I have been seeing Zoe Brain since 12 December last year. She is a 47 year-old woman with a gender identity disorder who is undergoing transition.
Zoe is married to Carmel and they have a four year-old son, Andrew, who is just starting preschool. This year Zoe is commencing a PhD in Computer Science.
On first meeting Zoe, she described having an epiphany of the fact she wanted to become a woman in May 2005 and dressed in women's clothing for the first time on 7 July. She said thare had been some unsuaual hormone-related changes occurring to her body before taking hormone therapy which had perplexed the issue. During these months Zoe told me her mood would fluctuate and she became distressed and depressed. Since I have seen her, Zoe's mood has been normal, although she has been very happy about undergoing transition.
There is no past psychiatric history, though Zoe reported mood swings occurring every month, though not severe enough to reach clinical awareness.
There is no history of overdoses or self harm, and she has never taken any psychiatric medication.
On reviewing personal history, it is clear that there had been issues of gender dysphoria not acknowledged (or repressed) since puberty and during their marriage.
On mental state examination Zoe presents as a woman and "passes" well.
There is no evidence of psychosis or any mood disturbance apart from reactive euphoria when discussing her change.
I consider Zoe has a gender identity disorder which is fuelling her desire for hormone treatment and surgery. I do not think there are any other conditions such as personality disorder, psychosis, schizophrenia, or mood disorder implicated.
Dr Emma Adams MBBA FRANZCP
To Dr Suporn Watanyusakul MD
CC Prof A.W.Steinbeck MD BS Syd PhD Lond. FRCP Lond. FRACP
CC Dr S Jamieson Cert. Fin d'Etudes Medicales (Geneva)
My "Walking Papers", addressed to my prospective surgeon, my endocrinologist, and my General Practioner.
Stating that I'm officially not sane, but only bonkers in a very particular way that can only be cured by hormones and surgery. Almost like a purely medical condition, like a hair lip.