By Dr Ananya Mandal, MD
Gender dysphoria usually means a difficulty in identifying with the biological sex in an individual.
The causes of gender dysphoria are not fully clear.
Psychiatric and biological causes
It was traditionally thought to be a psychiatric condition meaning a mental ailment. Now there is evidence that the disease may not have origins in the brain alone.
Studies suggest that gender dysphoria may have biological causes associated with the development of gender identity before birth.
More research is needed before the causes of gender dysphoria can be fully understood.
Genetic causes of biological sex
Research suggests that development that determines biological sex happens in the mother’s womb.
Anatomical sex is determined by chromosomes that contain the genes and DNA.
Each individual has two sex chromosomes. One of the chromosomes is from the father and the other from the mother.
A normal man has an X and a Y sex chromosome and a normal woman has two X chromosomes.
It is seen that during early pregnancy, all unborn babies are female because only the female sex chromosome (or the X chromosome) that is inherited from the mother being the active one.
After the eighth week of pregnancy, the chromosome from the father (an X for a female and a Y for the male), gains in activity.
If the father’s contribution is the X chromosome the baby continues to develop as female with a surge of female hormones.
This helps develop her female sex organs, reproductive organs and features. This makes her sex and gender female.
If the inherited chromosome from the father is a Y there is a surge of testosterone and other male hormones that lead to development of male characteristics, such as testes.
This makes the baby’s sex and gender male. (1)
Causes of gender differences
There are several different potential causes of gender differences, these include hormonal changes, exposure to estrogenic drugs and so forth. (1-4)
Hormones that trigger the development of sex and gender in the womb may not function adequately.
For example, anatomical sex from the genitals may be male, while the gender identity that comes from the brain could be female.
This may result from the excess female hormones from the mother’s system or by the foetus’s insensitivity to the hormones.
The latter condition is called androgen insensitivity syndrome (AIS).
Exposure to progesterone or other estrogenic drugs
Although there is no research that shows that males or females exposed to progesterone in the womb or other estrogenic drugs, such as diethylstilbestrol (DES) may have a raised risk of gender dysphoria; there may be an association in some atypical aspects of gender role behavior.
Rare conditions that may lead to gender dysphoria
There may be rare conditions like congenital adrenal hyperplasia (CAH), and intersex conditions (also known as hermaphroditism) which may also result in gender dysphoria.
In CAH a female foetus has adrenal glands (small caps of glands over the kidneys) that produce high level of male hormones. This enlarges the female genitals and the female baby may be confused with a male at birth.
Intersex conditions mean babies may be born with the genitalia of both sexes. In these cases the child is allowed to grow and choose his or her own before any surgery is carried out to confirm it.
Other causes of gender dysphoria
- There may be chromosomal abnormalities that may lead to gender dysphoria.
- Sometimes defects in normal human bonding and child rearing may be contributing factor to gender identity disorders.
Edited by April Cashin-Garbutt, BA Hons (Cantab)
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