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“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.’”What’s more, people who experience gender dysphoria may find it comes and goes.
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It may also lessen or even disappear when they change their behaviors, dress differently, or undergo therapy or medical or surgical procedures with a goal of transitioning to the gender they identify with.
Gender Dysphoria A Controversial Term
While the American Psychiatric Association (APA) uses the term “gender dysphoria,” it is not the preferred term worldwide.
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The International Classification of Diseases (ICD), a diagnostic tool used by healthcare providers globally, uses the term “gender incongruence” instead to reflect contemporary understanding of gender identity and sexual health.
“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.
“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.
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“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.
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Thomas explains.According to the World Health Organization (WHO), the shift toward describing gender incongruence as a sexual health condition rather than a mental health disorder is intended to lessen the stigma around this condition.
What Are the Symptoms of Gender Dysphoria
The symptoms of gender dysphoria vary from person to person. “People with dysphoria about their gender might be fearful, depressed, anxious, or scared,” Thomas explains.
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Other symptoms may include:
Feeling isolated, ashamed, or misunderstoodA strong dislike of one’s sexual anatomyFeeling very uncomfortable with one’s appearanceHaving an urge to harm oneselfWhile the signs of gender dysphoria may not show up until adulthood for some people, they begin in childhood for many others. A small study published in March 2020 in JAMA Network Open found that 78 percent of transgender men and 73 percent of transgender women first experienced gender dysphoria by age 7.
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Kids with gender dysphoria may demonstrate a strong preference for toys, activities, or clothing associated with another gender rather than the gender they were assigned at birth. But some research suggests that only 10 to 20 percent of children with gender dysphoria will continue to experience symptoms during adolescence. Many children who role-play or experiment with gender identity will not continue to exhibit these behaviors after puberty.
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If kids show extreme emotional distress because of their gender identity, parents may want to talk to a medical expert about it. But gender dysphoria diagnoses in kids are uncommon. What’s more, the diagnosis and treatment of gender dysphoria in kids is a highly debated topic in the medical community.
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“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
To diagnose gender dysphoria, doctors typically perform a behavioral health evaluation and use the criteria set in the APA’s Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). According to the DSM-5, to qualify for a diagnosis of gender dysphoria, a person must experience “clinically significant distress or impairment in social, occupational, or other important areas of functioning.” The manual provides different diagnostic criteria based on a person’s age.
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Diagnosing Children
According to the DSM-5, gender dysphoria in children is defined as a marked incongruence between one’s gender identity and the gender assigned at birth that lasts at least six months and includes at least six of the following other criteria: A significant desire to identify as another gender or an insistence on identifying as a gender different from the child’s assigned sex at birthA strong preference for wearing clothing associated with the gender they identify withA strong preference for make-believe or fantasy play involving cross-gender rolesA strong preference for toys, games, or activities typically associated with the gender they identify withA preference for friends of the gender they identify withA refusal to engage in activities, toys, or games that aren’t typically associated with their gender identityA deep dislike of their own sexual anatomyA desire to have the physical sex characteristics that match their gender identityDiagnosing Teens and Adults
Gender dysphoria in adolescents and adults is defined as a marked incongruence between one’s gender identity and one's assigned gender that lasts at least six months and includes at least two of the following criteria: A significant incongruence between one’s personal gender identity and their physical bodyA 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 withA substantial desire to be of a gender that’s different from their gender assigned at birthA strong intention to be treated in accordance with their gender identityA belief that they have feelings and reactions of a gender that’s different from the one they were assigned at birthCauses of Gender Dysphoria
Researchers don’t know exactly what causes gender dysphoria, but some theorize that genetic or environmental triggers can increase a person’s chances of being transgender. For example, a study published in 2013 in the International Journal of Transgenderism found that identical twins were more likely to be transgender than fraternal twins, which might suggest a genetic link. Some research has suggested biological changes before birth or exposure to hormones or chemicals in the womb may play a role.
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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.
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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.
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Lichtenstein’s advice? “Don’t feel like you need to compare your transition to anyone else’s.
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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.
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Medical Treatments and Surgery
Medical treatments for gender dysphoria typically include hormones or surgery to lessen distress and help people feel more attuned to their gender identity. “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.Hormone options include: Testosterone, a masculinizing hormone, for transgender menTestosterone blockers and estrogen/progesterone, which are feminizing hormones, for transgender womenGender affirmation surgical procedures include: 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.
