Gender Dysphoria

Gender dysphoria is a feeling of distress that can occur when a person’s internal sense of gender doesn’t match the sex they were assigned at birth. While many transgender and gender-diverse people experience this distress at some point in their lives, not everyone does—and for those who do, the intensity can vary greatly.

Table of contents

• What is Gender Dysphoria?
• Signs and Symptoms
• How is it Diagnosed?
• What Causes Gender Dysphoria?
• Related Mental Health Concerns
• Treatment Options
• Getting Help and Support
• Coping Strategies

What is Gender Dysphoria?

Gender dysphoria describes a feeling of distress or discomfort that can happen when a person’s gender identity (their internal sense of being male, female, or another gender) differs from the sex assigned to them at birth^[1]. This internal sense of unease may be mild for some people, while for others it can be intense and significantly affect daily life^[3].

Gender identity refers to how we see ourselves and how we describe who we are. Most people identify as “male” or “female,” which are sometimes called “binary” identities. However, some people feel their gender identity is different from their biological sex. For example, someone may have male genitals and facial hair but not identify as male or feel masculine^[3].

Some people do not define themselves as having a binary identity. For them, the concept of gender is not relevant to their identity in traditional terms. They may use different terms such as agender, gender diverse, gender non-conforming, or gender fluid to describe their identity. As a group, they are often called “non-binary”^[3].

It’s important to understand that gender dysphoria is different from simply not following stereotypical gender behaviors. It involves feelings of distress due to a strong, lasting desire to be another gender^[1]. Not all transgender and gender-diverse people experience gender dysphoria, and many feel at ease with their bodies and gender identities^[1].

Gender dysphoria is not a mental illness, but some people may develop mental health problems because of the distress it causes^[3]. The diagnosis was created to help people with gender dysphoria get access to the healthcare and treatment they need. The diagnosis focuses on the feeling of distress as the issue, not gender identity itself^[1].

Signs and Symptoms

People with gender dysphoria may show various signs of discomfort or distress. These feelings can affect how they present themselves and how they feel emotionally^[3]. Common signs include:

• Low self-esteem
• Becoming withdrawn or socially isolated
• Depression or anxiety
• Taking unnecessary risks
• Neglecting themselves

Gender dysphoria symptoms generally fall into two categories: social dysphoria and physical dysphoria. Social dysphoria involves discomfort with how others perceive and categorize your gender. This might include distress when people use certain pronouns or include you in gender-specific groups that don’t match your identity^[12].

Physical dysphoria refers to discomfort or unhappiness with physical characteristics associated with your assigned sex. This can include features like facial hair, breasts, height, voice, or even hand size^[12].

The intensity of gender dysphoria can vary greatly. Some people experience it as a very mild feeling, while others can feel overwhelmed and debilitated by the experience. For example, if someone feels insecure that their voice doesn’t match their identity, they could get anxious when talking or even avoid situations that require public speaking^[12].

Gender dysphoria might start in childhood and continue into the teen years and adulthood. But some people may have periods of time in which they don’t notice gender dysphoria, or the feelings may seem to come and go. Some people have gender dysphoria when puberty starts, while in others, it may not develop until later in life^[1].

How is it Diagnosed?

A diagnosis of gender dysphoria may be made when you talk with your doctor about feeling upset or distressed that your gender identity isn’t the same as your sex assigned at birth^[5]. The diagnosis is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association^[1].

According to diagnostic criteria, a diagnosis of gender dysphoria includes distress due to gender identity differing from sex assigned at birth that lasts at least six months and involves two or more of the following^[7]:

• A difference between gender identity and genitals or secondary sex characteristics (such as breasts and facial hair)
• A strong desire to be rid of genitals or secondary sex characteristics, or a desire to prevent their development
• A strong desire to have the genitals and secondary sex characteristics of another gender
• A strong desire to be or to be treated as another gender
• A strong belief of having the typical feelings and behaviors of another gender

The diagnosis also includes distress that makes it hard to handle work, school, social situations, and other parts of daily life^[7]. However, even if your symptoms don’t quite align with formal diagnostic criteria, and even if they don’t lead to severe distress or impairment in your daily life, you can still experience gender dysphoria^[12].

