What Is Gender Dysphoria?

Have you ever felt distress and other negative feelings because your assigned sex at birth does not match how you identify yourself?  Well, that is known as gender dysphoria (GD). While GD may appear during childhood, some people might experience it during adolescence or adulthood.

In 2021-2022, more than 3500 individuals with GD seek help at gender identity development services (GIDS) in the UK. To manage GD, these services aim to provide psychological support as well as medical options so individuals can explore their affirmed gender. This may help people feel better.  

This article will dive further into GD, the available treatments, its management and finally, the tips on how to support a loved one who is going through it. 

Sex vs gender identity

Before going further into the topic, it is important to distinguish between sex and gender identity. 

• Sex: established at birth according to physical features and reproductive organs, for example: assigned female at birth (AFAB) and assigned male at birth (AMAB)
• Gender identity: one’s self-perception as male, female, non-binary or others

Further understanding of gender dysphoria

According to the DSM-5, gender dysphoria is a diagnosis that describes the emotional distress a person suffers when their gender identity does not align with their assigned sex at birth.¹ It is not a mental disorder, but it can negatively impact your mental health if it is not addressed properly, and it could potentially lead to low self-esteem, self-harm, and suicidality. 

Furthermore, it is also important to note that GD has nothing to do with sexual orientation. 

How is gender dysphoria diagnosed?

The DSM-5 provides separate diagnoses for children, adolescents and adults. 

GD in children

The marked inconsistency between their assigned sex at birth and desired gender identity lasts 6 months and is also manifested by at least 6 of the following:¹

• A strong wish to be of the desired gender identity or an alternative gender which does not match the assigned sex at birth
• In AMAB, a strong preference for wearing typically considered feminine attires, and in AFAB, a strong preference for wearing typically considered masculine attires and strong resistance to wearing typically considered feminine clothing
• A strong preference for cross-gender roles in made-up plays 
• A strong preference for toys, games, or activities stereotypically attributed to the other gender
• A strong preference for friends of the other gender
• In AMAB, a strong rejection of typically considered  masculine toys, games, and activities and a strong avoidance of rough-and-tumble play, and in AFAB, a strong rejection of typically considered feminine toys, games, and activities
• A strong dislike of their reproductive anatomy
• A strong desire for the physical features that match their gender identity 
• Significant clinical distress and impairment of social, school, and other areas of functioning

GD in adolescents and adults

Similar to the children's diagnosis, adolescents and adults are also diagnosed with the marked inconsistency between their assigned sex at birth and their desired gender identity, which lasts at least 6 months. Moreover, at least 2 of the following need to be present:¹

• The gender identity does not match the primary and secondary sex characteristics (in young adolescents, it includes not wanting the expected changes associated with puberty)
• A strong desire to get rid of primary and secondary sex characteristics because they do not match with the gender identity (in young adolescents, it is displayed as a desire to prevent the development of the features associated with puberty)
• A strong desire to have primary and/or secondary sex characteristics that differ from the ones present from birth
• A strong wish to be of one’s gender identity (or some alternative gender different from the one assigned at birth)
• A strong desire to be treated as one’s gender identity (or an alternative gender which does not match the assigned sex at birth)
• A strong conviction that one has the considered typical feelings and reactions of one’s gender identity (or an alternative gender which does not match the assigned sex at birth)
• Significant clinical distress and impairment of social, occupational, and other areas of functioning

What treatments are available for gender dysphoria?

The World Professional Association for Transgender Health (WPATH) recognised the ‘Dutch model’ as the current care model to treat GD. This model consists of a multidisciplinary approach to psychological and physical interventions.³ However, each patient will have different needs, so the treatment must be personalised.

Psychological support

Before beginning the medical treatment, you will need to undergo a psychological evaluation to verify that your diagnosis is GD, and also to determine if you might suffer from other mental conditions, like depression, or if you may have suicidal thoughts. This is important to ensure you receive adequate mental care, and that it is safe to proceed with the treatment.³ 

Additionally, psychological care also aims to:^2,3

• Inform you and your family about the treatment, its benefits, and potential risks
• Address possible unrealistic expectations regarding physical appearance
• Help you and your family explore and settle within your desired gender identity, for example, adopting new pronouns, changing your name, etc
• Guide your family and friends on how to create a supportive environment for you
• Discuss fertility preservation before you start hormonal and surgical treatment

You should have psychological support, and continue with therapy through your transition, as mental health is important for your well-being.

