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Purpose – This study examines the consequences of sudden influx of medicalized discourse of gender in Japan by introduction of gender identity disorder (GID) in the late 1990s where transgender identities and the LGBT activism have had a different history and meanings from Western societies.

Methodology – I use discourse analysis of autobiographies of people with GID in Japan and the limited studies concerning the history of GID and transgender in Japan.

Findings – The introduction of GID to Japanese society contributed to increased social awareness of transsexual individuals. However, it also resulted in transsexual fundamentalism, which has excluded individuals who do not meet certain rigid medical and social identity criteria. This development reinforces the conventional binary gender norms instead of problematizing them. Furthermore, a legislation strictly based on the diagnosis has produced two groups: transsexual individuals with GID diagnosis who will be legally and socially recognized as legitimate, and those who are not GID and thus undeserving of such recognitions.

Social implications – Diagnosis cannot exist without criteria, therefore it is impossible for GID to function as an inclusive identity category. Therefore, we must seek a system to provide medical services that do not necessitate diagnosis. It is also crucial to nurture the social environment where people can freely choose gender identities and expressions that go beyond conventional binary gender system and to keep insisting on plurality and fluidity of gender so that people do not have to rush for a narrow window of recognition.

Purpose – To examine debates within the transgender rights movement over the GID diagnosis in order to demonstrate how diagnosis can be resisted as a source of stigma and social control at the same time that it is embraced as a means of legitimating experience and gaining access to resources, including medical services.

Methodology/approach – This chapter draws on qualitative data from: in-depth interviews with transgender rights activists and advocates, participant observation in transgender health care and activism settings, and content analysis of print and web-based materials on transgender health.

Findings – Transgender rights activists and advocates overwhelmingly reject the pathologization of gender variance. However, some actors advocate complete demedicalization, while others advocate diagnostic reform. Actors' advocacy for each position is influenced by the perceived costs versus benefits of diagnosis.

Social implications – The findings of this research shed light on the multiple and often contradictory effects of diagnosis. Diagnoses can both normalize and stigmatize. They can function to allow or deny access to medical services and they can support or act as barriers to legal rights and protections. Understanding these contradictory effects is essential to understanding contests over diagnosis, including the contemporary debate over GID.

Originality/value of paper – Through examination of an intra-constituent contest over diagnosis, this research demonstrates the need to distinguish medicalization from pathologization and illustrates the importance of examining the multiple and contradictory effects of diagnosis, both in and outside of medical settings.

Purpose – The purpose of this chapter is to theorize the relationship between diagnosis and medicalization through an examination of the medicalization of childhood gender variance and the Gender Identity Disorder of Childhood diagnosis.

Methodology/approach – The chapter examines textual data (published clinical and research literatures, and critiques of the diagnosis appearing in a range of venues) to track how childhood gender variance is medicalized over time and the role of diagnosis in that medicalization.

Findings – While diagnosis certainly plays a role in shoring up medicalization, this case study reveals the many ways in which diagnoses may also become key tools in attempts to curtail medicalization.

Research limitations/implications – As a case study, the findings are not generalizable to all diagnoses. As a study of an instance of the medicalization of deviance, these findings may be particularly applicable to analogous cases.

Social implications – These findings show the sometimes tenuous nature of medicalization processes, and the social uses of diagnoses in those processes.

Originality/value of paper – This chapter sheds light on a relationship that is often assumed to be unidirectional (e.g., that the formation of diagnosis results in increased medicalization), and answers calls for a more nuanced sociology of diagnosis, including greater attention to the relationship between diagnosis and medicalization.

The purpose of this paper is to systematically review the literature on gender identity disorder (GID) and associated gender disorders in people with learning disabilities and autism, specifically focusing on aetiology, treatment and management.

This study reviewed all the published papers about individuals with both a learning disability and/or autistic spectrum disorder and a gender disorder. Papers from 1980 onwards were included as this was the year of the introduction of GID to the ICD-10. Gender disorders were taken to include the following: GID, transsexualism, cross-dressing, transvestitism or a gender-related sexual disorder.

In total, 16 papers described 43 individuals meeting the inclusion criteria. There was a dearth of guidance on appropriate treatment or management.

Only English language papers were searched. This review points towards more research needed in this area.

In collating relevant papers the review begins the search for evidence regarding aetiology, treatment and management of gender disorders in an area where evidence-based guidelines are needed.

The purpose of this paper is to explore the gender identity of people with learning disabilities as a precursor to considerations of gender dysphoria.

Discussion supported by illustrations from the literature.

