Gender Dysphoria Basics

In this guide, you’ll learn the signs of gender dysphoria, how it’s diagnosed and how it’s treated.

Gender Dysphoria: What Is It?

Gender dysphoria is extreme discomfort caused by a discrepancy between a person’s gender at birth (called assigned gender) and the gender they feel themselves to be (affirmed gender). Children with gender dysphoria experience great anguish as a result of feeling “trapped” inside a body that does not match the gender that feels right to them. The severity of the suffering these children feel can lead to anxiety and depression, as well as a high risk of self-injury and suicide.

Gender dysphoria was created as a distinct disorder to clarify that being transgender, or identifying as a gender different from the one of your birth, is not in itself a psychiatric disorder. The new disorder was meant to remove the stigma from being transgender, and to shift the concern of mental health professionals to assisting those for whom the experience of being transgender has resulted in significant distress and impaired functioning.

Gender Dysphoria: What to Look For

Children who have gender dysphoria have a disconnect between the gender they are assumed by others to be, based on sex characteristics and the gender they feel themselves to be. In childhood some show a strong preference for dress, toys, and activities associated with the other gender, and they may assert that they are the other gender or will grow up to be the other gender. But other individuals present as their assigned gender during childhood, or stay gender neutral as children, showing no strong preference for things or roles associated with either gender.  But as they reach adolescence they may express a strong dislike of their own sexual anatomy and a strong desire to have sex characteristics of their experienced gender. This may come as a complete surprise to their parents. It’s not gender dysphoria unless the incongruity causes them significant distress or impairment in important areas of functioning.

Gender Dysphoria: Risk Factors

Though there is debate over what might cause gender incongruence, the causes of distress involved in gender dysphoria are largely sociological: in a society that still views transgenderism as outside of the norm, it is understandable that children and adolescents may experience significant distress as the result not only of struggling to make sense of their own gender identity, but of being stigmatized, ostracized and bullied.

Gender Dysphoria: Diagnosis

Young people who have experienced acute distress or discomfort as a result of their assigned gender or accompanying gender roles for at least six months  may have gender dysphoria. To be diagnosed with the disorder, they must have “feelings of incongruence” between their assigned gender and their affirmed gender and a wish to be, and be treated as, the other gender. In addition, they must be distressed to the point of impaired ability to function at school, at home, or in social settings. In diagnosing gender dysphoria, a doctor will rule out a physical intersex or sexual development condition.

Gender Dysphoria: Treatment

Treatment for gender dysphoria focuses on alleviating the patient’s distress surrounding their gender identity. That often means psychotherapy — and dialectical behavior therapy in particular—in which a therapist validates their emotions and helps them develop effective coping skills, to avoid things like self-injury and suicidality.  If their distress has led to depression or anxiety, those may be treated with therapy or medication. Therapists also work with gender dysphoria patients, and their families, to help them determine the best way to shape their gender expression for the healthiest outcome.

Some patients desire hormone therapy or sex reassignment surgery; others do not. Transgender and endocrinology organizations recommend waiting until at least 16 to start hormone treatment, but what is best for the individual needs to be considered. Hormone treatment to suppress puberty for as long as several years is sometimes used to give a patient time to decide whether to do surgery; since it stops the development of secondary sex characteristics — breast development, or the deepening of the voice and growth of facial hair — it also prevents the added distress of a patient’s body acting in a way that does not align with their affirmed gender.

Gender Dysphoria: Risk For Other Disorders

An adolescent who is experiencing distress as a result of his gender identity, especially if he is bullied or ostracized, is at heightened risk for anxiety, depression and substance abuse, as well as suicide.  A study of transgender teens found that more than 50 percent of transgender males and almost 30 percent of transgender females reported attempting suicide.