Cross dressing and gender dysphoria in people with learning disabilities: a descriptive study

Accessible summary Some men with learning disability like to dress in women’s clothes and some men want to be women. Some women with learning disability like to dress in men’s clothes or want to be men. We found that many people like this had mental health problems. Some people were abused when they were children. Some people were gay. They were not happy about this. Many people could decide for themselves what support and treatment was best for them, but some people couldn’t. Summary We aimed to determine the characteristics of people with learning disability who cross‐dress or who have gender dysphoria. Using a retrospective review of anonymised data from clinical records about people referred to a specialist service. All 13 participants cross‐dressed and 12 were biological males. Only one person was in a core transsexual group which may do better from sex reassignment surgery. There was a high level of mental health problems and high levels of reported childhood abuse. Three people were unhappy about their homosexual feelings, and two people had capacity issues. People with learning disabilities experience a wide range of gender identity issues similar to those seen in the non‐learning disabled population. They would benefit from a more person centred understanding. People with learning disability may need longer assessments and more psychotherapeutic exploration and intervention prior to thinking about hormone and surgical interventions. Deciding treatment in someone’s best interests for those lacking capacity presents complex ethical dilemmas.