‘The only thing that has been achieved so far is to try to adapt the body to the mind, instead of trying to alleviate the cerebral problem’
The diagnosis of transsexualism is based on both medical and psychiatric findings, criteria that have been enshrined in medical guidelines, such as the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), drawn up by the American Psychiatric Association, or the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).2
However, before attempting to determine the existence of transsexuality and its possible immediate consequence, gender dysphoria, karyotyping should be performed to try to rule out a chromosome disorder, the result of an enzyme defect, that could lead to sexual ambiguity, as occurs in Turner’s or Klinefelter syndrome.3
According to the DSM-5, in order to diagnose gender dysphoria, there has to be objective incongruity between the sex assigned at birth and the one the individual desires, i.e. a marked difference between the gender that one feels and the one assigned at birth, and this disharmony must persist for at least 6 months.
In the case of children, gender dysphoria can manifest between two and four years old, when affected children can start to express preferences or social attitudes of the sex opposite to the gender to which they biologically belong, but this desire must be determined objectively.
According to World Professional Association for Transgender Health (WPATH) guidelines, the diagnosis of gender dysphoria is an essential condition in order for a person to be able to request sex reassignment surgery.