Snapshot Your patient is a 15-year-old male who is brought in by his parents because his father feels like something is not right with his son. According to the parents, the boy used to play with items classically intended for girls (dolls) and insists on wearing girls clothing and makeup. Concerned, you interview the patient and find that he verbally insists on being a female and feels at times that he does not fit in as a male. He seems to demonstrate a strong preference for being a female, and this has persisted throughout his life. Introduction Clinical definition discomfort with one's genetic sex neither a sexual dysfunction nor a paraphilia diagnosed clinically by mental health providers "strong desire to be of the other gender," is the specific wording used in diagnosing children Epidemiology Most frequently in young men ETIOLOGY Associated conditions depression anxiety substance abuse personality disorders Presentation Symptoms dressing in opposite gender's clothes taking hormones to change voice concealing secondary sex characteristics strong preference to be another gender Treatment Psychotherapy supportive family counseling Surgical sexual reassignment in some cases Endocrine hormonal therapy (testosterone, estrogen)