Discrimination and psychopathology in gender dysphoria: a hormone therapy

Document Type : Original Article


1 Counseling Center of Expertise on Sexual Disorders of Pooyan, Gorgan, Iran

2 Department of Psychology, University of Essex, Colchester, United Kingdom


Purpose: One of the strategies for treating gender dysphoria is cross-sex hormone therapy (CHT). Our study aimed to explore the differences in the psychopathology of people with gender dysphoria who received the hormone with those who did not this treatment. We also wanted to explore discrimination and rejection among people with gender dysphoria.

: We administered a demographic questionnaire and the structured clinical interview for DSM Axis I disorders (SCID_I) to all participants. Our study sample consisted of 41 people with gender dysphoria (20 MtF and 21 FtM), of whom 21 received Cross-sex hormone therapy (CHT) and 20 did not.

Results: Results indicated that they were on CHT had lower psychological problems than those who did not receive hormone therapy. CHT was influenced by gender dysphoria’s psychological health. On the other hand, gender dysphoria that doesn’t receive CHT, had further depression, anxiety, obsession-compulsion, and in general Axis-I disorders. We also found that male-to-female people with gender dysphoria were more likely to suffer from discrimination and rejection.

Conclusions: We concluded that CHT could affect the mental health of people with gender dysphoria. Our knowledge of the role of discrimination, ridicule and rejection on the psychological pathology of people with gender dysphoria can help specialists to find the best treatment for these people.


