- Male, but were assigned female sex at birth
- Female, but were assigned male sex at birth
- Nonbinary, meaning they don't identify as male or female
- Gender fluid, meaning their gender identity changes
- Two-spirited, or a Native American person who identifies as having a male spirit and a female spirit
Not everyone who identifies as transgender has gender dysphoria. “Many folks who are of transgender experience don’t have dysphoria around their bodies and feel supported in their gender identity and expression of their gender,” says?Max Lichtenstein, MD, the director of psychiatry at the Institute for Advanced Medicine and Center for Transgender Medicine and Surgery at the Icahn School of Medicine at Mount Sinai in New York City. “Good feelings around one’s gender are called ‘gender euphoria.’”
Gender Dysphoria: A Controversial Term?
“The idea is that we are moving away from making it a pathology,” says?Kate Thomas, PhD, the director of mental health services at the Johns Hopkins Center for Transgender Health in Baltimore. “Gender incongruence just means we’re incongruent, not necessarily dysphoric or upset about our assigned sex. So, there’s some controversy over the term gender dysphoria,” Dr. Thomas explains.
What Are the Symptoms of Gender Dysphoria?
- Feeling isolated, ashamed, or misunderstood
- A strong dislike of one’s sexual anatomy
- Feeling very uncomfortable with one’s appearance
- Having an urge to harm oneself
What’s more, the diagnosis and treatment of gender dysphoria in kids is a highly debated topic in the medical community. “All I can tell you is that it’s hugely controversial,” says Thomas. “The field is split on how to handle young people and whether or not to have different guidelines and criteria for children and adolescents than we do for adults.”
How Is Gender Dysphoria Diagnosed?
- A significant desire to identify as another gender or an insistence on identifying as a gender different from the child’s assigned sex at birth
- A strong preference for wearing clothing associated with the gender they identify with
- A strong preference for make-believe or fantasy play involving cross-gender roles
- A strong preference for toys, games, or activities typically associated with the gender they identify with
- A preference for friends of the gender they identify with
- A refusal to engage in activities, toys, or games that aren’t typically associated with their gender identity
- A deep dislike of their own sexual anatomy
- A desire to have the physical sex characteristics that match their gender identity
Diagnosing Teens and Adults
- A significant incongruence between one’s personal gender identity and their physical body
- A strong desire to be rid of one’s primary or secondary sex characteristics (or in young adolescents, a strong desire to prevent the development of secondary sex characteristics, such as body hair, rounded hips, or a muscular build of the upper body)
- A considerable desire to have the primary or secondary sex characteristics of the gender they identify with
- A substantial desire to be of a gender that’s different from their gender assigned at birth
- A strong intention to be treated in accordance with their gender identity
- A belief that they have feelings and reactions of a gender that’s different from the one they were assigned at birth
Causes of Gender Dysphoria
That said, Lichtenstein notes, there doesn’t need to be a clear cause for transgender identities. “What is clear is that trans people have existed as long as there have been people. While we have a gender binary in modern ‘Western’ society, other cultures have had third gender roles for thousands of years, such as the Hijra of India, the Kathoey of Thailand, and Native American two-spirit cultures that were equally as essential as male and female in our current society,” Lichtenstein explains.
Treatment of Gender Dysphoria
Treatment for gender dysphoria primarily depends on a person’s preferences and goals. Lichtenstein’s advice? “Don’t feel like you need to compare your transition to anyone else’s. Everyone has a pace and goals that work for them. There’s no perfect plan but the one that works for you.”
It's also important, Lichtenstein says, to realize that ignoring your feelings or trying to change your gender identity is not helpful for managing dysphoria. “We know that conversion therapy, which is attempting to change one’s gender or sexuality through therapy or other treatments, is harmful psychologically and does not reduce gender dysphoria either,” Lichtenstein says.
Medical Treatments and Surgery
“The idea is we want to help people find where they feel their identity is comfortable, and they can be more at ease,” Thomas says.
- Testosterone, a masculinizing hormone, for transgender men
- Testosterone blockers and?estrogen/progesterone, which are feminizing hormones, for transgender women
- Top surgery?This procedure adds breast tissue for trans women or removes it for trans men.
- Bottom surgery?Trans men may undergo procedures like a metoidioplasty or phalloplasty to create a penis using tissue from other areas of the body. Trans women may elect to have a vaginoplasty to create a vagina after removing the penis and scrotum.
- Facial procedures?Certain surgeries, including facial masculinization or feminization surgery, can make a person’s face more feminine- or masculine-looking.
Gender expression involves adopting behaviors to help a person achieve their preferred gender identity. “In some cases, [the transition] is not anything physical, but just to express in certain ways — names, hairstyles, or pronouns,” explains Thomas.
In the past, medical experts used to recommend that all transgender people go through some form of psychotherapy before undergoing treatment, but this practice has fallen by the wayside for adults, Thomas says.
“The history is that psychotherapy had kind of a bad reputation in the transgender community because we were seen as the gatekeepers, and we were the ones who were going to decide if you were going to have hormones or surgeries. But that’s no longer true,” Thomas explains. “What I try to help people realize is that this is not about that. This is about helping you figure out what’s best for you.”
If the person chooses, therapy sessions can also include spouses, family members, friends, and even children.
Potential Complications of Gender Dysphoria
“Unfortunately, transgender people are often discriminated against. This makes things like finding employment, housing, and healthcare that much harder,” says Lichtenstein. “In addition, social and family rejection can take a major psychological and material toll.”
