What Is Gender Dysphoria?

Medically reviewed by Timothy J. Legg, PhD, CRNP on October 26, 2017Written by Kimberly Holland

Overview

Gender dysphoria occurs when a person feels strongly that the gender that corresponds to the sex they were assigned at birth doesn’t match the gender with which they identify.

When babies are born, they’re assigned a sex based on their anatomy. The sex often determines the behaviors and activities parents practice with their children. These behaviors are many times tied to one gender or another. For example, parents may buy dolls for a child assigned “female” and tech- or science-based toys for a child assigned “male.”

Over time, children may come to feel their anatomy isn’t the gender they view themselves as. For example, a person with a vagina may feel that despite their anatomy, they are male and wish to have a male body. They may adopt behaviors that are identified with males and dress in stereotypical men’s clothing. They may use a different name and prefer for people to use male pronouns when referring to them.

Some people will go to varying lengths to change things in their lives that will more closely align with the sex that they identify with. For example, some may ultimately undergo a medical transition with hormone therapy and a sex-change surgery. The level of transition for each person is different.

People with gender dysphoria feel anxiety or dissatisfaction with their gender. Some people may never openly admit to this discomfort. That’s why it’s unclear how common it is. Some individuals don’t report their feelings for fear of ridicule, shame, or abandonment.

Gender dysphoria was once called “gender identity disorder.” That name is no longer used because gender dysphoria isn’t a mental disorder. Likewise, “transsexualism” is no longer used to describe the gender dysphoria. However, “transgender” may be used to describe someone whose personal identity and expressed gender aren’t the same as their assigned gender.

Gender dysphoria is the umbrella term used by the American Psychiatric Association to describe distress that often accompanies the difference between a person’s experienced or expressed gender and their assigned gender (that is, their initial assignment as male or female, sometimes referred to as “natal gender”). A variety of terms have been used over many years across and within a variety of disciplines to describe these differences.

Gender dysphoria vs. gender nonconformity

Gender dysphoria is part of a group of behaviors and conditions called gender nonconformity. This broader term defines a variety of behaviors that don’t match society’s gender expectations. Some nonconforming individuals will experience dysphoria, but not all.

An example of nonconforming behavior is a girl who prefers to dress in boys’ clothes. She may exhibit behaviors that are more culturally typical of boys, too. That doesn’t mean the girl has gender dysphoria. It doesn’t mean that she wishes she were male instead of female.

Gender dysphoria isn’t connected to homosexuality or homosexual behaviors. A homosexual is a person who is attracted sexually to people of the same sex. Sexual attraction isn’t a consideration in diagnosing gender dysphoria.

Diagnosing gender dysphoria

An accurate diagnosis can help a person understand why their internal sense of gender feels different from their physical sex. A diagnosis can help a person feel less anxiety or fear. It may also help answer many questions a person has had for years or even decades.

Adolescents and adults with gender dysphoria experience a sense of disconnection between their sense of gender and their assigned gender. They also experience significant distress. They may have difficulty functioning because of this distress.

In order to receive a diagnosis of gender dysphoria, they must also experience two of the following:

  • a strong desire to be the other gender
  • a strong desire to have the primary or secondary sex characteristics of the other gender
  • a strong desire to no longer have the primary or secondary sex characteristics of the assigned gender
  • a feeling of detachment from your assigned gender’s primary or secondary sex characteristics and your expressed gender
  • a strong sense that your feelings and behaviors match the other gender
  • a strong desire to be treated as the other gender

Diagnosis in children

Gender dysphoria can be diagnosed in children, too. By age 2 or 3, many children are developing behaviors aligned with their assigned gender. Some may start showing signs of gender-nonconforming behavior at that time.

Some children may begin experiencing a disconnect between their sex and their gender as early as 4. These early signs of gender dysphoria may be mild at first but grow as the children age. It may not be until puberty that the feelings of dissatisfaction are intense or severe enough for a diagnosis.

Children with gender dysphoria experience significant distress because they feel like their bodies don’t properly match who they think they are. The distress is so severe that it can cause significant impairment in social, school, or other important areas of functioning for six months.