Medical interventions

Medical interventions with hormones and surgeries are more recommended for adolescents and adults, rather than children. The Dutch model proposes that medical treatment should be prescribed depending on the stage of puberty.³ This will vary from individual to individual, which is why the treatment needs to be personalised.

Hormone therapy

Before beginning, if you are in your early adolescence, experts need to establish at what stage of puberty you are at. Once determined, they may proceed with prescribing you the following hormonal therapy:^1,2,3

• Puberty blockers: gonadotropin-releasing hormone agonists (GnRHa) are usually prescribed to suppress the expression of secondary sex characteristics like facial hair and voice changing in AMAB, and breast development in AFAB. Research indicates that the average age adolescents start with GnRHa is 14.5 years.⁴
• Cross-sex hormones: steroid hormones like oestrogen for AMAB, and testosterone for AFAB, are prescribed to promote the expression of the desired secondary sex characteristics and to achieve their gender identity. This is usually prescribed at an older age, the average age being 16.2 years according to research.⁴ 

Please note: you should not take any type of hormones that are not prescribed to you by a medical expert, as it could be dangerous for your well-being.

Gender-affirming surgeries

You might also want to undergo surgery to achieve physical changes of your desired gender. In most countries, you need to be 18 years old for this procedure. However, if you are underage, you might still be able to have surgical treatment with your parents' or legal tutors' consent. Something else to consider is that if you are an adult, while you are free to do as you wish, it is recommended to be on hormonal therapy and live as your desired gender for one year before any type of surgery.¹  Common surgeries include:

• Upper body surgery: to add or remove breast tissue
• Lower body surgery: to create reproductive organs from existing tissue, for example, metoidioplasty, scrotoplasty, or phalloplasty to create a penis or vaginoplasty for a vagina
• Other esthetic surgeries 

This is a personal choice, and every person will have different preferences, which experts need to take into consideration.

Mental health and well-being

As previously mentioned, GD causes emotional distress and anxiety, and it can eventually lead to depression, self-harm and suicidal thoughts if it is not treated. Social stigmatisation, not being accepted by loved ones and invalidating feelings can make the situation even worse.

Going to therapy can help you address and understand all the negative emotions you are feeling, give you tools to cope with the mentioned issues, and offer you the appropriate care for depression and suicidal tendencies. Furthermore, it can help you navigate all the challenges you may encounter with your new gender identity.

Moreover, having positive affirmation and a support group is important. Joining a group with people in the same situation as you can help you learn from their experiences, teach you how to address difficult situations like discrimination, and provide you comfort. 

How can I show support to a loved one with gender dysphoria?

Having constant support from friends, family and their community will have a favourable outcome for individuals with GD. Here are some ways you can demonstrate your support to someone suffering from GD:

• Do not treat them as if they are ill
• Address them with their preferred pronouns and name
• Acknowledge and validate their feelings and do not try to change their mind
• Participate in group therapy
• Be there for them 
• Advocate for them to reduce stigma and discrimination in your community

Summary

Gender dysphoria (GD) is the feeling of distress caused when the sex and gender identity of a person do not match. It is not a mental disorder, but if it is not addressed it can lead to depression and suicidality. The treatment for GD involves a multidisciplinary approach involving psychological care, hormonal intervention, and surgical interventions. Experts consider that treatment is determined by age, along with the fact that each individual has different needs, which calls for individualised care. Moreover, offering individuals GD  support can lead to a positive outcome in their mental health and well-being. Finally, the interdisciplinary medical team must be open-minded and unbiased, to offer the best care.    

FAQs

What causes gender dysphoria?

The cause of GD is not clear, and there are researchers still studying it. It is a complex topic and is still considered relatively new in Western society. We are still trying to learn about it. However, an important note is that GD has nothing to do with sexual orientation.

When does gender dysphoria usually begin?

There is not an exact onset age for GD. While some may display it during childhood, in others it may appear later in life.

Are autism and gender dysphoria linked?

There appears to be a link between GD and autism, and autistic people present a higher chance of experiencing GD. However, the reason behind this is unclear. More research is needed.