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I'm no expert, but below are some premises I've gleaned from my independent research.

  • Schizophrenia usually does not manifest until a person's 20s. The onset is often gradual, during which time the person will have symptoms that can fly under the radar for years before rising to a level warranting a diagnosis.
  • I have read mixed reports about the prevalence of gender dysphoria-like delusions among schizophrenics, but it appears that it does happen.
  • Gender-affirming medical care, like hormone therapy and surgery, is sometimes provided to teenagers, the rationale being that earlier affirming care improves mental health outcomes.

I presume that gender-affirming medical professionals are aware of and on the lookout for other potential causes of gender dysphoria, including confounding mental health issues. But if schizophrenia usually cannot be diagnosed until adulthood, doesn't this mean there's a risk of a young person presenting with gender dysphoria, ultimately receiving irreversible gender-affirming care, later being diagnosed and treated for schizophrenia, then finding that the gender dysphoria was actually a delusion caused by the schizophrenia, and finally regretting their transition? This is, in fact, exactly what is described here.

So, how big of a risk is this? Is it a big enough risk to justify delaying medical transition until the patient is older? Might it justify the use of antipsychotic drugs as a test to weed out those who are likely to regret their transition later?

(I realize this question might sound like I'm fishing for a justification for medical discrimination against trans people since two of the questions in the above paragraph look an awful lot like gatekeeping, and the exploratory antipsychotics idea sounds particularly unethical to me. I assure you that's not where this is coming from. I am a trans ally and this question arose out of my various interactions with gender-critical types who often argue some variation of "transgender people are mentally ill and gender dysphoria is nothing more than a delusion.)

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Gender dysphoria is characterized by a persistent discomfort with one's assigned gender and a strong desire to be of another gender. Schizophrenia, on the other hand, is a severe mental disorder characterized by delusions, hallucinations, disorganized thinking, and impaired cognitive function.

But NOT JUST delusions. And that's what many people don't get.

A diagnosis of schizophrenia requires the presence of certain core symptoms, with careful consideration of their duration, frequency, and impact on the individual's daily life. The symptoms are categorized into positive and negative symptoms.

https://en.wikipedia.org/wiki/Positive_and_Negative_Syndrome_Scale

Positive Symptoms: These symptoms involve an excess or distortion of normal functions.

  • Hallucinations: False perceptions that are not based on external stimuli. Auditory hallucinations (hearing voices) are common, but visual and other sensory hallucinations can also occur.

  • Delusions: Strongly held false beliefs that are not influenced by reasoning or evidence to the contrary. Delusions can be paranoid (believing others are plotting against them), grandiose (believing in exceptional abilities), or bizarre (implausible and not based in reality).

  • Disorganized Thinking: Individuals may have difficulty organizing their thoughts, leading to incoherent speech and difficulty expressing themselves logically.

  • Disorganized or Abnormal Motor Behavior: This can manifest as unpredictable and inappropriate movements, agitation, catatonia (lack of movement or response), or repetitive actions.

Negative Symptoms: These symptoms involve a decrease or loss of normal functions. They include:

  • Affective Flattening: Reduced emotional expression and responsiveness.

  • Alogia: Poverty of speech; difficulty or inability to maintain normal conversation.

  • Anhedonia: Reduced ability to experience pleasure from activities previously enjoyed.

  • Avolition: Decreased motivation and difficulty initiating and sustaining purposeful activities.

  • Social Withdrawal: Reduced interest in social interactions and a preference for isolation.

So it's not just some delusion. Otherwise you can claim 99% of human population being schizofrenic on their beliefs.

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  • $\begingroup$ Great answer, but you might want to add some references as to where the elements forming your answer come from! $\endgroup$
    – J..y B..y
    Aug 14 at 11:39
  • $\begingroup$ Thanks for taking the time to write an answer. But it doesn't actually answer my question. You've provided the Wikipedia descriptions of the 2 conditions to contrast them but you have not addressed the specific issue I raised: the possibility that prodrome-phase (ie pre-psychotic, pre-diagnosis) schizophrenia can mimic legitimate gender dysphoria, as evidenced by the case study I linked to, and the degree to which this possibility presents a risk to teens receiving gender-affirming care. $\endgroup$
    – ibonyun
    Aug 15 at 18:39

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