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Gender dysphoria

Definition

Gender dysphoria occurs when a person feels deep discomfort and distress about the gender they were born with because it does not match their gender identity. For example, a person who was physically born female instead feels a deep inner sense of being male. This mismatch causes severe discomfort, anxiety, and depression.

Alternative Names

Gender-incongruent; Transgender; Transsexualism 

Causes

The cause of gender dysphoria is unknown. Hormones in the womb, genes, and cultural and environmental factors are thought to be involved.

Symptoms

Gender dysphoria can occur in children and in adults. Symptoms vary by age.

Children may:

  • Insist that they are the other gender
  • Strongly want to be the other gender
  • Want to dress in the clothes of the other gender and resist wearing clothes of their biological gender
  • Prefer to act the role of the other gender in play or fantasy
  • Prefer toys and activities of the other gender
  • Strongly prefer to play with children of the other gender
  • Feel a strong dislike of their genitals
  • Want to have the physical characteristics of the other gender

Adults may:

  • Strongly want to be the other gender (or a gender different from the one they were born with)
  • Want to have the physical and sexual characteristics of the other gender
  • Want to be rid of their own genitals
  • Want to be treated like the other gender
  • Strongly believe that they have the feelings and reactions of the other gender

Both adults and children may feel a feel a deep distress that interferes with school, work, social life, religious practice, or other areas of life. They may become anxious, depressed, and even suicidal.

Exams and Tests

Only health care providers trained to identify and work with people with gender dysphoria should make a diagnosis.

The provider will take a medical history and do a psychiatric evaluation. Gender dysphoria may be diagnosed if two symptoms or more last at least 6 months.

Treatment

It is important to work with providers trained in working with and treating people with gender dysphoria. The goal of treatment is to help the person overcome the distress they feel. It often includes helping the person transition to the gender they identify with.

Treatment for gender dysphoria may include:

  • Counseling to help the person understand their feelings and to provide support and coping skills
  • Couples or family counseling to help reduce conflicts, create understanding, and provide a supportive environment
  • Gender-affirming hormone therapy (sex hormone therapy)
  • Gender-affirming surgery (sex-reassignment surgery)

The person usually must have sex hormone therapy and have lived as their chosen gender for at least a year before a decision is made about surgery. There are two main types of surgery: one affects fertility, the other does not. Not everyone chooses to have surgery, or they may choose only one type of surgery. People choose the level of treatment that helps them feel most comfortable.

Because of societal and family pressures, having gender dysphoria can affect a person's mental well-being. It is important for the person to receive counseling and support throughout and even after their transition.

Outlook (Prognosis)

Diagnosing and treating gender dysphoria early can reduce the chance of depression, emotional distress, and suicide.

Treatment can relieve symptoms of gender dysphoria. However, reactions from others to the person's transition can continue to create difficulties with work, family, religious, and social life.

When to Contact a Medical Professional

Make an appointment with a trained health care provider if you or your child has symptoms of gender dysphoria.

References

American Psychiatric Association. Gender dysphoria. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:451-460.

Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. PMID: 28945902 www.ncbi.nlm.nih.gov/pubmed/28945902.

Shafer LC. Sexual disorders and sexual dysfunction. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 36.

White PC. Disorders of sexual development. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 233.


Review Date: 8/13/2018
Reviewed By: Ryan James Kimmel, MD, Medical Director of Hospital Psychiatry at the University of Washington Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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