Main Subjects

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) American Psychiatric Pub. Arlington, VA, USA.
Başar, K., Öz, G., & Karakaya, J. (2016). Perceived discrimination, social support, and quality of life in gender dysphoria. The journal of sexual medicine, 13(7), 1133-1141.
Colizzi, M., Costa, R., Pace, V., & Todarello, O. (2013). Hormonal treatment reduces psychobiological distress in gender identity disorder, independently of the attachment style. The journal of sexual medicine, 10(12), 3049-3058.
Colton Meier, S. L., Fitzgerald, K. M., Pardo, S. T., & Babcock, J. (2011). The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals. Journal of gay & lesbian mental health, 15(3), 281-299.
Corda, E., Bandecchi, C., Deiana, V., Pintore, S., Pinna, F., Pusceddu, R., Oppo, A., Mariotti, S., Argiolas, A., & Carpiniello, B. (2016). Body image and gender role perceived in gender dysphoria: cross-sex hormone therapy effects. European Psychiatry, 33(S1), S589-S589.
Costa, R., & Colizzi, M. (2016). The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: a systematic review. Neuropsychiatric Disease and Treatment, 12, 1953.
de Vries, A. L., Doreleijers, T. A., Steensma, T. D., & Cohen‐Kettenis, P. T. (2011). Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry, 52(11), 1195-1202.
Dhejne, C., Van Vlerken, R., Heylens, G., & Arcelus, J. (2016). Mental health and gender dysphoria: A review of the literature. International review of psychiatry, 28(1), 44-57.
Fabris, B., Bernardi, S., & Trombetta, C. (2015). Cross-sex hormone therapy for gender dysphoria. Journal of Endocrinological Investigation, 38(3), 269-282.
First, M., Spitzer, R., Gibbon, M., & Williams, J. (1997). User’s Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders SCID-I: Clinician Version (American Psychiatric Pub, Washington, DC:).[Google Scholar].
First, M. B., Williams, J. B., Karg, R. S., & Spitzer, R. L. (2016). User's guide for the SCID-5-CV Structured Clinical Interview for DSM-5® disorders: Clinical version. American Psychiatric Publishing, Inc.
Fisher, A. D., Castellini, G., Bandini, E., Casale, H., Fanni, E., Benni, L., Ferruccio, N., Meriggiola, M. C., Manieri, C., & Gualerzi, A. (2014). Cross‐sex hormonal treatment and body uneasiness in individuals with gender dysphoria. The journal of sexual medicine, 11(3), 709-719.
Gijs, L., Putten-Bierman, E. v. d., & Cuypere, G. D. (2014). Psychiatric comorbidity in adults with gender identity problems. In Gender dysphoria and disorders of sex development (pp. 255-276). Springer.
Gómez-Gil, E., Zubiaurre-Elorza, L., Esteva, I., Guillamon, A., Godás, T., Almaraz, M. C., Halperin, I., & Salamero, M. (2012). Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology, 37(5), 662-670.
Gorin‐Lazard, A., Baumstarck, K., Boyer, L., Maquigneau, A., Gebleux, S., Penochet, J. C., Pringuey, D., Albarel, F., Morange, I., & Loundou, A. (2012). Is hormonal therapy associated with better quality of life in transsexuals? A cross‐sectional study. The journal of sexual medicine, 9(2), 531-541.
Hasan, S., Alviany, Y., Clarissa, C., & Sudana, S. (2017). High perceived discrimination and no family support increase risk of poor quality of life in gender dysphoria. Universa Medicina, 36(3), 187-196.
Havar, E. S., Yasrebi, K., Hassanzadeh, R., Moshkani, M., & Kaboosi, A. (2015). Personality disorders and psychiatric comorbidity among persons with gender identity disorder. Journal of the Indian Academy of Applied Psychology, 41(3), 141.
Hepp, U., Kraemer, B., Schnyder, U., Miller, N., & Delsignore, A. (2005). Psychiatric comorbidity in gender identity disorder. Journal of psychosomatic research, 58(3), 259-261.
Heylens, G., Elaut, E., Kreukels, B. P., Paap, M. C., Cerwenka, S., Richter-Appelt, H., Cohen-Kettenis, P. T., Haraldsen, I. R., & De Cuypere, G. (2014). Psychiatric characteristics in transsexual individuals: multicentre study in four European countries. The British Journal of Psychiatry, 204(2), 151-156.
Ibrahim, C., Haddad, R., & Richa, S. (2016). Psychiatric comorbidities in transsexualism: study of a Lebanese transgender population. L'encephale, 42(6), 517-522.
Javaheri, F. (2010). A study of transsexuality in Iran. Iranian Studies, 43(3), 365-377.
Javaheri, F., & Hosseinzadeh, M. (2012). Social consequences of sexual identity disorder: A study on transsexuals’ social capital and quality of life. Journal of Iranian Social Studies, 5(3), 3-22.
Javaheri, F., & Kouchakian, Z. (2006). Gender identity disorder and its social factors, to investigate the phenomenon of gender dysphoria in Iran. Social Welfare Quarterly, 5(21), 265-292.
Murad, M. H., Elamin, M. B., Garcia, M. Z., Mullan, R. J., Murad, A., Erwin, P. J., & Montori, V. M. (2010). Hormonal therapy and sex reassignment: A systematic review and meta‐analysis of quality of life and psychosocial outcomes. Clinical endocrinology, 72(2), 214-231.
Newfield, E., Hart, S., Dibble, S., & Kohler, L. (2006). Female-to-male transgender quality of life. Quality of life Research, 15(9), 1447-1457.
Osório, F. L., Loureiro, S. R., Hallak, J. E. C., Machado‐de‐Sousa, J. P., Ushirohira, J. M., Baes, C. V., Apolinario, T. D., Donadon, M. F., Bolsoni, L. M., & Guimarães, T. (2019). Clinical validity and intrarater and test–retest reliability of the Structured Clinical Interview for DSM‐5–Clinician Version (SCID‐5‐CV). Psychiatry and clinical neurosciences, 73(12), 754-760.
Perrotta, G. (2021). Etiological factors and comorbidities associated with the “Gender Dysphoria”: Definition, clinical contexts, differential diagnosis and clinical treatments. International Journal of Sexual and Reproductive Health Care, 4(1), 001-005.
Pusceddu, R., Bandecchi, C., Pinna, F., Pintore, S., Corda, E., Deiana, V., Oppo, A., Mariotti, S., Argiolas, A., & Carpiniello, B. (2016). Clinical characteristics of gender identity disorder. European Psychiatry, 33(S1), S589-S590.
Sadock, B., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of psychiatry: behavioral sciences: Walters Kluwer.
Shirdel-Havar, E., Steensma, T. D., Cohen-Kettenis, P. T., & Kreukels, B. P. (2019). Psychological symptoms and body image in individuals with gender dysphoria: A comparison between Iranian and Dutch clinics. International Journal of Transgenderism, 20(1), 108-117.
Smith, K. P., Madison, C. M., & Milne, N. M. (2014). Gonadal suppressive and cross‐sex hormone therapy for gender dysphoria in adolescents and adults. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 34(12), 1282-1297.
Unger, C. A. (2016). Hormone therapy for transgender patients. Translational andrology and urology, 5(6), 877.
White Hughto, J. M., & Reisner, S. L. (2016). A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender health, 1(1), 21-31.