male; D008875:Middle Aged; D012649:Self Concept; D057829:Gender-Affirming Procedures / Q000523:psychology*
Congenital adrenal hyperplasia; Disorders of sex development; Gender dysphoria; Sex-reassignment surgery