In part because of social stigma, gender dysphoria may be overlooked or untreated, which Lichtenstein says can lead to:
- Traumatic stress disorders
- Higher rates of homelessness
- Underemployment or unemployment
Research and Statistics
- Nearly 1 in 5 people who identify as transgender are between ages 13 and 17
- In recent years, the number of youths who identify as transgender has almost doubled from the Williams Institute’s previous estimate
- The number of adults who identify as transgender has stayed steady over time
- About 1.6 million people ages 13 and older in the United States identify as transgender
“The numbers in young people have grown exponentially,” says Thomas. “The thing that’s giving some people pause is that they are wondering if there is something else going on that we’re missing. Or, maybe it’s just that there’s a lot more acceptance for people to come out at younger ages.”
People of Color and Gender Dysphoria
“Folks who have intersecting marginalized identities face even more barriers to care,” says Lichtenstein.
How to Talk about Gender Dysphoria
Coping with gender dysphoria and talking about it can be challenging for the affected person and for their loved ones.
“We try to remind people that they have to be patient. Often, you end up telling someone who’s important in your life; you’ve been struggling with this internally for years, but they just found out. So, they need some time for adjustment and sometimes even grieving [the loss of their previous perception of you],” says Thomas.
“The most important thing for folks with gender dysphoria is to find the folks in your life who are supportive,” Lichtenstein adds.
- Listen.?Create a safe space for them to talk about their feelings without judgment.
- Use the right pronouns.?Let the person tell you what pronoun you should use when referring to them.
- Don’t make assumptions about their sexual orientation.?Gender identity is different from sexual orientation — transgender people can be straight, gay, lesbian, bisexual, or another sexual orientation.
- Don’t ask what their “real” sex or name is.?Respect their current identity without asking about the past.
- Don’t try to change their mind.?A transgender person has already decided on their gender identity — if they tell you they’re transgender, accept it.
- Be trustworthy. If a transgender person opens up to you, be sure to keep your conversations confidential, and avoid disclosing their gender history to anyone else if they haven’t publicly done so themselves.
- Let your transgender loved one know how you feel. If you’re struggling with a loved one’s transition, it’s okay to be honest while still being sensitive to their feelings. A therapy setting is often a helpful place to talk about this.
Resources We Love
If you or a loved one is dealing with gender dysphoria, it helps to stay informed. Certain resources can help you find ways to cope with your stress, advocate for transgender issues, or learn about treatment options. Here are some of Everyday Health’s top picks.
The APA is the premier psychiatric organization that helps advance mental health as a part of general health and well-being. Their site offers educational material about gender dysphoria and breaks down the DSM-5 diagnostic criteria.
You can find information about gender dysphoria, how it’s diagnosed, and available treatments on Cleveland Clinic’s site.
For more than 30 years, GLAAD has been promoting cultural change and acceptance for the LGBTQ+ community. The organization offers an array of online materials and also hosts events like the?Annual GLAAD Media Awards.
Mayo Clinic is a nonprofit organization that promotes education and research to people who need healing and healthcare. Their page on gender dysphoria covers the topic at length.
The National Center for Transgender Equality advocates for policies that bolster acceptance of transgender people. On their site, you can find educational information, advocacy opportunities, and more.
This organization provides resources to help LGBTQ+ individuals thrive. One unique feature is their?free 24/7 crisis counseling service for individuals who need help.
The Transgender Law Center is the largest national trans-led organization that advocates for self-determination for all people. The center helps change attitudes, laws, and policies so trans people can live lives free of discrimination.
Editorial Sources and Fact-Checking
- Gender Dysphoria.?Mayo Clinic. February 26, 2022.
- Gender Dysphoria.?Cleveland Clinic. March 28, 2022.
- Gender Dysphoria.?Boston Children’s Hospital.
- What Is Gender Dysphoria??American Psychiatric Association. August 2022.
- Gender Incongruence and Transgender Health in the ICD.?World Health Organization.
- Zaliznyak M, Bresee C, Garcia MM, et al. Age at First Experience of Gender Dysphoria Among Transgender Adults Seeking Gender-Affirming Surgery. JAMA Network Open. March 16, 2020.
- Bizic MR, Jeftovic M, Pusica S, et al. Gender Dysphoria: Bioethical Aspects of Medical Treatment. BioMed Research International. June 13, 2018.
- Signs (Gender Dysphoria).?National Health Service. May 28, 2020.
- Quick Guide to Gender Dysphoria.?Child Mind Institute. November 10, 2021.
- Diamond M. Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation.?International Journal of Transgenderism. May 16, 2013.
- Sadr M, Khorashad BS, Talaei A, et al. 2D:4D Suggests a Role of Prenatal Testosterone in Gender Dysphoria.?Archives of Sexual Behavior. January 23, 2020.
- García-Vega E, Camero A, Fernández M, et al. Suicidal Ideation and Suicide Attempts in Persons With Gender Dysphoria.?Psicothema. 2018.
- Brown A. About 5% of Young Adults in the U.S. Say Their Gender Is Different From Their Sex Assigned at Birth.?Pew Research Center. June 7, 2022.
- Herman JL, Flores AR, O’Neill KK. How Many Adults and Youth Identify as Transgender in the United States??Williams Institute at UCLA School of Law. June 2022.
- Byne W, Karasic DH, Coleman E, et al. Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists.?Transgender Health. May 18, 2018.
- Flores AR, Brown TNT, Herman JL, et al. Race and Ethnicity of Adults Who Identify as Transgender in the United States.?Williams Institute at UCLA School of Law. October 2016.
- Report on the Experiences of Black Respondents.?2015 U.S. Transgender Survey. September 2017.
- Tips for Allies of Transgender People.?GLAAD.