There is limited research on gender identity for people with learning disabilities.

There is an urgent need to look at how men with Klinefelter's syndrome and learning disabilities are supported in relation to common female sexual characteristics.

This is personal perspective on gender and people with learning disabilities which may support work with people who question their gender.

The case of a woman with a history of offending and prolonged imprisonment is given. The purpose of this paper is to explore the complex interplay between diagnoses of autistic spectrum disorder (ASD), personality disorder and gender dysphoria. A discussion on useful and less useful treatment approaches follows, given the unusual and complex clinical presentation.

This is a case report with a summary of the background to this under-researched area.

The way in which the diagnostic picture clarified over time is explained. The difficulties in accurately diagnosing are put forward and strategies to address this are suggested. Successful treatment of unusual clinical problems may require highly individualised care within generic services.

The authors know of no similar case reports in the published literature. The clinical associations between ASDs, personality disorders and gender dysphoria, in forensic mental health populations, appears to be unexplored in the literature.

Through the media it is clear that the number of people who are openly identifying as transgender is growing. Some of those people who are identified as transgender are adults but many times they are younger and sometimes young children (under the age of eight). As young children are sharing with family and school personnel that their gender and the assigned gender at birth are not an exact match, families and school personnel need the tools to support these children. Since most teacher training programs do not currently have preparation in working with children who are transgender or gender fluid, it is up to teachers and administrators to seek out materials and resources until such time as teacher preparation programs include this in the curriculum. In this chapter, the author shares basic terminology, ideas about changing curriculum, language, and environment in early childhood settings to help welcome young children who are transgender or gender fluid into these spaces. In addition, possible questions children and adults may ask are included along with resources and books about people who are transgender that are age appropriate for early childhood settings.

This paper addresses the question of gender and identity in relation to a number of considerations for supporting men with learning disabilities who cross‐dress (wearing the clothes of the opposite sex), or want gender reassignment (accessing hormonal and surgical treatment to develop the physical characteristics of the opposite sex). Drawing on practice experience, it identifies a number of issues which will need to be considered when working on these topics, and presents a model for taking forward work with staff and service users.

Historically, it has been common practice for doctors and parents to withhold the diagnosis from their minor intersex patients. This study seeks to integrate intersex youth experiences into the growing body of literature on diagnosis disclosure for intersex patients.

Using gender structure theory as a model, 16 intersex youth were given in-depth surveys regarding their experiences with their intersex identity in individual, interactional, and institutional contexts.

Participants more positively experience intersex than the earlier generations of intersex people. They were not deeply troubled by their diagnosis as doctors have historically feared, and they are open about their diagnosis with their non-intersex peers and teachers. They also find peer support valuable.

Data was collected from a single event and cannot represent all intersex youth. Future research must continue to engage with intersex youth experiences both inside of and beyond activist and support group networks.

These findings are strong exploratory evidence for the importance of diagnosis disclosure for intersex youth. Policies of withholding intersex diagnoses in clinical and familial contexts should be reevaluated in light of the experiences of intersex youth.

Diagnosis disclosure for intersex youth creates the potential for increased medical decision-making participation and increased capacity for activism and community building around intersex issues.

Our results encourage future studies that center the experiences of intersex youth, for we conclude that theorizing the lived experiences of intersex people is incomplete without their perspectives.

Transgender sex offenders are a small, complex and atypical group. The purpose of this paper is to highlight the issues in relationship to the assessment of gender dysphoria in transgender sex offenders and approaches to risk management.

Clinical and research experience as a Gender Specialist and Consultant Forensic Psychiatrist who has managed sex offender populations has informed this publication.

Little is known about the relationship between gender dysphoria and criminality. More research is required to develop a typology of transgender sex offenders and develop actuarial risk instruments. Protective factors in relation to gender affirmative care are also important to understand.

There is little empirical research to guide gender specialists and criminal justice professionals in the management of gender dysphoria and address risk and recidivism in transgender offender populations. The treatment of gender dysphoria could result in improved well-being and better psychosocial adjustment but cannot be relied to reduce future recidivism.

There is no evidence that treatment of gender dysphoria reduces risk and recidivism in transgender sex offenders and that research is required to identify specific gender related dynamic risk factors.

Recommendations are directly relevant to the work of prison and probation staff, community supervisors and gender identity specialists.

As far as the author is aware it is the first paper on the assessment and management of gender diverse sex offenders integrating approaches to gender dysphoria assessment and treatment and risk management. It has implication for gender identity specialists, criminal justice professionals, research and policy.