In children, the diagnostic criteria are slightly different. Children with gender dysphoria may have similar feelings as adults, including feeling upset about parts of their body that don’t match their gender identity^[5]. It’s important to note that children may show an interest in clothes or toys that society associates with a different gender, but this type of behavior is reasonably common in childhood and is part of growing up. It does not mean that all children behaving this way have gender dysphoria^[3].

What Causes Gender Dysphoria?

The pathophysiology of gender dysphoria is multifactorial and incompletely understood^[8]. Several factors have been associated with gender dysphoria, though no single cause has been identified. These factors include:

• Genetics
• Androgen exposure
• Neuroanatomy and brain connectivity
• History of trauma
• Parents with psychological disorders
• Being raised by less than two parents

These associations suggest that gender dysphoria may result from a complex interaction of biological, psychological, and social factors^[8]. However, the exact cause remains unclear, and research in this area is ongoing.

Related Mental Health Concerns

Gender dysphoria can further result in relationship difficulties with family, peers, and friends and lead to interpersonal conflicts, rejection from society, symptoms of depression and anxiety, substance use disorders, a negative sense of well-being and poor self-esteem, and an increased risk of self-harm and suicidality^[4].

Anxiety and depression are the two most common conditions that occur alongside gender dysphoria and may be the reason someone first seeks medical care^[8]. The distress caused by gender dysphoria can lead to these mental health challenges, particularly when individuals face discrimination, rejection, or lack of support from their communities^[3].

Some people may feel extra stress because of discrimination in their community. Rejection, prejudice, and fear can cause long-term stress^[5]. This cultural stigmatization can worsen mental health outcomes and make it more difficult for individuals to cope with gender dysphoria.

Treatment Options

The purpose of treatment is to ease gender dysphoria. Specific goals for gender dysphoria treatment depend on the person^[7]. Usually, gender dysphoria is treated by helping someone affirm their gender identity through finding ways to express it. The types of things that help someone express their gender can vary from person to person and can also be different for children and young people than for adults^[5].

Treatments provided are intended to provide lasting relief from gender dysphoria. This can mean different things to different people. For some, treatment may just involve acceptance and affirmation or confirmation of their identity. For others, it may involve bigger changes, such as changes to their voice, hormone treatment, or surgery^[3].

Non-Medical Treatment Options

Non-medical options for expressing gender identity may include^[5]:

• Clothing, hairstyles, or makeup
• Voice therapy or coaching
• Hair removal
• Breast binding or padding
• Penis tucking or packing
• Name and gender marker corrections on official documents
• Counseling

Psychological support is an important component of treatment. This can include individual therapy, family therapy, or group work for young people and their parents^[9]. For those with more serious emotional issues, referral to mental health services may be appropriate.

Hormone Therapy

Medical options may include gender-affirming hormones. The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel^[9]. In general, people wanting masculinization usually take testosterone, and people seeking feminization usually take estrogen. Both usually have the additional effect of suppressing the release of “unwanted” hormones from the testes or ovaries^[9].

It’s important to remember that hormone therapy is only one of the treatments for gender dysphoria. The hormones usually need to be taken for the rest of your life, even if you have gender surgery. Whatever hormone therapy is used, it can take several months for hormone therapy to be effective, which can be frustrating^[9].

These hormones cause some irreversible changes, such as breast development (caused by taking estrogen) or breaking or deepening of the voice (caused by taking testosterone). Long-term gender-affirming hormone treatment may cause temporary or even permanent infertility^[9].

Treatment for Children and Young People

For children and teenagers, treatment approaches are more cautious. Most treatments offered at early stages are psychological rather than medical, because in many cases gender variant behavior or feelings disappear as children reach puberty^[9].

