Schizophrenia modifying the expression of gender identity disorder

According to the Brazilian Federal Medical Association, transsexualism is recognized as a gender identity disorder if a long-term diagnostic therapeutic process has demonstrated that the transposition of gender roles is irreversible, and if only hormonal and surgical procedures are appropriate to relieve the stress associated with the gender identity. Although such treatment will only be initiated with caution and after a long phase of intense diagnostic screening, the differentiation between pure identity disorders and transsexual feelings secondary to an ongoing psychopathologic process, such as schizophrenia, can be arduous for many health professionals.

To report a case of a female patient with schizophrenia and transsexualism and the risks of a potential diagnostic confusion.

A 19-year-old black woman, with an 8-year history of undifferentiated schizophrenia and intense gender dysphoria, was referred for sex reassignment surgery evaluation in the Ambulatory for the Treatment of Sexual Disorders of the ABC Medical School.

After a more adequate antipsychotic treatment, her masculine behavior has persisted, but her desire to change her own genital organs has decreased.

A better acceptance of the multiplicity of possible genders should neither contribute to inadequate interpretations of the signs and symptoms of our patients nor facilitate dangerous clinical or surgical recommendations.