Find out about this type of distress that affects some gender-nonconforming people and how it can be treated.
Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics.
Transgender and gender-nonconforming people might experience gender dysphoria at some point in their lives. But not everyone is affected. Some transgender and gender-nonconforming people feel at ease with their bodies, either with or without medical intervention.
Gender dysphoria is a diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a manual published by the American Psychiatric Association to diagnose mental conditions. This term is intended to be more descriptive than the one that was previously used, gender identity disorder. The term gender dysphoria focuses on one's discomfort as the problem, rather than identity. A diagnosis for gender dysphoria was created to help people get access to necessary health care and effective treatment.
Gender dysphoria might cause adolescents and adults to experience:
Gender dysphoria might start in childhood and continue into adolescence and adulthood (early onset). Or, you might have periods in which you no longer experience gender dysphoria followed by a recurrence of gender dysphoria. You might also experience gender dysphoria around the time of puberty or much later in life (late onset).
Gender dysphoria can impair many aspects of life. Preoccupation with being of another gender than the one assigned often interferes with daily activities. People experiencing gender dysphoria might refuse to go to school, due to pressure to dress in a way that's associated with their sex or out of fear of being harassed or teased. Gender dysphoria can also impair the ability to function at school or at work, resulting in school dropout or unemployment. Relationship difficulties are common. Anxiety, depression, self-harm, eating disorders, substance abuse and other problems can occur.
People who have gender dysphoria also often experience discrimination, resulting in minority stress. Access to health services and mental health services can be difficult, due to fear of stigma and a lack of experienced providers.
Adolescents and adults with gender dysphoria before gender reassignment might be at risk of suicidal ideation, suicide attempts and suicide. After gender reassignment, suicide risk might continue.
Your health care professional might make a diagnosis of gender dysphoria based on:
Gender dysphoria is different from simply not conforming to stereotypical gender role behavior. Gender dysphoria involves feelings of distress due to a strong desire to be of another gender than the one assigned and by the extent and pervasiveness of gender-variant activities and interests.
While some adolescents might express their feelings of gender dysphoria to their parents or a doctor, others might instead show symptoms of a mood disorder, anxiety or depression or display social or academic problems.
Treatment can help people who have gender dysphoria to explore their gender identity and find the gender role that feels comfortable for them, easing distress. But treatment needs to be individualized. What might help one person might not help another. The process might or might not involve a change in gender expression or body modifications. Treatment options might include changes in gender expression and role, hormone therapy, surgery, and behavioral therapy.
If you have gender dysphoria, seek help from a doctor who has expertise in the care of transgender people.
When coming up with a treatment plan, your provider will screen you for mental health concerns that might need to be addressed, such as depression or anxiety. Failing to treat these concerns can make it more difficult to explore your gender identity and ease gender dysphoria.
This might involve living part time or full time in another gender role that is consistent with your gender identity.
Medical treatment of gender dysphoria might include:
Some people use hormone therapy to seek maximum feminization or masculinization. Others might find relief from gender dysphoria by using hormones to minimize secondary sex characteristics, such as breasts and facial hair. Treatments are based on your goals, as well as an evaluation of the risks and benefits of medication use, the presence of any other conditions, and consideration of your social and economic issues. Many people also find that surgery is necessary to relieve their gender dysphoria.
The World Professional Association for Transgender Health provides the following criteria for hormonal and/or surgical treatment of gender dysphoria:
Additional criteria apply to some surgical procedures.
A pretreatment medical evaluation is done by a doctor with experience and expertise in transgender and intersex care before hormonal and surgical treatment of gender dysphoria. This can help rule out or address medical conditions that might affect these treatments or make the treatments inadvisable. This evaluation may include:
This treatment aims to improve your psychological well-being, quality of life and self-fulfillment. Behavioral therapy isn't intended to alter your gender identity. Instead, therapy can help you explore gender concerns and find ways to lessen gender dysphoria. The goal is to help transgender and gender-nonconforming individuals become comfortable with their gender identity expression, enabling success in relationships, education and work. Therapy can also address any other mental health concerns.
Therapy might include individual, couple, family and group counseling to help you:
Therapy might be helpful during many stages of your life.
A pretreatment behavioral health evaluation by a doctor with experience and expertise in transgender and intersex health is needed before hormonal and surgical treatment of gender dysphoria. This evaluation might assess:
Other ways to ease gender dysphoria might include use of:
Gender dysphoria can be lessened by supportive environments and knowledge about treatment to reduce the difference between your inner gender identity and sex assigned at birth or sex-related physical characteristics.
Social support from family, friends and peers can be a protective factor against developing depression, suicidal ideation, suicide attempts, anxiety or high-risk behaviors.
Other options for support include:
You may start by seeing your primary care provider. Or, you may be referred to a behavioral health professional.
Here's some information to help you get ready for your appointment.
Before your appointment, make a list of:
For gender dysphoria, some basic questions to ask your doctor include:
Don't hesitate to ask other questions.
Your doctor is likely to ask you several questions, such as:
December 23rd, 2020