Abstinence of drugs as a step towards gender transition: a transgender tale

Background
The terms transgender, gender dysphoria (DSM-5) and gender incongruence (ICD-11) refer to a situation where an individual’s gender identity differs from external sexual anatomy at birth. For those who desire to undergo gender transition, available gender identity-affirming care may include hormone therapy and surgery. Before considering such interventions, it is necessary to confirm the diagnosis of gender dysphoria and identify any medical and psychiatric diagnosis that may require treatment. The transgender population has high rates of alcohol use, illicit drug use, and nonmedical use of prescription drugs, and show more severe misuse of these substances when compared with nontransgender individuals. Explanations for this heightened risk of substance use disorders have focused predominantly on cultural and environmental factors such as social stigma, transphobia, prejudice and discrimination.

Objective/Methods:
This report includes one case illustration of a gender dysphoric patient presenting to an addiction unit for treatment of alcohol and cocaine use disorders.
A PubMed search of English-language publications (January1, 2014–January31, 2019) was conducted using the terms gender dysphoria, transgender and addiction. Relevant articles known to the authors were also included.

Results/Conclusions: The patient is an adult with unambiguous anatomical male sex at birth, providing a typical history of gender dysphoria beginning at 10 years of age. He started his addictive behaviours at the age of 16 and considers them a coping mechanism towards his gender-related distress. He was refered to a gender-affirming care unit and has maintained abstinence of cocaine and moderate use of alcohol as a condition to proceed with treatment.
This case calls for specific attention to address problematic substance use among transgender individuals, indicating a need for culturally sensitive interventions.