Abstract
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.
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Acknowledgments
We thank the patient and his family, for consenting to the publication of the case; the residents, graduates, and medical staff of the Adrenal Outpatient Clinic, at Escola Paulista de Medicina, Universidade Federal de São Paulo; and CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil), for funding Mariana Telles-Silveira’s Ph.D. scholarship during the period of this project (2010–2014).
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Silveira, M.T., Knobloch, F., Silva Janovsky, C.C.P. et al. Gender Dysphoria in a 62-Year-Old Genetic Female With Congenital Adrenal Hyperplasia. Arch Sex Behav 45, 1871–1875 (2016). https://doi.org/10.1007/s10508-016-0750-2
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DOI: https://doi.org/10.1007/s10508-016-0750-2