Gender Dysphoria

What is gender dysphoria?

Gender dysphoria describes a sense of unease regarding the mismatch between assigned gender and gender identity. This feeling affects many — but not all — transgender people before they begin living as their authentic selves (transition and gender expression). And it can occur at any point during life, from childhood to adulthood. People with gender dysphoria may experience severe emotional and psychological distress if they’re unable to express their experienced gender and/or if they don’t receive the support and acceptance they need.

What does it mean to be transgender?

The term “transgender” is an umbrella term that describes people whose gender identity and sex assigned at birth don’t align based on traditional expectations of gender. For example:

• A person assigned female sex at birth (AFAB) whose gender identity is male.
• A person assigned male sex at birth (AMAB) whose gender identity is female.

The term “transgender” can include other gender identities, too, and is evolving with new generations. People who are transgender may be a combination of gender identities, or they may identify as:

• Nonbinary: A person who identifies as neither (or both) male or female.
• Gender fluid: A person whose gender identity shifts back and forth.
• Two-spirited: A Native American, First Nations or Alaska Natives person who identifies as a third gender who has a male spirit and female spirit.

Individuals who’re on the nonbinary spectrum may further describe their gender identity by using descriptors such as “nonbinary transmasculine” or “nonbinary transfeminine,” or may use different terminology such as “agender,” “no-gender,” “androgynous,” and/or “gender queer.”

Is gender dysphoria a mental illness?

Gender dysphoria isn’t a mental illness. Rather, it describes the uneasiness stemming from the mismatch between the experienced gender and assigned sex at birth. However, some of the unpleasant feelings that sometimes accompany gender dysphoria include:

• Anxiety.
• Depression.
• Eating disorders.
• Post-traumatic stress disorder (PTSD).
• Substance abuse.

Although gender dysphoria is not a mental illness, when not addressed, it may lead to worsening mood issues, depression and anxiety, and may further complicate the issues the individuals may be having. Insurance may cover some illnesses associated with gender dysphoria and gender dysphoria care.

What does gender dysphoria feel like?

Most people with gender dysphoria suffer from intense, complex emotions that stem from having the physical attributes of one gender and identifying with either an opposite gender or a gender that doesn’t fit the definition of binary genders (male and female).

You may feel:

• Anxious.
• Depressed.
• Isolated.
• Misunderstood.
• A part of you is missing.
• Shameful.
• Suicidal.
• An urge to self-harm.
• Uncomfortable with your appearance.

When do people start experiencing symptoms?

Gender dysphoria symptoms can start at any stage of life.

What causes gender dysphoria?

Researchers are still working to determine the cause. The condition may start with biological changes that happen before birth.

The anxiety, stress and general discomfort associated with gender dysphoria may be linked to social stigma. Gender nonconforming children, adolescents and adults often face discrimination and verbal harassment. One in 4 are physically attacked, and more than 1 in 10 are victims of sexual assault.

Is there a gender dysphoria test?

Though it isn’t a formal test, the American Psychological Association (APA) has criteria for diagnosing gender dysphoria in children, adolescents and adults.

Children

Gender dysphoria can be diagnosed in children if they display contradictions between their assigned gender and the gender they express over a period of at least six months. They must display at least six of the following traits:

• They wish to be another gender or insist they’re another gender.
• They prefer playing with peers of another gender.
• They prefer another gender’s typical roles during make-believe play.
• They prefer dressing in clothes that are associated with another gender.
• They prefer toys or activities that are associated with another gender.
• They don’t like toys or activities that are associated with their assigned gender.
• They don’t like their sexual anatomy.
• They wish for sex characteristics that match their expressed gender.

Adolescents and adults

Gender dysphoria can be diagnosed in adolescents and adults if they display contradictions between their assigned gender and the gender they express over a period of at least six months. They must display at least two of the following traits:

• They wish to be another gender.
• They wish to be treated as another gender.
• They recognize a contradiction between their expressed gender and their sex characteristics.
• They wish they had the primary sex characteristics or secondary sex characteristics of another gender. Primary sex characteristics are directly responsible for reproduction. They include the penis, testes, vagina and ovaries. Secondary sex characteristics aren’t responsible for reproduction. In a person AMAB, they include facial hair, increased body hair and broad chests. In a person AFAB, they include breasts, round hips and a relative lack of body hair.
• They wish they didn’t have their primary or secondary sex characteristics or, in the case of young adolescents, they wish they could prevent their secondary sex characteristics from developing.
• They believe they have the characteristic feelings and reactions of another gender.

