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What Is Gender Dysphoria?

Gender dysphoria is a term used to describe the emotional and psychological distress that arises when an individual’s gender identity does not align with their assigned sex at birth.

For example, someone born with mostly, visibly female genitalia female would likely be assigned female at birth. However, from an early age, this person might feel that their gender identity did not align with this assignment. This person might feel a profound sense of discomfort in their body, as well as with the societal expectations associated with being a girl. They could identify more with the male gender, from physical appearance to behavioral characteristics. As this person ages, these feelings could intensify, especially with a surge in hormones due to puberty, leading to significant distress in various aspects of their life.

In earlier editions of The Diagnostic and Statistical Manual of Mental Disorders (DSM) Gender Dysphoria was previously known as “Gender Identity Disorder.” “Gender Identity Disorder” has historically carried a great deal of stigma, specifically the word “Disorder,” implying that being transgender or having a non-cisgender identity was a mental illness or something inherently problematic. Additionally, this did not take into consideration the entirety of the gender spectrum, as gender had previously been categorized as binary in nature for some cultures. As a result, the diagnostic criteria were revised. The name of this condition was updated in later editions of the DSM to “Gender Dysphoria” to address the issue of stigma.

It is essential to differentiate between gender dysphoria and being a transgender person. Not all transgender individuals experience gender dysphoria, and some may only experience it at specific points in their lives. Also important to note is that under the umbrella of the term “transgender” can be encompassed both binary and non binary gender identities (e.g., transgender male, transgender female, non-binary, they/them pronouns). Individuals who identify as non-binary also may or may not experience gender dysphoria or experience it at certain points in their lives.

Types of Gender Dysphoria

Gender dysphoria can manifest in various ways, and it can be experienced by individuals of all ages, including children and adults.

The prevalence and how gender dysphoria is expressed may vary by age group:

  • Gender dysphoria in children occurs when a child consistently identifies as a gender different from their assigned sex, leading to emotional distress. This can become evident as early as the age of two or three years old. Many of these children may not experience gender dysphoria in adulthood, as their gender identity may evolve or change. Supportive, affirming care from families and professionals is crucial for these children to explore and express their gender identity in a safe and healthy manner.

    According to a recent Cedar Sinai study, it revealed that 73% of the transgender women and 78% of the transgender men first experienced gender dysphoria by age 7.

    Additionally, Steensma et. Al, (2013) found a link between the intensity and persistence of gender dysphoria in childhood. They noted that psychological functioning and the quality of peer relationships were not predictive of persistence of childhood dysphoria.

  • Adolescents who experience gender dysphoria may have a more stable and persistent gender identity that continues into adulthood. Adolescence is a common time for individuals to become more aware of their gender identity and may seek gender-affirming care. The experience of puberty often exacerbates the intensity of dysphoria as well. Supportive and understanding family and mental health professionals are essential for these individuals.
  • Gender dysphoria in adults can be experienced by adults who have had a lifelong sense of incongruence between their experienced gender and assigned sex at birth. Many transgender adults seek gender-affirming care, including hormone therapy and gender-affirming surgeries, to alleviate gender dysphoria and align their physical characteristics with their gender identity.

Signs and Symptoms of Gender Dysphoria

The signs and symptoms of gender dysphoria can vary by person, and they typically revolve around an individual’s distress related to their gender identity and incongruence with their assigned sex at birth. These distressing feelings often start in childhood or adolescence and can persist into adulthood.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines the criteria for diagnosing gender dysphoria. The symptoms can vary in intensity and may include:

  • A strong desire to be of another gender or insistence that they are of another gender.
  • A profound discomfort with one’s primary and secondary sex characteristics.
  • A desire for the physical attributes of the desired gender.
  • A strong preference for cross-gender roles in play or fantasy.
  • A marked incongruence between the experienced or expressed gender and the sex assigned at birth.
  • Significant distress or impairment in social, occupational, or other areas of functioning.

Diagnosis and assessment should be conducted by a qualified mental health professional.

Lifestance Health specializes in Gender Dysphoria treatment with multiple locations in 33 states. Services and available treatments vary by location.

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Diagnosing Gender Dysphoria

Assessment of persons with gender dysphoria and diagnosis of the condition is a multidisciplinary action. A detailed psychiatric history, psychosexual development, behavior history, neuropsychological testing, and behavioral analysis may be needed.

The team may comprise of:

  • Psychiatrists
  • Psychologists
  • Neurologists
  • Endocrinologists (who specialize in hormonal functions)
  • Urologists (who specialize in the urinary tract and its abnormalities)
  • Behavioral and occupation therapists
  • Counselors etc.

The assessment for gender dysphoria typically involves:

  • Clinical Interviews: A mental health professional will conduct interviews to understand the individual’s feelings, experiences, and history related to their gender identity.
  • Self-Report: Individuals are often asked to describe their feelings and experiences with regard to their gender identity.
  • Diagnostic Criteria: The mental health professional will assess whether the individual’s experiences align with the diagnostic criteria for gender dysphoria, as outlined in the DSM-5.
  • Psychological Evaluation: Psychological assessments may be used to help evaluate the individual’s mental health and well-being and assess for readiness for gender affirming surgery.
  • Medical Evaluation: For those interested in gender-affirming medical interventions, a medical evaluation may be conducted to ensure the individual’s overall health.

There are no online tools or self-diagnostic tests for gender dysphoria that are considered reliable or valid for diagnosing this condition. Gender dysphoria is a complex and deeply personal experience, and its diagnosis requires a comprehensive evaluation by qualified and licensed mental health professionals who are knowledgeable about gender issues. Attempting to self-diagnose or relying on online tools can be misleading and may not provide an accurate understanding of one’s experiences or needs. It is crucial to consult with a trained clinician if you have concerns about your gender identity or if you believe you may be experiencing gender dysphoria. They can offer appropriate guidance, support, and a professional assessment to help you navigate your gender identity and mental health concerns.

What Causes Gender Dysphoria

The exact causes of gender dysphoria are not fully understood, but several factors may contribute, including:

  • Biological Factors: Genetic, hormonal, and neuroanatomical differences may play a role in an individual’s gender identity. Some studies (Roselli, 2018) suggest that differences in brain structure or function may be linked to gender dysphoria, potentially influencing an individual’s gender identity.
  • Psychological Factors: Early experiences, socialization, and family dynamics can also influence how an individual perceives their gender identity.
  • Environmental Factors: Cultural and societal expectations, discrimination, and stigmatization can lead to distress and dysphoria.

References

Most Gender Dysphoria Established by Age 7, Study Finds (June 16, 2020). Retrieved from https://www.cedars-sinai.org/newsroom/most-gender-dysphoria-established-by-age-7-study-finds/

Roselli CE. Neurobiology of gender identity and sexual orientation. J Neuroendocrinol. 2018 Jul;30(7):e12562. doi:10.1111/jne.12562. PMID: 29211317; PMCID: PMC6677266.
Steensma, T. D., Zucker, K. J., & Kreukels, B. P. C. (2013). Gender identity development in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 52(6), 649-650. https://www.sciencedirect.com/science/article/abs/pii/S0018506X13000676?dgcid=api_sd_search-api-endpoint