Acting on the results of a recent study which suggests that nearly 2/3 of people with gender identity disorder go undiagnosed, the American Psychiatric Association has recommended routine screening for this condition.

Gender identity disorder, or GID, is characterized by strong and persistent cross-gender identification and persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender-role of that sex. These symptoms often cause significant impairment in social functioning and lead to disastrous wardrobe, make-up and hairstyling choices in patients who do not receive proper counseling.

According to Gail Silverman, APA spokesperson and lead author of the study, "We are just now learning that millions of people suffer needlessly due to GID. When there are effective treatments available such as hormone therapy and, ultimately, anatomy-altering surgery, it's simply unconscionable that we allow so many to go undiagnosed." Dr. Silverman also cited lack of reimbursement as a major barrier to individuals with GID getting help. Currently, less than 1 in 10 insurance providers will cover gender identity services and individuals who do receive treatment - which are now believed to represent less than 30% of those affected with the disorder - can incur out-of-pocket expenses reaching tens of thousands of dollars.

The APA will recommend a list of screening questions to identify those who are at risk for GID which can be remembered using the mnemonic "TRANS." It is recommended that all patients screened at routine intervals.

• Thoughts - Have you ever thought about what it would be like to be the opposite gender?


• wRong - Have you ever felt like you were born the wrong gender?


• Anatomy - Are you distressed by your own primary and secondary sexual characteristics?


• Nervous - Does dressing as your assigned gender make you uncomfortable?


• tranS Sexual - Have you ever gone to see Rocky Horror Picture Show?

Opponents of the new guidelines argue that there is not yet enough data to properly evaluate outcomes for individuals receiving treatment. Psychiatrist Harry Seeward today was quoted as saying, "With the enormous technical obstacles we continue face in the phalloplasty procedure, our efforts must first focus on designing a better penis before we can reap the benefits of early diagnosis of GID."