Gender dysphoria (GD) may appear in individuals with schizophrenia either as the consequence of a delusional change in gender identity or it may appear separately from psychotic symptoms. Differentiating between these scenarios is not only a difficult task from a diagnostic standpoint, but it also has an impact on treatment choices. People with GD should undergo detailed psychiatric and psychosocial evaluation as unnecessary hormone replacement therapy and sex reassignment surgery could be avoided in cases where it is secondary to a primary psychiatric illness. When both illnesses co-occur, it is imperative to analyze the occurrence and progression of each symptom, their consistency (across time), the patient's feedback, and their reaction to antipsychotic medication.
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