Some young people with lasting signs of gender dysphoria who meet strict criteria may be referred to a hormone specialist. Puberty suppressing hormones are not currently widely available to children and young people for the treatment of gender dysphoria or gender incongruence, as there is not enough evidence on their clinical safety and effectiveness^[9].

From around the age of 16, young people with a diagnosis of gender incongruence or gender dysphoria who meet various clinical criteria may be given gender-affirming hormones alongside psychosocial and psychological support^[9].

Surgical Options

Gender-affirming surgeries are available depending on the individual case and the patient’s needs^[4]. The frequency and severity of treatment-related complications increases progressively as treatments go from conservative to more invasive^[8].

Getting Help and Support

If you think you or your child may have gender dysphoria, it’s important to see a doctor. If your doctor agrees, they can refer you to a gender dysphoria clinic where you’ll be assessed by a specialist team^[3].

You do not need to be assessed by a mental health service first, and the doctor does not need prior approval from local health services. You can self-refer to a gender dysphoria clinic, but a referral by your doctor is best because they can give the clinic your detailed medical history^[3].

If you have gender dysphoria, it’s important to find a healthcare professional who has expertise in the care of gender-diverse people. Organizations such as the World Professional Association for Transgender Health (WPATH) offer resources to find healthcare professionals in your area who work with transgender and gender-diverse people^[7].

It’s important to know that you’re not alone if you have gender dysphoria. Many people have gone through what you’re going through now. It can be comforting and helpful to talk to those people. You can find them through local or online groups^[5].

Waiting times for referral and treatment can be long due to a huge increase in the number of people seeking care. Your doctor and other organizations can provide support while you wait to see a specialist clinic^[3].

Coping Strategies

Gender dysphoria is experienced differently by everyone, and there’s no one way to deal with it. Different things work for different people, and what works at one time may not be the same at another time^[11]. Here are some ideas that could help:

Express Your Feelings

Share your feelings in a notebook or blog, or express how you feel through an art, craft, or music project^[11].

Talk to Someone Who Understands

Talk to a supportive friend, find an online trans community you feel connection with, or speak to support services. If you have a counselor or therapist you feel safe talking with about your gender dysphoria, make time to bring this up with them^[11].

Listen to Others with Similar Experiences

Talk to friends who also experience dysphoria, or watch content creators who you relate to^[11].

Use Items That Help Express Your Gender

Find or use items that aid in expressing your gender and make you feel more confident in yourself. This might include binders, packers, breast forms, padded underwear, makeup, clothes, shoes, accessories, hair removal items, or hair styling products^[11].

Affirm Your Gender

Do small or big things that affirm your gender, whether it’s wearing a small accessory that is affirmative for you, re-styling your hair, or telling people your preferred name and pronouns^[11].

Take Steps Toward Your Goals

Make plans, research, or take small steps towards your long-term social, medical, or legal transition goals^[11].

Find Ways to Reduce Dysphoria in Everyday Activities

Find ways to do everyday things that reduce your dysphoria. This might include covering bathroom mirrors, using specific bathing techniques, or other personal strategies that work for you^[11].

Be Kind to Yourself

Tell yourself, out loud, that your body does not define your gender. Take a moment to point out a few positive things you love about your body more generally—things you are great at, or things you like about yourself. Remember to be easy on yourself and remind yourself of the diversity of all people’s bodies and gender presentations^[11].

Exercise and Self-Care

A healthy amount of exercise can improve your mood and overall well-being^[15].

Supporting Someone with Gender Dysphoria

If someone you care about has gender dysphoria, there are ways that you can help^[5]:

• Show unconditional love and support—gender dysphoria can cause great distress, and feeling loved, supported, and accepted can help
• Respect the person’s choices—ask which pronouns the person prefers and use those pronouns consistently
• If the person is changing their name, always use the new name when you talk to or about the person
• If you make a mistake with pronouns or names, don’t make a big deal out of it—just correct yourself and move on
• Be an advocate—step in and correct others who use the wrong pronoun or name
• If you hear people saying unkind things about transgender people or making fun of them, speak up
• Learn all you can about gender identity through supportive organizations and resources