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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
Gender expression involves adopting behaviors to help a person achieve their preferred gender identity.
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“In some cases, [the transition] is not anything physical, but just to express in certain ways — names, hairstyles, or pronouns,” explains Thomas.Gender expression may also include dressing differently or making other aesthetic changes to a person’s appearance, such as adding or removing facial hair.
Therapy
Therapy with a licensed mental health professional can play an important role in helping someone with gender dysphoria work through negative thoughts and psychological distress, and learn coping skills. 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.
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“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.
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“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.
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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 fact, much of the distress and negative self-image that results in gender dysphoria is connected to discrimination, stigma, or a lack of social support. In part because of social stigma, gender dysphoria may be overlooked or untreated, which Lichtenstein says can lead to:DepressionAnxietyTraumatic stress disordersHigher rates of homelessnessUnderemployment or unemploymentSuicideA small study published in 2018 in the journal Psicothema found that more than 48 percent of people with gender dysphoria had experienced suicidal ideation, and nearly 24 percent had attempted suicide at least once.
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Research and Statistics
A June 2022 Pew Research Center survey found that 1.6 percent of adults in the United States are transgender or nonbinary. That proportion is higher among young adults — the same survey revealed that about 5.1 percent of adults younger than age 30 identify as transgender or nonbinary. According to data analyzed by researchers at the Williams Institute at the University of California in Los Angeles (UCLA) School of Law: Nearly 1 in 5 people who identify as transgender are between ages 13 and 17In recent years, the number of youths who identify as transgender has almost doubled from the Williams Institute’s previous estimateThe number of adults who identify as transgender has stayed steady over timeAbout 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.
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“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.”Although studies on the prevalence of gender dysphoria in transgender adults have shown mixed results, the DSM-5 has projected that about 0.005 percent to 0.014 percent of people assigned male at birth and 0.002 percent to 0.003 percent of people assigned female at birth may have diagnosable gender dysphoria.
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Some experts believe the true numbers are much higher than these estimates, which only reflect people who’ve been formally diagnosed with gender dysphoria and have sought treatment for it.
People of Color and Gender Dysphoria
Data on the race and ethnicity of adults who identify as transgender is limited, according to the Williams Institute. That said, an October 2016 Williams Institute report titled Race and Ethnicity of Adults Who Identify as Transgender in the United States concluded that the population of adults who are transgender is more racially and ethnically diverse than the general population in the United States.
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Specifically, they found that Black, African American, Latino, and Hispanic adults, as well as adults of other nonwhite races or ethnicities, were more likely than white adults to identify as transgender. According the 2015 U.S. Transgender Survey, people of color who are transgender may experience compounding effects of discrimination due to their race and sexual identity.
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Among other findings, the analysis revealed that 41 percent of Black respondents reported experiencing serious psychological distress in the month before taking part in the survey. “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.
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“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.
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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.If you know someone struggling with gender dysphoria, here are some ways you can help:
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.
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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.
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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.
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American Psychiatric Association (APA)
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.
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Black Trans Advocacy Coalition
The Black Trans Advocacy Coalition aims to improve Black trans experiences by overcoming violence and injustice. They provide resources to advocate for health, housing, and employment equality.
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Cleveland Clinic
You can find information about gender dysphoria, how it’s diagnosed, and available treatments on Cleveland Clinic’s site. GLAAD
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.
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Mayo Clinic
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.
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National Center for Transgender Equality
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.
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The Trevor Project
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.
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Transgender Law Center
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.
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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.
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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.
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JAMA Network Open. March 16, 2020.Bizic MR, Jeftovic M, Pusica S, et al. Gender Dysphoria: Bioethical Aspects of Medical Treatment.
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BioMed Research International. June 13, 2018.Signs (Gender Dysphoria). National Health Service. May 28, 2020.Quick Guide to Gender Dysphoria. Child Mind Institute.
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November 10, 2021.Diamond M. Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation. International Journal of Transgenderism.
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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.
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Suicidal Ideation and Suicide Attempts in Persons With Gender Dysphoria. Psicothema. 2018.Brown A.
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About 5% of Young Adults in the U.S. Say Their Gender Is Different From Their Sex Assigned at Birth. Pew Research Center.
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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.
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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.
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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.
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Transgender Survey. September 2017.Tips for Allies of Transgender People. GLAAD.Show LessNEWSLETTERS
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