Gender dysphoria is the feeling of discomfort or distress that can occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics.

Transgender and gender-diverse individuals may experience gender dysphoria at some point in their lives, but some feel at ease with their bodies with or without medical intervention.

The diagnosis of gender dysphoria is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to help individuals with gender dysphoria access necessary healthcare and effective treatment. The term focuses on discomfort as the problem, rather than identity.

Symptoms of Gender Dysphoria

Gender dysphoria may cause adolescents and adults to experience a marked difference between their inner gender identity and their assigned gender for at least six months. This difference is characterized by at least two of the following:

  • A difference between gender identity and genitals or secondary sex characteristics, such as breast size, voice, and facial hair. In young adolescents, a difference between gender identity and anticipated secondary sex characteristics.
  • A strong desire to be rid of these genitals or secondary sex characteristics or to prevent the development of secondary sex characteristics.
  • 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 reactions of another gender.

Gender dysphoria may also cause significant distress that affects how individuals function in social situations, at work or school, and in other areas of life.

Gender dysphoria may start in childhood and continue into adolescence and adulthood. Some individuals may experience periods in which they no longer experience gender dysphoria. It can also emerge around the time of puberty or much later in life.

Complications of Gender Dysphoria

Gender dysphoria can affect various aspects of life, including daily activities. Individuals experiencing gender dysphoria might face difficulty at school due to pressure to conform to the gender associated with their sex assigned at birth or out of fear of harassment or teasing.

If gender dysphoria impairs the ability to function at school or work, it may lead to school dropout or unemployment. Relationship difficulties are common, and individuals may also experience anxiety, depression, self-harm, eating disorders, substance misuse, and other problems.

People with gender dysphoria often experience discrimination, resulting in stress. Accessing healthcare and mental health services can be challenging due to fear of stigma and a lack of experienced care providers.

Adolescents and adults with gender dysphoria without gender-affirming treatment might be at risk of contemplating or attempting suicide.

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Healthcare providers may diagnose gender dysphoria based on:

  • Behavioral health evaluation: The provider evaluates the presence of gender dysphoria and how prejudice and discrimination due to gender identity impact mental health. They also inquire about the level of support from family, chosen family, and peers.
  • DSM-5: Mental health professionals use the criteria for gender dysphoria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association.

Gender dysphoria is distinct from simply not conforming to stereotypical gender role behavior. It involves distress due to a strong, pervasive desire to be another gender.

Treatment of Gender Dysphoria

Treatment for gender dysphoria aims to explore gender identity and find a gender role that brings comfort and eases distress. Treatment options should be individualized as what works for one person may not be suitable for another.

Treatment options may include:

  • Changes in gender expression and role: Living part-time or full-time in another gender role consistent with gender identity.
  • Medical treatment: This may involve hormone therapy (feminizing or masculinizing hormone therapy) and surgery (feminizing or masculinizing) to change various physical characteristics.
  • Behavioral therapy: This treatment aims to improve psychological well-being, quality of life, and self-fulfillment. The goal is not to alter gender identity but to explore gender concerns and alleviate gender dysphoria. Behavioral therapy can include individual, couples, family, and group counseling.

A behavioral health evaluation may not always be required before receiving hormonal and surgical treatment of gender dysphoria, but it can play an important role in making treatment decisions.

Other Steps and Coping Support

Other ways to ease gender dysphoria may involve various methods, such as peer support groups, voice and communication therapy, hair removal or transplantation, and more. Coping and support for gender dysphoria can be enhanced through supportive environments, knowledge about treatment options, and social support from family, friends, and peers.

Other options for support include mental health care, support groups, prioritizing self-care, meditation or prayer, and getting involved in the community through volunteering.

Preparing for Your Appointment

Before your appointment, prepare a list of your symptoms, personal information, all medications and supplements you take, and any questions you have for your healthcare provider.

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