To be or not to be! – A case of an aging transvestite presenting with gender dysphoria

Gender dysphoria is defined as the incongruence between one's expressed gender and assigned sex at birth. We present a case of an elderly male with a history of transvestism and autogynephilia, seeking transition to female gender in the background of depressive symptoms, following an episode of acute angina. Worsening physical health, poor psycho-sexual adjustment with aging and depression were identified to be the key precipitants of this client’s desire for sex change. Comprehensive evaluation is crucial to exclude cognitive deficits, paraphilic behaviours, or mood disorders to provide appropriate and individualized care for those requiring gender-affirming therapy.