What Is Gender Dysphoria?

Gender dysphoria refers to feelings of distress and discomfort that a person experiences when their assigned gender does not match their gender identity. People who experience gender dysphoria may feel uncomfortable with and distressed over the conflict between the sexual characteristics of their physical body and how they feel and think about themselves.

They may also experience feelings of distress or discomfort over the traditional gender roles expected of their assigned gender.

The effects of gender dysphoria can differ from one person to the next. For some people, these feelings of conflict may affect their self-image and behavior. A person with gender dysphoria may cope with discomfort by altering their gender expression, gender representation, or gender assignment from their gender assigned at birth. They may also make adjustments to their physical appearance.

Children who experience gender dysphoria may express their wish to be the opposite gender and insist on toys, hairstyles, and clothing typically associated with the opposite gender. 

Symptoms of Gender Dysphoria

Symptoms of gender dysphoria can include feeling a strong sense of distress or discomfort with one's assigned gender. Some signs that someone is experiencing gender dysphoria include:

• A desire to no longer have the primary sex characteristics of their birth-assigned gender
• A desire to be treated as the opposite gender
• A desire to have the primary and secondary sex characteristics of their preferred gender identity
• The insistence that they are a gender different from their birth-assigned sex
• Preferences for roles that are different from those expected of their gender assigned at birth
• Strong rejection of toys, games, and other things that are typically associated with their birth-assigned gender
• Wearing clothing typically associated with the opposite gender

People who experience gender dysphoria may frequently express that they want to be the opposite gender. They often feel uncomfortable with the gender roles and gender expressions of their birth-assigned sex. This might manifest in behaviors such as dressing as their preferred gender, playing with toys typically associated with the opposite gender and rejecting many gender-stereotypical behaviors.

Gender dysphoria is not related to an individual's sexual orientation. People who experience gender dysphoria may be straight, gay, lesbian, or bisexual. People who feel gender dysphoria may also be gender-nonconforming or transgender. However, it is important to recognize that not everyone who is transgender or gender nonconforming experiences gender dysphoria. 

Diagnosis of Gender Dysphoria

Gender dysphoria is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the previous edition of the DSM, it was known as gender identity disorder. This was changed in 2013 to remove the stigma associated with calling it a disorder. Where it was previously presented as a disorder related to identity, the DSM-5 takes a more descriptive approach that is focused on the discomfort and distress that dysphoria causes. 

The 2022 publication of the DSM-5-TR (text revision), gender dysphoria terminology was updated to help ensure the use of less stigmatizing and more culturally-sensitive language. The DSM now uses the terms "experienced gender," "gender-affirming hormone treatment," "individual assigned male at birth," and "individual assigned female at birth."

In Adolescents and Adults

To be diagnosed with gender dysphoria as an adolescent or adult, an individual must experience clinically significant distress or impairments in social, work, and other important life areas. These feelings must last for at least six months and be accompanied by at least two of the following:

• A significant incongruence between primary and secondary sex characteristics and the individual's experienced gender
• A marked desire to be rid of primary or secondary sex characteristics
• A desire to have the primary or secondary sex characteristics of their experienced gender
• A desire to be their experienced gender
• A wish to be treated as their experienced gender
• A belief that they have the behaviors, feelings, and reactions that are characteristics of their experienced gender

In Children

Children can also experience gender dysphoria. It is not uncommon for kids to exhibit gender non-conforming behaviors. Therefore, it's important to distinguish between typical childhood behaviors and true gender dysphoria.

Like adults, children must experience impairments in functioning or significant distress lasting a minimum of six months. They must also experience at least six of the following symptoms:

• The insistence that they are the opposite gender or a desire to be the opposite gender
• A preference for engaging in fantasy play or make-believe as the opposite gender role
• A preference for clothing typically associated with the opposite gender
• A preference for toys stereotypically preferred by the opposite gender
• Rejecting toys or activities typically associated with their assigned gender
• Expressing dislike for their physical sex characteristics
• A desire to have the sex characteristics that match their gender identity
• Preferring to play with other children of the opposite gender

Signs of gender dysphoria in children can be present as early as age 4. These symptoms often grow more severe as children get older, particularly once they experience the physical changes associated with puberty. 

Causes of Gender Dysphoria

The exact causes of gender dysphoria are not entirely understood, but several factors may play a role. Genetics, hormonal influences during prenatal development, and environmental factors may be involved.

For example, prenatal exposure to certain chemicals has been associated with disruptions in the normal development of sex determination before birth. Research also points to a genetic link since there is a higher shared prevalence between identical twins than fraternal twins.

The onset of gender dysphoria is often during early childhood. While the exact mechanisms are unclear, we know that when children are born, they are assigned a sex based upon their physical anatomy. The sex that a child is assigned at birth often determines how they are raised and how others interact with them. As they grow older, they may begin to feel a mismatch between their gender identity and their assigned sex. In some cases, this mismatch can lead to feelings of gender dysphoria. 

