Transforming the paradigm of transgender health: a field in transition

This special issue of Sexual and Relationship Therapy entitled "Gender Variance and Transgender Identity'' is comprised of a collection of articles that reflect a transition in this growing field from a disease-based to an identity-based model of transgender health. The disease-based model assumes that normative gender identity development has been compromised and that the associated distress can be alleviated by establishing congruence between sex, gender identity and gender role, if necessary through hormonal and surgical sex reassignment. The identity-based model assumes that gender variance is merely an example of human diversity and that the distress transgender individuals might experience results from social stigma attached to gender variance. The latter model views transgender people as having an experience, identity and sexuality distinct from those of both non-transgender women and men. This paradigm shift forms the context for nine peer reviewed articles ranging from empirical research on transgender identity expression and validation; developmental tasks facilitated through depth psychotherapy; theoretical analysis of a possible association between gender dysphoria and Asperger's Disorder; implications of transgender coming out for couples and couple therapy; evidence-based recommendations for feminizing and masculinizing hormone therapy; satisfaction with transgender-specific health services; understanding autogynephilia and its role in therapy; an intervention for transgender youth that focuses on stigma reduction in the social environment rather than on the youth themselves; and finally, features of eating disorder among transgender women.