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Cureus. 2017 Dec 24;9(12):e1984. doi: 10.7759/cureus.1984.

Transgender Associations and Possible Etiology: A Literature Review.

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Internal medicine, King Edward Medical University Lahore, Pakistan.
R Endocrinology, New Jersey, Asst. Professor, Internal Medicine and Endocrinology, Umdnj.


Transgender or gender dysphoria has been defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as distress resulting from the incongruence between one's experienced gender and one's assigned gender, along with a persistent and strong desire to be of another gender, and accompanied by clinically significant distress. Adolescents referred for evaluation often want hormonal therapy and several among them also express a desire for gender reassignment surgery. Furthermore, evidence shows that adolescents and adults with gender dysphoria without a sex development disorder, before gender reassignments, are at increased risk for suicide. For this review, a search of the English language scientific literature was conducted using the PubMed database. This summary discusses the associations and comorbidities of gender dysphoria and reiterates the evidence that its etiology is multifactorial. Transsexualism involves prenatal neuroanatomical changes, has a psychiatric association, and is found to be more prevalent in conjunction with schizophrenia and autism spectrum disorders. Childhood adversities and neglect are also linked to having a transgender identity. Moreover, the evidence favors a genetic predisposition. Likewise, there seems to be a growing concern with regards to the relationship between endocrine disruptors and transsexuals as well as other gender minority populations. More research needs to be done to understand the exact pathways.


autism spectrum disorders; gender dysphoria; gender identity disorder; transexualism; transgender

Conflict of interest statement

The authors have declared that no competing interests exist.

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