For children to be diagnosed, they must also meet six of these criteria:

  • an insistence that they aren’t the gender they are told they are
  • a strong desire to be a different gender
  • a strong preference for activities, games, and toys that are traditionally tied to the opposite gender
  • a strong preference for cross-gender roles in make-believe play
  • a strong preference for wearing clothes typical of the opposite gender
  • a strong rejection of activities, games, and toys that match their assigned gender
  • a strong preference for playmates of the opposite gender
  • a strong dislike for their own sexual anatomy
  • a strong desire for physical sex characteristics that match the gender they feel they are

Children often exhibit gender-nonconforming behavior throughout their development years. These behaviors are part of a normal development. However, if children’s behaviors grow more persistent and their preferences become consistent with age, and if they exhibit distress because of these behaviors, they may be showing signs related to gender dysphoria.

Managing gender dysphoria

Gender dysphoria isn’t “treated” in the normal sense of the word. Treatment implies it may go away or ease up. Such isn’t the case with gender dysphoria, nor is it the goal of gender dysphoria treatment.

Instead, treatment is focused on helping people with gender dysphoria to find relief from the dissatisfaction and anxiety it causes. For this, several options are available:

Therapy

Many people with gender dysphoria experience anxiety and depression. In severe cases, self-harm behaviors may occur. Mental health treatment can help individuals learn to cope with these feelings in a healthy, affirming way.

Puberty suppression

If a child is diagnosed with gender dysphoria, doctors can use treatment to suppress the release of hormones. Without these hormones, the body remains unchanged.

Cross-sex hormones

Some individuals with may wish to transition to their experienced gender. Hormone therapy can begin this process. Women may take testosterone supplements to encourage hair growth, muscle development, and a lower voice. Men may take estrogen to encourage breast tissue growth, fat redistribution, and facial changes.

Gender confirmation surgery

Some people with gender dysphoria want to alter their body so it matches their experienced gender.

Transitioning genders can be difficult and challenging at any age. A team of doctors and professionals is vital. The period of transition is a combination of physical and mental changes, and the best way for people to face the changes is to have a team of people they can rely on and trust. This is especially important for children and adolescents, as their peers may be less understanding and sensitive to these changes.

Legal considerations

If you wish to be legally recognized as the opposite gender and want to change your name, you can do so in most states.

You can petition for a legal name change in court. Some judges may require proof of gender confirmation surgery before they’ll grant the change. People with prior criminal convictions may have more difficulty getting the change granted.

Once your name is changed legally, you should be able to change your name on official documents like a birth certificate, passport, and driver’s license.

Changing your gender may require more work. Some states or offices require individuals to submit an affidavit or medical form from a doctor before they’ll let a person legally change their gender. Not all states or government groups will allow a gender change, however.

You may benefit from having legal assistance through the process. Organizations like the American Civil Liberties Union (ACLU) and the Human Rights Campaign often have resources available.

Complications

Gender dysphoria often causes a lot of problems, including distress, anxiety, and depression. Other complications or issues people with gender dysphoria may experience include:

  • Stigmas.
  • Discrimination. Many states and cities have passed laws that protect transgender individuals against discrimination. Not all have, however.
  • Victimization. Gender-nonconforming individuals are more likely to experience hate crimes and harassment than the general public.
  • Increased risk of suicide. The depression, sadness, and anxiety people with gender dysphoria often experience may lead to self-harm. This can ultimately result in suicide.
  • Emotional and behavioral problems. Teasing and harassment is a common problem, especially for children and adolescents. This can lead to long-term mental health issues. Work with teachers and school professionals to address concerns you have for your child.
  • Reduced health care access. People who want to transition may have trouble finding health insurance that will cover the procedure and follow-up care.

Helping a loved one

Helping a loved one manage feelings of dysphoria is important for many friends and family. This may involve attending doctors’ appointments and accompanying them to legal proceedings. It can be consuming and challenging in many ways.

That’s why friends and family of a person experiencing dysphoria may benefit from therapy or counseling, too.

These outlets may be helpful:

See a therapist

A psychologist or psychotherapist may be helpful for one-on-one therapy or group therapy. Many health insurance plans also cover these appointments.

Seek out a support group

Some organizations and advocacy groups sponsor a variety of support groups. This may include one for family members, spouses, or loved ones of people experiencing dysphoria. You may also find one for loved ones of people who have transitioned.

Find an online community

If you can’t find people near you that support your concerns and help answer your questions, you’ll likely find someone online who can. A variety of organizations and groups designed to support transgender, transitioned individuals, and their loved ones are available.

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