Treatment of Gender Dysphoria

Treatment for gender dysphoria is highly individual and based on each person’s unique needs. It usually focuses on helping the individual explore their gender identity, often by allowing them to express their gender in a way that corresponds to their internal sense of gender. This can include dressing in a way that aligns with their gender identity, using different names and pronouns, or taking medical steps to change the body physically.

Medical Options

Some people with gender dysphoria may prefer more extensive treatment involving gender-affirming hormone treatment and gender-affirming medical procedures. Treatment may also involve body modifications that help align a person’s outward presentation with their internal gender identity.

Hormone therapy and surgery are two ways to accomplish this. But again, treatment needs to be adapted to the needs and goals of the individual. Some people may want to achieve a full transition to the gender with which they identify. Others may wish only to minimize the secondary sex characteristics, such as facial hair or breasts, that do not align with their gender identity.

It is important to remember that while surgical gender affirmation surgery is an option, not everyone with gender dysphoria makes that choice. Surgery is expensive and usually not covered by insurance, and not everyone wants to have complete gender reassignment. Hormone therapy may help some people, while others may choose to change their outward gender expression and dress to correspond with their internal sense of gender identity. 

Masculinizing and feminizing hormones can sometimes help lessen or resolve feelings of gender dysphoria. Such hormones can have side effects, including changes in libido and the potential for manic, hypomanic, or psychotic symptoms in people with an underlying psychiatric condition.

However, people who cannot take any of these steps may begin to experience increased psychological distress, including feelings of anxiety and depression. In such cases, psychotherapy may help people feel more comfortable expressing their internal sense of gender and improve mental well-being.

Psychotherapy

Some individuals may wish to have counseling to help them feel more comfortable with their feelings, affirm their identity, and help them cope or reduce any feelings of distress. Relationship or family counseling can help partners, parents, and other family members better understand what their loved one is experiencing. This can help the individual gain social and peer support, providing a more affirming environment.

The goal is to help people feel more fulfilled and improve their quality of life by lessening feelings of dysphoria. This is sometimes accomplished by:

• Exploring gender identity and expression
• Learning ways to manage stress
• Practicing self-acceptance
• Building a support network
• Making decisions about transition options
• Improving relationships

Therapy can help people reduce feelings of dysphoria, but it can also help people at any phase of the process improve their quality of life and well-being. 

Challenges

People who are gender nonconforming and their families are often at an increased risk of exposure to stigma and discrimination because of their gender identity. People with gender dysphoria who are transgender or gender nonconforming also have a higher risk of being the victims of violence or bullying. 

Those who do pursue medical treatments such as hormones or surgical procedures may also face difficulties in accessing appropriate healthcare and insurance coverage for their treatment.

Feelings of dysphoria combined with a lack of social support can often contribute to mental distress and other issues. Some disorders associated with gender dysphoria include depression, anxiety, substance misuse, self-harm, and other mental health problems. 

Research has also shown that people with gender dysphoria have a higher risk of dying by suicide than the general population. One study found that 48.3% of participants with gender dysphoria had experienced suicidal ideation, and 23.8% had attempted suicide at least once.

Coping With Gender Dysphoria

Coping with feelings of gender dysphoria typically involves treatment that focuses on helping people feel more comfortable with their gender identity. Some other strategies that can help people manage with feelings of gender dysphoria include:

• Find support: Try joining a support group and talking to peers who have had similar experiences.
• Reduce discomfort: Utilize practices such as breast binding or genital tucking to minimize physical characteristics that contribute to feelings of dysphoria.
• Care for yourself: Prioritizing self-care and emotional wellness, including doing things that make you feel good about yourself and your body.
• Affirm your identity: Try doing small things that will help affirm your gender identity. This might include wearing certain accessories, changing your hairstyle, or asking others to refer to you by your preferred pronouns. 
• Plan for the future: People may also opt to pursue legal options to transition to their desired gender and transition in social settings. Research the steps and make a plan that will help you work toward your long-term goals, whether those goals involve making a medical, social, or legal transition.

As you work toward your long-term goals, look for solutions that will also help you cope with your feelings of dysphoria in the short term. This might involve covering or minimizing your contact with the primary or secondary sex characteristics that cause feelings of distress. Spend time exploring your identity and the ways of expressing it that feel right for you.

Important Terms to Know

Some key terms that are related to gender dysphoria include:

• Cisgender: Describes a person whose gender identity is aligned with the sex assigned to them at birth
• Gender expression: The ways that people outwardly express their gender identity, often through their dress, physical appearance, mannerisms, and other characteristics
• Gender identity: A person's inner sense and experience of their gender
• Nonbinary: An umbrella term to describe people who are outside of the traditional male/female gender binary
• Transgender: An umbrella term to describe someone who identified as a gender different from the one they were assigned at birth