Disorders of gender identity.

Disorders of gender identity involve a greater number of disciplines than most other areas of psychiatry.a Endocrinologists, speech and language therapists, and surgeons (ears, nose and throat, plastic and urological) are routinely involved. Further, the field is highly politicised, attracting much public fascination and arousing strong opinions. Disorders of gender identity have probably always existed, inside and outside Europe (Heiman 1975). It seems that the incidence of trans sexualism is very roughly 1 in 60 000 males and 1 in 100 000 females, and it seems to have remained constant (Landen 1996). There is the suggestion that there may be a raised rate in Polynesians, possibly related to a greater incidence of partial androgen insensitivity syndromes (H. Bower, personal com­ munication, 2002).