What does treatment look like?

The goal of gender-affirming treatment is to help you gain peace of mind, which means different things to different people. And it often takes time to get results. Seeing a healthcare provider who specializes in transgender health can help you explore your options.

There are many methods of gender affirmation. Surgery can help, but it isn’t always necessary.

What treatments are available for gender dysphoria?

Treatment may include expressing your preferred gender identity or undergoing medical or surgical therapies.

Gender expression

This includes behaviors and actions that help you achieve your preferred gender identity. You may wish to:

• Change your name and the pronouns by which people refer to you (he, she or they).
• Update your gender on government-issued identification. This may include your passport or driver’s license.
• Dress in a manner that’s more masculine, feminine or gender-neutral.
• Make aesthetic changes, which may include adding or getting rid of facial hair.

Medical treatments

Medical therapies may include gender-affirming hormones:

• Masculinizing hormones (testosterone) for trans men.
• Testosterone blockers and feminizing hormones (estrogen and progesterone) for transwomen.

Gender affirmation surgery

Surgery enables permanent changes that are more consistent with your preferred gender. You may wish to pursue:

Top surgery

• Procedures to add breast tissue in trans women and remove it in trans men.

Bottom surgery

• For trans men, bottom surgery creates a penis using tissue from other areas of your body. Options include metoidioplasty or phalloplasty.
• In trans women, vaginoplasty creates a vagina after removing your penis and scrotum.

Facial procedures

• Facial feminization surgery makes your face more feminine. Surgery may include creating a smaller forehead or petite jawline.
• Facial masculinization surgery makes your face more masculine. Surgery may lengthen your forehead or make your brow line more angular.

What is the role of mental health therapy in gender dysphoria treatment?

Talking with a licensed mental health professional can help you:

• Address the negative feelings you’re experiencing.
• Learn coping skills and different ways of thinking.

Therapy may also include:

• Prescriptions for medications to help you gain better control of anxiety or depression.
• Emergency counseling if you’re experiencing a crisis and having suicidal thoughts.

If you’re considering gender affirmation surgery, your insurance plan may require therapy. You’ll need to show that you:

• Understand the long-term effects of surgery.
• Are mentally capable of agreeing to the procedure.

What support is available to people with gender dysphoria?

Support plays a vital role in helping you navigate challenges in your life. You may wish to participate in a transgender support group. Participating helps you learn from the experiences of other people in your situation. Support to help you address challenges like bullying or discrimination may also be available in your community.

Which treatments are best for children and adolescents?

Young people can start some treatments right away. But it’s best to wait for other treatments because their bodies are still developing.

• Start therapy right away. Therapy explores the reasons behind the negative feelings. It also provides options for addressing them.
• Consider puberty suppression in adolescence. Treatment may delay changes such as breast development or facial hair growth.
• Wait to begin other therapies. Hormone therapy can start at 16 years old. Surgery is best for people 18 and older.

What’s the outlook for individuals with gender dysphoria?

Seeking treatment can help you break free of the negative feelings you’re experiencing. When you feel better about yourself, it’s easier to make decisions about your future, like expressing your preferred gender identity.

How can I support a loved one with gender dysphoria?

There are many steps you can take, including:

• Listening to them.
• Acknowledging and validating their feelings.
• Not trying to change their mind.
• Participating in family therapy to work through challenges.
• Using their preferred name and pronouns.
• Seeking counseling for them if they’re having suicidal thoughts or self-harming.

A note from Cleveland Clinic

Feelings of gender dysphoria may come and go throughout your life, but people living with it can still have a bright future. Therapy can help you gain confidence in expressing your preferred gender. You may wish to make small changes at first, like going by a different name. Permanent changes may include medical therapies and gender affirmation surgery. The treatments that are right for you and the pace at which you pursue them are up to you. An experienced healthcare provider can help you decide.