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Gender identity disorder is one of the most controversial diagnoses of DSM-IV and almost incomparable in the complexity of its social, ethical and political considerations to any other diagnosis. We present a case of 30 year-old male who presented with complaints of suggestive of depressive disorder with a recent suicidal attempt. Careful history taking reveals underlying conflicts with prominent gender dysphoria and social complexities. The patient is managed primarily by pharmacotherapy and harm reduction model. Our case reflects a unique coping strategy against the present sociocultural values and ambiguity of law in this part of the world.